An association seeking to establish an employee welfare benefit plan by the use of a self-funded or partially self-funded multiple employer welfare arrangement shall apply for a certificate of compliance on a form prescribed by the commissioner. The application shall be completed and submitted to the commissioner along with all of the following:
(a) Copies of all articles, bylaws, agreements, or other documents or instruments describing the rights and obligations of the employers, employees, and beneficiaries of the association with respect to the multiple employer welfare arrangement.
(b) Current audited financial statements of the association and the multiple employer welfare arrangement, and Internal Revenue Service Form number 5500 for the last five years.
(c) Proof of a fidelity bond in an amount equal to 10 percent of the funds handled annually by the multiple employer welfare arrangement. In no case may the amount of the bond be less than fifty thousand dollars ($50,000) nor more than five hundred thousand dollars ($500,000).
(d) A fiduciary liability policy with limits of not less than five hundred thousand dollars ($500,000).
(e) A statement showing in full detail the benefit plan upon which the association has established and maintained the multiple employer welfare arrangement.
(f) A copy of all contracts or other instruments that it makes with or issues to the association members, together with a copy of its plan description and the printed material which was used in enrolling members during 1993 and 1994.
(g) Proof of aggregate and specific stop loss insurance with an insurer licensed to do business in this state.
(h) A copy of all contracts or other instruments that were used with administrators and producers during 1993 and 1994.
(i) Biographical affidavits for the trustees, plan administrators of the multiple employer welfare arrangement, officers and directors of the association, other persons acting in a fiduciary capacity and any third-party administrators performing services on behalf of the multiple employer welfare arrangement.
(Added by Stats. 1994, Ch. 1082, Sec. 1. Effective January 1, 1995.)
Last modified: October 25, 2018