Initial AO Application Process (4 Steps)
- Complete the online New Application for Application Organization Registration (organizations will complete the non-resident or resident "Firm" application). The nonrefundable online filing fee is $50 for Indiana resident business entities and $100 for non-resident business entities, and the processing fee is $14.40 (as of 9/3/14--subject to change). Note: Additional documentation required in Steps 2-4 may be attached electronically to the application. Applicants may check the status of their application online through sircon.com. Application submissions that are still "Pending" or "Under State Review" after 90 days from the submission date will be withdrawn.
- If the AO will have more than one location, the organization must submit to IDOI the following for each location of the AO: (1) Name, (2) Address, (3) Telephone, (4) Email, (5) Website (if applicable), and (6) Contact Person. The organization may also include on the list all Indiana counties a particular location services, if the location services one or more counties outside of its location. The list will be used to publish AO locations by county on the Indiana Healthcare Reform website at www.in.gov/healthcarereform/2468.htm.
- Review the Conflict of Interest Policy, then complete and submit the AO Conflict of Interest Disclosure Form.
- Review, sign, and submit the AO Privacy and Security Agreement.
All documents may be attached electronically to the end of the online application. They may also be submitted to IDOI by either: Email: firstname.lastname@example.org; Fax: 317-234-5882 ("attn: Navigator Director"); or Mail: Indiana Department of Insurance, c/o Navigator Director, 311 W. Washington St., Indianapolis, IN 46204