Health Plan Purchasing Cooperatives

For the payment of the $605 licensing application and processing fee: 

Send payment along with the HPPC Licensing form - GID-080 to the lockbox address provided. Both addresses on the form are for the lockbox only. This process will allow Fiscal to enter the payment and allow us to proceed with the application review. No payments should be sent to our office. If we receive any payments, the payments are forwarded to the lockbox and will delay the processing of applications. 

Complete the following forms:

• Application for License as a HPCC - GID-80-NT
• Biographical Statement and Affidavit Form - GID-052-NT for each officer, owner, director or individual that exercises control or influence over the affairs
• Authority for Release of Information - GID-53-NT for each submitted Biographical Statement and Affidavit form
• Resolution Form - GID-55-NT
• Surety Bond - GID-057-NT with the following requirements. If this form is not used, the language of the bond must be similar and have the same requirements.
  • policy must be in continuous form and for at least one year
  • minimum of $100,000 to be otherwise determined by the following
    • If already acting, the amount of the bond should be equal to at least ten percent of the amount of the funds handled or managed annually or if no funds were handled during the preceding year, ten percent of the amount of funds reasonably estimated to be handled during the current calendar year
  • cancellation or termination of the policy is not effective except upon sixty (60) days written notice to the other party to the policy and to the Commissioner
  • policy must be automatically renewable at the expiration of the policy period except upon sixty (60) days written notice by the party not renewing
• Citizenship Affidavit and Copy of Acceptable ID

Provide the following documents, reports and list prepared by your entity:

• Organizational Documents - certificate of existence from Secretary of State of Georgia, articles of incorporation or other formation documents with all amendments
• By-laws, statements of policy or similar documents regulating the conduct of the internal affairs of the entity
• List of names, addresses, official positions and all professional qualifications of the individuals responsible for the conduct of the affairs of the HPPC, including all members of the board of directors, board of trustees, executive committee, or other governing board or committee, the principal officers of the corporation, the membership of any advisory group or groups, and any other person who exercises control over the affairs of the HPPC
• Audited Financial Statements or reports for each of the three most recent years reflecting a minimum of $200,000 net worth. If the applicant is not currently acting as a HPPC, a statement of the amounts and sources of the funds available for organization expenses and the proposed arrangements for reimbursement and compensation of incorporators or other principals.
• A business plan detailing the operation of the health plan purchasing cooperative in Georgia that includes the applicant's method(s) of solicitation, names of insurers and insurance products offered through the cooperative and the geographic area(s) the health plan purchasing cooperative is intending to serve
• Copies of all agreements between the health plan purchasing cooperative and the carrier(s) as stipulated by O.C.G.A. § 33-30A-4(f) as well as any administrator agreement(s) and/or agent agreement(s) used in the operations of the applicant.
• Copy of the guarantee of uninterrupted coverage as stipulated by O.C.G.A. § 33-30A-8(c)

 

All document requirements can either be sent via mail or courier to our office or via email to [email protected]. 

The filing fee and License Application must be sent separately to the lockbox. 

We will acknowledge receipt of the documents and will complete an initial review within 10 days of receipt of the documents and confirmation of receipt of the filing fees.  Any deficiencies or request for more information will be sent via email. 

Mailing address:

Office of Commissioner of Insurance and Safety Fire

Limited Risk Department

2 Martin Luther King Jr Dr

West Tower, Suite 702

Atlanta, GA 30334

• After submission, an email will be sent confirming submittal.
• The application will be reviewed within ten (10) business days of receipt of filing and payment
• Any deficiencies will be sent via an email to the applicant email address
• All deficiencies must be resolved within 60 days of the email notice
  • If not completed, the application will be closed incomplete
  • Another application submittal including payment of all fees will be required. No refunds for closed incomplete applications.
• If the application is approved, the license will be sent via email as an attachment. Please save the license. Any future copies could require a fee for printing.

• Application for License as a HPCC - GID-80-NT
• Biographical Statement and Affidavit Form - GID-052-NT
• Authority for Release of Information - GID-53-NT
• Resolution Form - GID-55-NT
• Surety Bond - GID-057-NT 

Links to resources:

O.C.G.A. § 33-30A

Rule 120-2-79 Health Plan Purchasing Cooperatives