AK Stat § 21.85.040 (2021)
2021 Alaska Statutes|Title 21. Insurance|Chapter 85. Regulation of Multiple Employer Welfare Arrangements|Sec. 21.85.040. Application for a certificate of authority.

To apply for an original certificate of authority, a self-funded multiple employer welfare arrangement shall file with the director its application, accompanied by the applicable fees set under AS 21.06.250, showing its name, the location of its home office, its date of organization, its state of domicile, and additional information that the director may reasonably require. The application shall be submitted together with (1) a copy of all articles, bylaws, agreements, trusts, or other documents or instruments describing the rights and obligations of the employers, employees, and beneficiaries of the arrangement; (2) a copy of each summary plan description of the arrangement filed or required to be filed with the United States Department of Labor, including any amendments to each description; (3) evidence of coverage of or letter of intent to participate executed by at least two employers providing allowable benefits to at least 75 employees; (4) a copy of the arrangement's most recent financial statement in compliance with AS 21.85.080 or, if the arrangement has been in existence for less than one year, pro forma financial statements, including a balance sheet, an income statement, a statement of changes in financial condition, and an actuarial opinion that the unpaid claim liability of the arrangement satisfies the standards in AS 21.18.080 - 21.18.086; (5) proof that the arrangement maintains and will continue to maintain fidelity bonds required by the United States Department of Labor under 29 U.S.C. 1001 - 1461 (Employee Retirement Income Security Act of 1974); (6) a copy of any stop-loss insurance policies maintained or proposed to be maintained by the arrangement; (7) biographical reports, on forms prescribed by the National Association of Insurance Commissioners, evidencing the general trustworthiness and competence of each individual who is serving or who will serve as a managing employee or fiduciary of the arrangement; (8) a notarized statement executed by an officer of the arrangement certifying, to the best knowledge and belief of the officer, that the information provided in the application is true and correct and that the arrangement is in compliance with the requirements in (A) AS 21.85.020; (B) 29 U.S.C. 1001 - 1461 (Employee Retirement Income Security Act of 1974) or a statement of any requirements with which the arrangement is not in compliance and a statement of proposed corrective action; and (C) AS 21.85.050; (9) base contribution rates for participation under the arrangement for its initial year of operations; and (10) for a foreign multiple employer welfare arrangement, (A) a certificate of the public official having supervision of insurance in its state or country of domicile or state of entry into the United States, showing that it is authorized to transact the kinds of insurance proposed to be transacted in this state or an affidavit attesting to the reasons why a certificate is not available; (B) a copy of the arrangement's most recent financial statement filed with its state of domicile, if any, with an actuarial opinion on reported unpaid claims; (C) a copy of a management discussion and analysis filed with its state of domicile, if any; and (D) a copy of the report of last examination, if any, made of the insurer, issued by the insurance supervisory official of its state of domicile or state of entry into the United States.