Nebraska Department of Insurance

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COMPANY/THIRD-PARTY ADMINISTRATOR/
VIATICAL PROVIDER APPLICATIONS AND INFORMATION

Company Application

The Nebraska Department of Insurance accepts the "Uniform Certificate of Authority Application" from companies seeking a certificate of authority to write the business of insurance in Nebraska. The "Uniform Certificate of Authority Application" allows foreign insurers to file copies of the same application for admission in numerous states. Instructions to complete the forms are included with each form. This application can be accessed at www.naic.org/industry_ucaa.htm. (Nebraska has no state specific requirements.)

In addition, management needs to be familiar with the Nebraska Insurance Laws and have the experience and qualifications necessary to conduct the business of insurance. The Nebraska Insurance Laws can be accessed at www.statutes.unicam.state.ne.us.

If you should have specific questions regarding the Nebraska Insurance Laws or the requirements for establishment of a domestic company, please contact our Legal Division at (402) 471-2201.

Third Party Administrators

Third Party Administrator Packet

Includes instructions and the following form:
- Form TPA - Application for Certificate of Authority

Third Party Administrator Annual Statement form Significant changes have occurred to this form. Please read carefully.

Viatical Settlement Provider Application

Includes the following:
- Memorandum - Viatical Settlement Broker and Provider Licensing
- Viatical Settlement Provider Application

Purchasing Groups

Purchasing Group-Notice and Registration Form

Includes the following:
- Memorandum - Requirements Under Liability Risk Retention Act of 1986 and Nebraska Risk Retention Act
- Uniform Registration Form - Purchasing Group-Notice and Registration

Purchasing Group Registration Renewal Form and Instructions

Changes or additions to the Agent for Service of Process for Nebraska-licensed companies may be accomplished by completion and submission of the NAIC Uniform Certificate of Authority (UCAA) Form 12.

Accredited Reinsurers

Procedures for Purchasing Securities for Deposit

Schedule of Company Fees, Taxes, And Deposits

Memo to All Domestics Regarding On-site Financial Examinations

Nebraska Department of Insurance

Company Application

Third Party Administrators

Viatical Settlement Provider Application

Purchasing Groups

Multiple Employer Welfare Arrangements

Motor Club Service Company

Utilization Review Agent

Miscellaneous Information