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Application Forms
Acquisition of or Merger with Louisiana Domiciled Insurer
Discount Medical Plan Organization Application
Dissolution of a Louisiana Domiciled Insurer
Independent Review Organization
Medical Necessity Review Organization (previously known as Utilization Review Agent)
Property Residual Value Insurer (GAP)
Risk Purchasing Group Renewal Application
Uniform Certificate of Authority Application (UCAA) Louisiana State Specific Package
Vehicle Mechanical Breakdown Insurer
Withdrawal of a Foreign or Alien insurer licensed in Louisiana
Annual Report Forms
Third Party Administrator Annual Report
Viatical Settlement Broker Annual Report
Other Documents
List of Approved Investigative Firms
Affidavit of Loss of Original Certificate of Authority
Changes to Third Party Administrator Directive 01-159
NAIC Biographical Affidavit Form
NAIC Health Financial Blank (for health maintenance organization applications)
Regulation 66: Requirements for Officers, Directors, and Trustees of Domestic Regulated Entities