The Indiana M400 form is a renewal application specifically designed for the registration of Multiple Employer Welfare Arrangements (MEWAs). These arrangements provide employee benefits, such as accident and sickness or death benefits, to employees from at least two different employers. Completing this form is essential for MEWAs to maintain compliance and continue offering benefits to their members.
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The Indiana M400 form serves as a renewal application for the registration of Multiple Employer Welfare Arrangements (MEWAs). While this form is essential for maintaining compliance, several other documents often accompany it to ensure a complete application process. Below is a list of relevant forms and documents that may be needed alongside the M400.
Submitting the Indiana M400 form along with these supporting documents helps ensure that the MEWA remains compliant with state regulations and continues to provide valuable benefits to its members. Careful preparation and attention to detail in these submissions can facilitate a smoother renewal process.
Omitting Required Information: One common mistake is failing to provide all necessary details, such as the full name of the Multiple Employer Welfare Arrangement (MEWA) or its statutory home address. Each piece of information is crucial for processing the application.
Incorrect Certification: Applicants often misinterpret the certification section. It's essential to clearly indicate whether there have been changes to the previously submitted application information. Failing to do so can lead to delays.
Neglecting the Contact Information: Providing incomplete or incorrect contact information can hinder communication. This includes the contact person's name, title, and telephone number, which should be accurate to facilitate any necessary follow-ups.
Misunderstanding Association Membership: Some applicants mistakenly answer the question about whether employers in the MEWA are members of an association. This question requires careful consideration, as it can affect eligibility.
Overlooking the Fiscal Year Change: If there has been a change in the MEWA’s fiscal year, this must be reported. Ignoring this detail can lead to complications in compliance and reporting.
Failing to Provide Third-Party Administrator Information: If the MEWA has a contract with a third-party administrator, applicants must include this information. Omitting it can raise questions about the MEWA’s operations.
Inaccurate Fund Balance Reporting: When asked about the MEWA’s fund balance, providing inaccurate figures can mislead reviewers. It is vital to report this information truthfully and accurately.
Not Signing the Application: Lastly, forgetting to sign the application can result in immediate rejection. The signature of the Chair of the Board is a crucial element that validates the application.
When filling out the Indiana M400 form, there are several important points to keep in mind. Here are five key takeaways to ensure a smooth application process:
By paying attention to these details, you can enhance the chances of a successful application and ensure compliance with Indiana regulations.
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RENEWAL APPLICATION FOR REGISTRATION OF MULTIPLE
EMPLOYER WELFARE ARRANGEMENT (MEWA)-IC 27-1-34-1
NOTE: “Multiple Employer Welfare Arrangement” means an entity other than a duly admitted insurer that establishes an employee benefit plan for the purpose of offering or providing accident and sickness or death benefits to the employees of at least two (2) employers, including self-employed individuals and their dependents.
(1.)
Applicants Certification:
(A.)
I certify that
there have been no changes to the application information and documentation submitted during the last year
(B.)
there have been changes to the previously submitted application information and documentation and have
attached the revised documentation.
(2.)
Full name of MEWA
(3.)
Statutory home address of MEWA (street, city, state, ZIP code)
(4.)
Mailing address of MEWA (street, city, state, ZIP code)
(5.)
Contact person of MEWA
(5a.) Title
(5b.) Telephone number
(
)
(6.)
Are the employers in the MEWA members of an association or
(6a.) List trade or industry:
group of two (2) or more businesses in the same trade or
industry ?
yes
no
(7.)
Is the association substantially involved in the activity for its members other than sponsorship?
If answer is no please explain:
(8.)
Has the MEWA’s fiscal year changed?
(9.)
Is the MEWA a non-for-profit organization?
(10.) Does the MEWA have a contract with a third party
(10a.) If answer is yes list or attached the name of the third party
administrator?
administrator(s):
(11.)
Are any of the trustees an owner, officer, or employee if the administrator? yes
If yes, please explain:
(12.)
What is the MEWA’s fund balance?
Comments:
I certify that the above statements are true.
Signature of Chair of Board
Date
Printed Name of Signature
Title
Form M400
Ver. 1.0