WEST VIRGINIA
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Allan L. McVey
Insurance Commissioner
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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
Captive Insurance Companies
Forming a Captive Insurance Company
Forming an Association 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
Certified Reinsurer
Certified Reinsurer
Charitable Gift Annuity (CGA)
CGA Notification Gift Instructions
Notification of a CGA (CGA-1)
Discount Prescription Drug Plan Organizations
DPDPO Registering Instructions
DPDPO Registration Form (DPDP-1)
DPDPO Renewal Instructions
DPDPO Renewal Form (DPDP-2)
Discount Medical Plan Organizations (DMPO)
DMPO Licensing Instructions
DMPO Application (DMP-1)
DMPO Surety Bond (DMP-2)
DMPO Renewing Instructions
Domestic Farmers Mutual
Domestic Farmers Mutual Fire Renewal Instructions
Domestic Farmers Mutual Fire Application for License (Form A-10)
Domestic Hospital Medical & Dental Corporations (HMDI)
Domestic HMDI Renewal Instructions
Domestic HMDI Application for License (Form A-10)
Fraternal Societies
Fraternal Benefit Society - Filing Instructions for Articles & Bylaws
Fraternal Benefit Society - Licensing Instructions
Fraternal Benefit Society - Renewal Instructions
Fraternal Benefit Society - Application for License (Form A-10)
Health Insurance Providers & Independent Review Organizations Grievance Information
Health Insurance Provider External Review Information
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
Managing General Agent (MGA)
Managing General Agent License Instructions
Managing General Agent License Application Form MGA-1
Managing General Agent License Application Form MGA-3
Managing General Agent Renewal Instructions
Managing General Agent Renewal Application Form MGA-4
Medical Malpractice Claim Reporting
Online Reporting Form
Pharmacy Benefit Managers
Pharmacy Benefit Managers
Prepaid Limited Health Service Organizations
Prepaid Limited Health Service Org Requirements
Prepaid Limited Health Service Org Instructions
Prepaid Limited Health Service Org Application and Checklist (PLHSO-1)
Prepaid Limited Health Service Org Remittance Form (PLHSO-2)
Prepaid Limited Health Service Org Fidelity Worksheet (PLHSO-3)
Prepaid Limited Health Service Org Waiver Form (PLHSO-4)
Prepaid Limited Health Service Org Hold Harmless Language
Professional Employer Organization (PEO)
Professional Employer Organization Licensing Instructions
Professional Employer Organization Application (Form PEO-1)
Reinsurance Intermediary
Reinsurance Intermediary License Instructions
Reinsurance Intermediary License Form
Reinsurance Intermediary Renewal Instructions
Reinsurance Intermediary Renewal Form
Reinsurance Intermediary Manager Form
Reinsurance Intermediary Modification Form
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
Surplus Lines
Surplus Lines Filing Instructions
Surplus Lines Foreign Eligibility Application (Form SL1)
Surplus Lines Alien Eligibility Application (Form SL2)
Alien Surplus Lines Insurer Affidavit of Filing and Financial Statement Attestation
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 Self Funded (TPA-1 for Registration)
Pharmacy Auditing Entity Application
Viatical Settlement
Viatical Settlement Brokers
Viatical Settlement Provider Licensing & Renewing Instructions
Viatical Settlement Provider Application (Form VSP-2)
Viatical Settlement Provider Reporting Requirements (Form VSP-3)
Viatical Settlement Provider Surety Bond (Form VSP-4)