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Indiana Department of Insurance

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Indiana Department of Insurance

IDOI > Indiana Navigators > Initial Application Organization (AO) Application Process Initial Application Organization (AO) Application Process

Initial AO Application Process (4 Steps)

The initial Application Organization (AO) registration application consists of steps 1-4 below. Each step must be completed in order for an organization to become registered as an Application Organization. Applicants may check the status of their application online through www.sircon.com/indiana by selecting "Check license application status." Application submissions that are still "Pending" or "Under State Review" after 90 days from the submission date will be withdrawn. Once each step is completed and all application materials are submitted and approved, the organization will receive an automated approval email. Application Organization registration certificates may be obtained by emailing a request to navigator@idoi.in.gov.

The initial application process consists of the following four steps:

  1. NEW ONLINE APPLICATION. Complete new online application via Sircon.com (under "New Insurance Licenses" section - organizations complete the "Firm" application). There is a nonrefundable online application fee of $50 for Indiana resident business entities and $100 for non-resident business entities, and a processing fee. NOTE: Additional documentation required in Steps 2-4 may be attached electronically to the application. Applicants may check the status of their application online through www.sircon.com/indiana by selecting "Check license application status." Application submissions will remain "Pending" or "Under State Review" until all 4 Steps are complete. Applications that are still "Pending" or "Under State Review" after 90 days from the submission date will be withdrawn.
  2. LIST OF AO LOCATIONS. If the AO will have more than one location, the organization must submit to IDOI the following for each location of the AO: (1) Name of Location, (2) Address, (3) Telephone, (4) Email, (5) Website (if applicable), and (6) Contact Person. The list may be attached electronically to the online application. The organization may also include on the list all Indiana counties a particular location services, if the location services one or more counties outside of its location. The list will be used to publish AO assistance available by county on the Indiana Healthcare Reform website at www.in.gov/healthcarereform/2468.htm.
  3. CONFLICT OF INTEREST DISCLOSURE FORM. Review the Conflict of Interest Policy, then complete and submit the AO Conflict of Interest Disclosure Form. The form may be attached electronically to the online application.
  4. PRIVACY AND SECURITY AGREEMENT. Review, sign, and submit the AO Privacy and Security Agreement. The agreement may be attached electronically to the online application.

All documents may be attached electronically to the online application. They may also be submitted to IDOI by either: Email: navigator@idoi.in.gov; Fax: 317-234-5882 ("attn: Navigator Director"); or Mail: Indiana Department of Insurance, c/o Navigator Director, 311 West Washington Street, Indianapolis, Indiana 46204-2787