Admission surplus requirements and fees

Missouri is a "Uniform State" and uses the UCAA application.You will also need to submit these additional Missouri-specific items:

• Proposed policy forms
• Check our schedule for surplus requirements, deposits and fees. (Retaliatory Statement)
• Business Character Reports:

  The NAIC Biographical Affidavit is accepted as a Business Character Report if an independent third party, in the business of providing background investigations and with no affiliation with the applicant or the subject of the investigation, certifies that the Biographical Affidavit has no inaccurate or conflicting information and no material omissions.

• Additional requirement for the Department of Revenue
• For applicants for a Health Maintenance Organization (HMO) only:
  • Proposed provider contracts
  • Provider network data pursuant to the instructions for a non-contiguous "Service Area Expansion" for the proposed counties to be served
  • Documentation of registration to do business in MO (MO Secretary of State Certificate of Good Standing)

Check our Insurer FAQ page for details on changing your company's address, lines of authority or domestication state.

Please direct all applications and questions to:

Admissions Specialist
Division of Company Regulation
Missouri DCI
PO Box 690
Jefferson City, MO 65101