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054.00.119-5. Forms for Licensure of Self-Funded MEWAs

AR ADC 054.00.119-5Arkansas Administrative CodeEffective: December 5, 2019

West's Arkansas Administrative Code
Title 054. Insurance Department
Division 00.
Rule119. Multiple-Employer Welfare Benefits Plan
Effective: December 5, 2019
Ark. Admin. Code 054.00.119-5
054.00.119-5. Forms for Licensure of Self-Funded MEWAs
(a) The Arkansas Insurance Department adopts by reference standard forms for use in the administrative regulation of self-funded multiple-employer welfare arrangements. Applicants and licensed self-funded multiple-employer welfare arrangements are required to utilize these forms in preparing applications, statements, notices of required information and other submissions required under this Rule. These forms are more specifically identified as follows:
(1) Instructions Form A Application;
(2) Form A-MEWA Application Certificate of Authority;
(3) Form B-MEWA Application To Do Business;
(4) MEWA SOP (Service of Process);
(5) Officers Directors Trustees Page;
(6) Annual Filing Checklist;

Credits

Adopted Dec. 5, 2019.
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 054.00.119-5, AR ADC 054.00.119-5
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