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Office of Insurance Regulation

Company Admissions

Health Maintenance Organization Applications

NOTICE: Form OIR-C1-905 "Instructions for Furnishing Background Investigative Reports", has been revised. Applications submitted after January 1, 2005 that do not follow the revised instructions may be returned as incomplete.

ALL FORMS

APPLICATION FOR CERTIFICATE OF AUTHORITY HEALTH MAINTENANCE ORGANIZATION PACKAGE

OIR-C1-942

APPLICATION FOR CERTIFICATE OF AUTHORITY HEALTH MAINTENANCE ORGANIZATION

OIR-C1-1263

APPLICATION FOR CERTIFICATE OF AUTHORITY HEALTH MAINTENANCE ORGANIZATION REHABILITATION ADMINISTRATIVE EXPENSE FUND (Pursuant to Section 641.227, F.S.)

OIR-C1-903

REQUEST FOR PAYMENT OF FINGERPRINT CHARGES

OIR-B2-1093

SMALL EMPLOYER CARRIER'S APPLICATION TO BECOME A RISK ASSUMING CARRIER OR A REINSURING CARRIER, AS REQUIRED BY SECTION 627.6699(9), FLORIDA STATUTES.

OIR-C1-1432

MANAGEMENT INFORMATION FORM COMPLETE LIST OF OFFICERS, DIRECTORS, AND SHAREHOLDERS (5% OR MORE)

OIR-C1-905

INSTRUCTIONS FOR FURNISHING BACKGROUND INVESTIGATIVE REPORTS

OIR-C1-938

FINGERPRINT CARD INSTRUCTIONS

OIR-C1-1423

BIOGRAPHICAL AFFIDAVIT

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