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Office of Insurance Regulation

Company Admissions

Managed Care

Prepaid Limited Health Service Organization

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 PREPAID LIMITED HEALTH SERVICE ORGANIZATION APPLICATION PACKAGE

OIR-C1-1119

APPLICATION FOR CERTIFICATE OF AUTHORITY PREPAID LIMITED HEALTH SERVICE ORGANIZATION

OIR-C1-903

INVOICE - REQUEST FOR PAYMENT OF FINGERPRINT CHARGES

OIR-C1-905

INSTRUCTIONS FOR FURNISHING BACKGROUND INVESTIGATIVE REPORTS

OIR-C1-938

FINGERPRINT CARD INSTRUCTIONS

OIR-C1-1423

BIOGRAPHICAL AFFIDAVIT