Electronic Annual Statement Information
Insurance Companies
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.)
The pre-admission review fee is $1,000 and is subject to retaliation. The fee should be paid online through this link.
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 (Chapter 44) can be accessed at https://nebraskalegislature.gov/laws/browse-chapters.php?chapter=44
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.
Company Corporate Amendments
The Nebraska Department of Insurance requires the use of the "Uniform Certificate of Authority Corporate Amendment Applicant" for the filing of company changes. The "Uniform Certificate of Authority Corporate Amendment Application" allows foreign insurers to file copies of the same application for numerous states in which they are licensed. Instructions to complete the forms are included with the link to the application at https://content.naic.org/industry/ucaa.
The fees associated with the corporate amendment can be found at this link, https://doi.nebraska.gov/insurers/schedule-company-fees-taxes-and-deposits. These fees are retaliatory and should be paid online through this link.
Requesting Certificates
To request a Certificate of Authority, Certificate of Compliance, Certificate of Deposit or Certificate of Valuation, go to the following link, indicate which certificate type you want, and the quantity.
Advisory Organization/Statistical Agent
- See Neb.Rev.Stat. §44-7518 to 44-7523
- Application Form
- Renewal Form
Health Maintenance Organizations (HMO's)
In addition to the "Uniform Certificate of Authority Application" accessed at www.naic.org/industry_ucaa.htm, please refer to Neb.Rev.Stat. §44-32,117 for additional licensing requirements. (The Health Maintenance Organization Act begins at Neb.Rev.Stat. §44-3292).
Legal Service Insurance Corporations (See Neb.Rev.Stat. §44-3301)
Multiple Employer Welfare Arrangement
- Multiple Employer Welfare Arrangement (MEWAS) Application for Certificate of Registration
- Multiple Employer Welfare Arrangement (MEWAS) Annual Renewal
Motor Club Service Company
- Motor Club Application for Certificate of Authority
Indemnity Bond Required of a Motor Club Service Company- Motor Club Annual Renewal
Pharmacy Benefit Manager
- Pharmacy Benefit Manager licensure and Regulation Act
- Pharmacy Benefit Manager Application
- Pharmacy Benefit Manager Renewal Form
Pre-Paid Dental Service Plans (See Neb.Rev.Stat.§44-3801)
Pre-Need Seller Application and Forms
Pre-Paid Limited Health Service Organizations (See Neb.Rev.Stat.§44-4701)
- Requirements for Application for Certificate of Authority for Pre-Paid Limited Health Service Organizations
- Notice to Applicants for PLHSO License to Bid on HHS Medicaid Contract
Purchasing Groups
Risk Retention Groups
Nebraska follows the standard NAIC Risk Retention Group Registration format. The Risk Retention and Purchasing Group Handbook is available from the NAIC Insurance Products & Services Division.
Third Party Administrator
- TPA Licensing Requirements
- TPA Application Sample
- TPA Application for Certificate of Authority
- TPA Annual Statement Link
- TPA Annual Statement Information
- TPA Sample Annual Statement
Viatical Reports
- Viatical Settlement Provider Application
- Viatical Settlement Provider Annual Renewal
- Viatical Individual Mortality Annual Report
- Viatical Settlement Report for Nebraska
- Viatical Settlement Provider Mortality Report
- Viatical Settlement Provider Renewal Report Instructions - Portal
Discount Medical Plan Organizations (See Neb.Rev.Stat.§44-8301)
Discount medical plan means a business arrangement or contract in which a person, in exchange for fees, dues, charges, or other consideration, offers access for its members to providers of medical or ancillary services and the right to receive discounts on medical or ancillary services provided under the discount medical plan from those providers.
