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To register as a Multiple Employer Welfare Arrangement (MEWA), submit the following items.
Please reference each item in the upper right-hand corner to correspond with its letter or number in this Schedule of Requirements.
1. Each application question must be completed in full. Attach a separate sheet of paper, properly signed, if additional space is needed.
NOTE: The word "registrant" refers to the MEWA making application.
2. Documents listing of items that must be submitted with this application.
3. Application fee of $350 made out to IDOI, which is to be submitted as Item 11 of the Documents Listing.
4. Biographical affidavits for each of the MEWA Board of trustees or directors originally signed and notarized. These are to be submitted as Item 15 of the Documents Listing.
5. Compliance checklist, which is to be submitted as Item 16 of the Document Listing.
Send the completed application and information to:
Indiana Department of Insurance
311 West Washington Street, Suite 300
Indianapolis, Indiana 46204-2787
After we receive the proper filing and review is completed, a letter of registration will be prepared and sent to the contact person listed on the application.