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For Companies > Licensing and Approvals for Prospective Companies > Applications > HMO
Application for Insurance Companies Applying for Health Maintenance Organization Line of Business

RSA 420-B and Ins 2200 contain information for Health Maintenance Organizations (HMO). The following items are required to do business in this state as an HMO:

  • $1,000.00 application fee (make check payable to Treasurer, State of New Hampshire). Fee is non-refundable.
  • UCAA Application
  • Power of Attorney Form Adobe Acrobat Reader Symbol
  • The Company’s latest three Annual Statements
  • The Company’s latest examination report
  • By-Laws and Articles of Incorporation

Please note that if the company is applying for a regular Certificate of Authority along with an HMO Certificate of Authority, that the company may not use the same name for both licenses.

Please mail all the requested information to the New Hampshire Insurance Department Financial Examination and Analysis Division.

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New Hampshire Insurance Department | 21 South Fruit Street, Suite 14 | Concord, NH 03301
Phone 603.271.2261 | Fax 603.271.1406 | Consumer Hotline 1.800.852.3416

Copyright © State of New Hampshire, 2007