Nebraska Finance Licensing

Online

$100

Online

$100

Annually by April 30.

Online

$250

Online

$350

Annually by April 30.

Online

$350

Online

$350

Annually by April 30.

Online

$100

Online

$50

Annually by April 30.

Online

$100

Online

$100

Annually by April 30.

Online

$100

Online

$100

Annually by April 30.

Online

$100

Online

$100

Annually by April 30.

Online

$40

Online

$40

Annually by April 30.

Online

$40

Online

$40

Annually by April 30.

Online

$50

Online

$50

Annually by April 30.

Online

$50

Online

$50

Annually by April 30.

$50

There is no application form for branch offices. Instead, send the name, address, and phone number of the branch to the licensing division with the registration fee.

$35

Annually by December 1.

Renewal forms are sent in the mail at the beginning of November.

Initial License Application

$200 investigation fee + $200 license fee.

Agencies must submit a list of solicitor employee names and their date of hire along with a $1 fee per solicitor.

$75

Annually by December 1.

Renewal forms are sent in the mail at the beginning of November.

$0

Within 30 days of the change.

Changes to an agency's ownership, name, address, or executive officers must be reported in writing.

Online

$100

Online

$50

Annually by April 30.

Online

$100

Online

$100

Annually by April 30.

Independent Review Organization Application

$100

• Documentation that the applicant has received approval or accreditation by a nationally recognized private accrediting agency
• A list of the principal officers of the entity responsible for its operation, management, and control

Independent Review Organization Application (Renewal)

$100

Biennially by the date of issuance.

http://www.doi.nebraska.gov/license/

Varies by insurance type. Baseline of $50

http://www.doi.nebraska.gov/license/

Varies by insurance type. Baseline of $50

Annually or Biennially based on license type

Online

$100

Online

$100

Annually by April 30.

Online

$100

Online

$100

Annually by April 30.

Online

$100

Online

$100

Annually by April 30.

Online

$100

Online

$99

Annually by April 30.

Online

$100

Online

$100

Annually by April 30.

Online

$100

Online

$100

Annually by April 30.

Online

$100

Online

$100

Annually by April 30.

Online

$100

Online

$100

Annually by April 30.

Online

$250

Online

$250

Annually by April 30.

Online

$250

Online

$250

Annually by April 30.

Online

$250

Online

$250

Annually by April 30.

Online

$250

Online

$250

Annually by April 30.

Online

$100

Online

$100

Annually by April 30.

Online

$100

Online

$100

Annually by April 30.

1. An employer on behalf of its employees or the employees or one or more subsidiaries or affiliated corporations of such employer, (not all activity exempt, see General Information section of this notice)
2. A union on behalf of its members (not all activity exempt, see General Information section of this notice)
3. An insurer which is authorized to transact the business of insurance in this state with respect to a policy issued and delivered in and pursuant to the laws of this state or another state.
4. An agent or broker licensed to sell life insurance, sickness and accident insurance, workers compensation insurance coverage, or annuities in this state whose activities are limited exclusively to the sale of insurance (not all activity exempt, see General Information section).
5. A creditor on behalf of its debtors with respect to insurance covering a debt between the creditor and its debtor.
6. A trust and its trustees, agents, and employees acting pursuant to a trust established under 29 U.S.C. 186 or a trust exempt from taxation.
7. A trust exempt from taxation under Section 501(a) of the Internal Revenue Code, its trustees and employees, custodian and the custodian’s agents acting pursuant to a custodian account meeting the requirements of Section 401(f) of the Internal Revenue Code.
8. A credit union or financial institution subject to supervision by federal or state banking authorities or a mortgage lender, to the extent of collection remits premiums to licensed insurance agents or authorized insurers in connection with loan payments.
9. A credit card issuing company which advances for and collects premiums from credit card holders, if the company does not adjust or settle claims.
10. The person who adjusts or settles claims in the normal course of practice or employment as an attorney at law and who does not collect charges or premiums in connection with life insurance, sickness and accident insurance, workers compensation insurance coverage, or annuities.
11. A person acting solely as a TPA of one or more bona fide employee benefit plan established by an employer or employer’s organization, or both, for which the insurance laws of Nebraska are preempted pursuant to the Employee Retirement Income Security Act of 1974 (ERISA). However, such person has to register with the Director annually. (Not all activity exempt, see General Information section of this notice).
12. A person licensed as a managing general agent whose activities are limited exclusively to activities allowed under such license.

