Please be advised, the Wilmington Office of the Delaware Department of Insurance has moved to a new location effective June 30th, 2023. The new address for the Wilmington office is: 503 Carr Road, Suite 303, Wilmington, Delaware 19809. (All payments should be mailed to 1351 West North Street, Suite 101, Dover, Delaware 19904.)
Medicaid Unwinding FAQ – See More Info
COVID-19 Insurance FAQ - See More Info
Insurers are encouraged to file required forms electronically to berg@delaware.gov. Filing fees must be in the form of a check and be accompanied by a cover letter.
The Department will accept electronic signatures that comply with the Uniform Electronic Transactions Act, Title 6 Ch. 12A.
Affidavit Insurance Data Security Act Data Security Act – HB174 – Only required for Domestics
Certificate Request Request form for certificates. Applicable fees are required at time of request
Form D1 Designation of Person for Receipt of Service of Process
Form D2 Designation of Person to Receive Regulations, Bulletins, etc.
Form PF-1 Insurance Premium Finance Company Application
H-1 Form Application For Managed Care Organization Certificate Of Authority
H-2 Form Questionnaire For Certificate Of Authority Of Managed Care Organization
H-4 Form Designation of Individual for Receipt of Bulletins, Etc.
Voluntary Dissolution of a Delaware Domestic Company Procedure for dissolving a Delaware domestic company
UCAA – Primary, Expansion and Corporate Amendment Applications and Forms
- DOMESTIC:
- NAIC Biographical Affidavits are required for all changes in Officers, Directors or Key Managerial Personnel and individuals with a 10% or more beneficial ownership in the company. Email with cover letter to berg@delaware.gov within 60 days of the change
- FOREIGN:
- NAIC biographical affidavits are NOT required for new officers or directors. However, a letter of notification is required for changes to Officers (not directors) emailed to berg@delaware.gov within 60 days of change. Notification letter must include the Company Name(s), NAIC#(s), Business Address, Phone Number, and Email Address
Please refer to the state specific chart on the NAIC website: Fingerprint and Biographical Affidavit Requirements – Industry UCAA (naic.org)
Reminder: Non-Public information (NPI) should be sent securely using the State preferred method of Egress Secure
Security Exchange Request– Request changes to Securities held in EscrowUCAA – Uniform Certificate of Authority Application information
18 Del. Admin C. § 1405
Requirements for Obtaining Authority as a Fully Insured MEWA
Process for Applying for and Renewing a Fully Insured MEWA
Fully Insured MEWA Application
Form 12 .pdf (Uniform Consent to Service of Process)
Designation of Person to Receive Regulations, Bulletins, etc. (Form D2)
Biographical Affidavit – UCAA Form 11
Please refer to 18 Del. Admin C. § 1405-5.5 for information pertaining to Self-Insured MEWA’s.
18 Del. Admin C. § 1403 (Formerly Regulation 58)
Requirements for Obtaining Authority as a Managed Care Organization
- H-1 Form (Application)
- H-2 Form (Admittance Questionnaire)
- H-4 Form (Designation of Individual for Receipt of Bulletins, Etc.)
- Form 12 .pdf (Uniform Consent to Service of Process)
- Biographical Affidavit – UCAA Form 11
18 Del. C. § 33A
PBM Final Order Effective 8/11/2020
Pharmacy Benefits Manager Checklist/Registration application
- A pharmacy benefits manager shall register with the Commissioner as a pharmacy benefits manager before providing pharmacy benefits management services in this State. §3353A
Annual Renewal – May 1 (Please do not submit more than 60 days in advance)
Pharmacy Benefits Manager Name Change Application
Affidavit of Lost PBM Certificate form
Pharmacy Benefits Manager Address Change form
Pharmacy Benefits Manager Reports
- A pharmacy benefits manager shall provide a Pharmacy Benefits Manager Network Adequacy report annually describing the pharmacy benefits manager network and the pharmacy benefits manager network’s accessibility in this State. § 3363A (a)
- Delaware PBM Annual Network Adequacy Report
- A pharmacy benefit manager shall provide quarterly reports with itemized amounts of pharmacy benefits manager revenue, rebate and paid sources as required in § 3363A (b). The PBM will be required to submit one Attestation and Quarterly itemized report per insurer.
18 Del. Admin C. § 2001 (Formerly Regulation 21)
Requirements for Obtaining a License as a Premium Finance Company
- Form PF-1 (Application)
- Form PF-3 (Biographical Affidavit)
- Designation For Service of Process (Form D1)
- Designation of Person to Receive Regulations, Bulletins, etc. (Form D2)
- Application for Name Change
Annual Renewal – January 1 (Please do not submit more than 60 days in advance)
18 Del. C. §§ 2501-2534
Rating Organization License Application Checklist
Application for Rating Organization License
Annual Renewal – July 1 (Please do not submit more than 60 days in advance)
18 Del. C. §§ 1601-1613
- Application Corporation/Partnership
- Designation of Person for Receipt of Service of Process (D1)
- Use of Trade name or DBA
Annual Renewal – March 1 (Please do not submit more than 60 days in advance)
Annual Continuation Fee $100 effective 7/1/201718 Del. C. §§ 8001-8014
Risk Retention Group/Risk Purchasing Group Requirements
- Purchasing Group Application
- Risk Retention Group Application
- Designation of Person for Receipt of Service of Process (D1)
- RRG Voluntary Dissolution– UCAA Form 16b
Annual Renewal – March 1 with Premium Taxes
Surplus Lines Brokers
Domestic Surplus Lines Insurer (DSLI) Application Procedure
- DSLI Checklist for current Delaware Domestic Companies
- DSLI Checklist for Foreign Admitted companies seeking to redomesticate as a Delaware DSLI
- DSLI Checklist for Newly Formed or Foreign Non-Admitted companies
- Name Change for an Approved Surplus Lines Insurer or Accredited Reinsurer (D1 & D2)
- Redomestication for an Approved Surplus Lines Insurer or Approved Accredited Reinsurer (D1 & D2)
18 Del. Admin C. § 1406
- Uniform Application for License/Registration
- Use of Trade name or DBA
- UCAA Form 12 (Service of Process)
- Application for Name Change
- Affidavit of Lost License
- Affidavit of Exemption
- Voluntary Surrender of License – TPA
Annual Renewal – July 1 (Please do not submit more than 60 days in advance)
Annual Renewal Memorandum
18 Del. C. 9
- Requirements for Obtaining Accredited Reinsurer Status as an Alien Company Maintaining Trust Fund
- Requirements for Obtaining Accredited Reinsurer Status as a Foreign Unlicensed Company
- Guidelines for Credit Allowed a Domestic Ceding Insurer (Adopted January 1992)
- Form AR-1, Certificate of Assuming Insurer
Annual Renewal – March 1 with Premium Taxes
Delaware Captive Website
Premium Taxes and Annual Renewals
Rates and Forms (Life/Health and Property/Casualty) – including Nonadmitted Insurers, Risk Retention Groups and Risk Purchasing Groups
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