WEST VIRGINIA
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Insurance Commissioner
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Allan L. McVey
Insurance Commissioner
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Forms
Accredited Reinsurer
Requirements for Licensure
Certificate of Assuming Insurer (Form AR-1)
Form AR-1
Trusteed Reinsurer App. License (Form AR-2)
Trust Agreement Checklist
Accredited/Trusteed Reinsurer Renewal Instructions
Discount Medical Plan Org. (DMPO)
DMPO Licensing Instructions
DMPO Application (DMP-1)
DMPO Surety Bond (DMP-2)
DMPO Renewing Instructions
Reinsurance Intermediary
License Instructions
License Form
Renewal Instructions
Renewal Form
Manager Form
Modification Form
Professional Employer Organization (PEO)
Licensing Instructions
Application (Form PEO-1)
Surplus Lines
Filing Instructions
Foreign Eligibility Application (Form SL1)
Alien Eligibility Application (Form SL2)
Alien Insurer Affidavit of Filing & Financial Statement Attestation
Prepaid Limited Health Service
Organizations Requirements
Organizations Org Instructions
Organizations Application and Checklist (PLHSO-1)
Organizations Remittance Form (PLHSO-2)
Organizations Fidelity Worksheet (PLHSO-3)
Organizations Waiver Form (PLHSO-4)
Organizations Hold Harmless Language
Captive Insurance Companies
Forming a Captive Insurance Company
Forming an Asso Captive Insurance Company
Company Application Guidelines
Company Application (CAP-1)
Company POA (IC-CL3D)
Company Compliance Statement (CAP-2)
Company Irrevocable Letter of Credit (CAP-3)
Company App for CPA (CAP-4)
Company App to Certify Loss Reserves (CAP-5)
Company Biographical Affidavit
Domestic Farmers Mutual
Fire Renewal Instructions
Fire Application for License (Form A-10)
Managing General Agent (MGA)
License Instructions
License Application Form MGA-1
License Application Form MGA-3
Renewal Instructions
Renewal Application Form MGA-4
Third Party Administrator (TPA)
NAIC Uniform Application for TPA’s
TPA Affidavit
TPA Certificate Request
TPA Corporate Changes Instructions
TPA Licensing Instructions
TPA Renewal Instructions
TPA Attestation Statement for Home States
TPA Attestation Statement for Non-Residents
TPA Surety Bond
TPA Withdrawal Instructions
TPA-1 for Registration
Risk Retention / Purchasing Group
Requirements for Risk Retention Groups
Risk Retention Group State of Domicile Certification
NAIC Risk Retention Reporting Form
Risk Retention Group Modification Form
Affidavit of Filing and Annual Statement Attestation
Risk Purchasing Group Modification Form
Registration for Risk Purchasing Groups
Risk Purchasing Group Statement of Premiums
Discount Prescription Drug Plan Org.
DPDPO Registering Instructions
DPDPO Registration Form (DPDP-1)
DPDPO Renewal Instructions
DPDPO Renewal Form (DPDP-2)
Domestic Hospital Medical & Dental Corporations (HMDI)
Renewal Instructions
Application for License (Form A-10)
Fraternal Benefit Society
Filing Instructions for Articles & Bylaws
Licensing Instructions
Renewal Instructions
Application for License (Form A-10)
Health Maintenance Organization (HMO)
Domestic HMO License Instructions and Application
Foreign HMO License Instructions and Application
HMO Application for License (Form A-10)
HMO Annual/Quarterly County Enrollment Worksheet
HMO Product Mix Report
Viatical Settlement
Brokers
Provider Licensing & Renewing Instructions
Provider Application (Form VSP-2)
Provider Reporting Requirements (Form VSP-3)
Provider Surety Bond (Form VSP-4)