Licensing Information

• Important Information for Applicant (PDF)
• Application - Form H1 (PDF) ´Ç°ùÌýApplication - Form H1 (DOC)
• Checklist H2 - Part A (PDF) ´Ç°ùÌýChecklist H2 - Part A (DOC)
• Checklist H2 - Part B (PDF) ´Ç°ùÌýChecklist H2 - Part B (DOC)
• Uniform Consent to Service of Process Form (PDF) or Uniform Consent to Service of Process Form (DOC)
  • Agent Service of Process List (PDF)

Fees

• Company Renewal Dates and Fees (PDF)
•  (24-A M.R.S.A. § 601)
• HMO Fees 
• Producer Appointment Renewal Fees (DOC)
• Authorization of Credit Card Payment (PDF)Ìý´Ç°ù Authorization of Credit Card Payment (DOCX)

Annual Reporting Requirements

• Annual Statement Filing Instructions and Checklists
• fb88 Annual Data Reporting Requirements
• Health Maintenance Organization Annual and Quarterly Financial Statements

Rate and Form Filing Checklists

• Health and Life

Status Change Forms (Name Changes, Mergers, Redomestications, Etc.)

• Address Changes (PDF) ´Ç°ùÌýAddress Changes (DOC)
  •  - Change your address and/or contact information ON-LINE (fb88 Only)
  •  - Under ‘Corporate Amendment Forms’, scroll to Form 14.  Can be mailed, emailed, or filed electronically through UCAA Electronic application.
• Director and Officer Updates and Change Requirements
• Name Reservation (DOCX)

Credentialing Extension Application

• Completing and Sending Credentialing Extension Application and Supporting Documents

Requesting Confidential Treatment of Documents

• Instructions for requesting confidential treatment of documents

Statutory Requirements

•  - (Health Maintenance Organizations)
• Rule Chapter 191 (DOC) - (Application Submission Requirements)

The documents on this page are also available in hard copy by contacting the Bureau.