1. (a) The State Insurance Department adopts by reference standard forms for use in the administrative regulation of self-funded multiple-employer welfare arrangements.
2. (b) Applicants and licensed self-funded multiple-employer welfare arrangements are required to utilize these forms in preparing applications, statements, notices of required information, and other submissions required under this part.

3. (c) These forms are more specifically identified as follows:

   1. (1) Instructions Form A Application;
   2. (2) Form A-MEWA Application Certificate of Authority;
   3. (3) Form B-MEWA Application To Do Business;
   4. (4) MEWA SOP (Service of Process);
   5. (5) Officers Directors Trustees Page; and
   6. (6) Annual Filing Checklist.

Codification Notes: “MEWA” means multiple-employer welfare arrangement.