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Indiana Department of Insurance

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Indiana Department of Insurance

IDOI > Company/Entity Financial Compliance > Redomestication to Indiana > Limited Service Health Maintenance Organization Limited Service Health Maintenance Organization

Below are items needed for the review of a company requesting to re-domesticate to Indiana. Items #1 - #10 are to be filed in conjunction with the Uniform Certificate of Authority Primary Application.

Uniform Certificate of Authority Primary Application

  1. Foreign Corporations:
    1. Certificate of Authority, from the Secretary of State, to transact business in Indiana
  2. Most recent Annual Statement filing - Basket Clause (investment listing) in accordance with IC 27-13-11 and IC 27-1-13-3(c)(20) for Health Maintenance Organizations.
  3. All affiliated agreements currently in effect.
  4. Return the Company's current Indiana Certificate of Authority.
  5. Provide the Company's reason(s) for re-domestication to Indiana.
  6. A non-objection letter from the Company's current state of domicile, regarding re-domestication to Indiana.
  7. Board of Directors' resolution approving the Company's re-domestication to Indiana.
  8. Oath of Office by the directors and officers originally signed and notarized.
  9. Indiana Biographical Affidavit

The information requested in the preceding should be delivered to the following:
Admissions Coordinator
Indiana Department of Insurance
311 West Washington Street, Suite 300
Indianapolis, Indiana 46204-2787

Once the Department completes its review, we will prepare a certificate of authority and send it to the contact person listed on the application.