Quarterly Filing Requirements
Per 760 IAC 1-68-9(1), MEWAs are also required to make quarterly filings. The IDOI has developed a Quarterly Checklist of the required documents, please number each item in the upper right-hand corner or tab to correspond with its number in the Schedule of Requirements.
Annual Renewal Requirements
IDOI provides renewal requirements for Multiple Employer Welfare Arrangement. The required items must be submitted within ninety (90) days of the end of the MEWA’s fiscal year in order to obtain a renewal registration.
The IDOI has developed an Annual Report/Renewal Checklist of the required documents, please number each item in the upper right-hand corner or place under a tab to correspond with its number in the Schedule of Requirements.
Forms:
MEWA Renewal Application - Form M400
Fee Schedule - NAIC OPTins System
Biographical Affidavit
MEWA Coverage Affidavit - Form M500
MEWA Attestation - Form M800
MEWA Organizational requirements - Form M200
Service Request Form
Plan Review Requirements
No participation agreement or contract form, application form, certificate, rider, endorsement, summary plan description, or other evidence of coverage may be issued unless the form, and any subsequent changes to the form, has been filed with the commissioner. The form may not be used for thirty (30) days after the filing unless the commissioner gives written approval of the form before the expiration of thirty (30) days.
A fee of $35 shall accompany the filing of each form or plan filed as required. Each new plan should be accompanied by a completed MEWA Coverage Requirements form.
MEWA Coverage Requirements - Form M300
Please email renewal requirements to cowright1@idoi.in.gov