$200

• All basic organizational documents
  • Includes articles of incorporation, articles of association, partnership agreement, trade name certificate, trust agreement, shareholder agreement, and other applicable documents and all amendments to such documents, bylaws, rules, regulations, or similar documents regulating the internal affairs of the applicant.
• Bigraphical information about the individuals responsible for the TPA
  • The names, addresses, official positions, professional qualifications and biographical affidavit of the individuals who are responsible for the conduct of affairs of the applicant
  • Includes all members of the board of directors, board of trustees, executive committee or other governing board or committee, the principal officers in the case of a corporation or the partners or members in the case of a partnership or association, shareholders holding directly or indirectly ten percent or more of the voting securities of the applicant and any other person who exercises control or influence over the affairs of the applicant.
• Financial Statements
  • Annual financial statements or reports for the two most recent years that prove that the applicant is solvent, and such other information the director may require.
• Business Plan
  • A statement describing the business plan including information on staffing levels and activities proposed in this state and nationwide.
  • Includes: 
    a. Names and titles of the officers of the corporation
    b. Who owns the business
    c. Number of employees
    d. Number of claims processed
    e. Number of claims processors
    f. Type of training program for processors
    g. Marketing plans
    h. EDP hardware and software utilized
• Proof of agent agreements
  • If the applicant will be managing the solicitation of new or renewal business, proof that it employs or has contracted with an agent licensed in this state for solicitation and taking applications.
  • Any applicant that intends to directly solicit insurance contracts or to otherwise act as an insurance agent must provide proof that it has a license as an insurance agent in this state.
• Banking information
  • Identify the federally insured or state-insured financial institution where you maintain your fiduciary account.
• A statement of the duties the TPA is intending to perform on behalf of the insurer and the lines, classes, or types of insurance the TPA will be administering.
• At the discretion of the state, additional information may be required.

Online

$200

Annually by March 1. 

Neb. Rev. Stat. §44-5814

• The complete names and addresses of all insureds with which the third-party administrator had a written agreement during the preceding fiscal year. The term "insurer" shall include, but not limited to, an employer who is approved by the Nebraska Workers' Compensation Court as a self-insurer.
• Financial statements for the third-party administrator including a balance sheet and an income statement for the most recent complete calendar or fiscal year. If audited financial statements are not available by the due date, please submit unaudited at the time of filing online and the audited copies when they are available to kristy.hadden@nebraska.gov. If no financials are available by March 1, please contact Kristy Hadden at kristy.hadden@nebraska.gov to request an extension for the financial filing.
• Documentation of any material change in its ownership or control of other fact or circumstance affecting its qualification for a Certificate of Authority that has not previously been reported including, but not limited to, the following:
  • Basic organization documents of the TPA including any articles of incorporation, articles of association, partnership agreement, trade name certificate, trust agreement, shareholder agreement, and other applicable documents.
  • Basic organization documents of the TPA including any articles of incorporation, articles of association, partnership agreement, trade name certificate, trust agreement, shareholder agreement, and other applicable documents.
  • Names, addresses, official positions, professional qualifications and biographical affidavit of all positions submitted with the application pursuant to Neb. Rev. Stat. §44-5812 (2) (c).

Utilization Review Agent Application

$300

• Documentation that the applicant has received approval or accreditation by the American Accreditation HealthCare Commission/URAC, or a similar organization which has standards for utilization review agents that are substantially similar to the standards of the American Accreditation HealthCare Commission/URAC, and which has been approved by the director
• A list of the principal officers of the entity responsible for its operation, management, and control

$100

Biennially by the date of issuance.

There is no form, instead submit a statement describing any changes in information or documentation submitted with the initial application.