Ohio Insurance CE New Provider Application

Important Information for Ohio Insurance CE Provider Applicants

Application and Renewal Periods: Approved provider status is granted for one fiscal year beginning July 1. Prospective providers for the upcoming fiscal period, whether new or renewing, must have their applications submitted by November 30 to be considered.

Providers wishing to renew their status may submit applications between October 1 and November 30 for the following fiscal year.

Regardless of a provider's original approval date, all existing providers must renew during the renewal period to be considered for the following fiscal year. Please note, application fees are non-refundable, non-transferable, and cannot be pro-rated based on the provider's original application date.

Download the complete Ohio Department of Insurance Continuing Education Program Provider Information Packet (PDF | 1.5MB) for more details.

Instructions for Completing the Ohio Provider Application

Provider Name: Print or type the full legal name of the organization.

Physical Address: Provide the complete physical street address, including ZIP code, of the location at which continuing education records will be maintained. The physical location may not be a post office box.

Mailing Address: Include the provider’s mailing address if it is different than the physical address. Mailing address may be a post office box.

Contact Information (Phone number, Fax number and Email address): Include the phone number, including the area code, for students to contact the organization. Also provide a fax number and e-mail address.

FEIN: Include the provider’s Federal Employer Identification Number.

Provider Website Address: Include the provider’s URL.

Names and Titles of Owners or Officers: List the name and title of each individual who has a significant financial interest in your organization. For partnerships, list all partners. For corporations, name all officers, as well as any shareholders, who have a 10 percent or greater interest.

Type of Organization: Check the type that best describes your organization. The “Other” category is intended to cover organizations that do not fit into the listed categories. If you use the “Other” category, briefly describe your organization.

Previous Names and Locations: If your organization has ever operated under a different name, list all names. If a sole proprietorship or partnership, indicate the names of all training companies for which the proprietor or any partner has been a proprietor, partner or held at least a 50 percent ownership interest. If a corporation, for each owner who holds at least 50 percent of the voting stock, please list all training companies for which any of these owners has been proprietor, partner or has held at least 50 percent of the voting stock.

Fee Option: Providers must elect their fee option status at the start of each year; if a provider changes its fee option status during the year and a different fee is due, the new fee will be in addition to previous payments with no credit for the prior payments. Select one of the following:

• Flat fee $1,000 annually with unlimited course submissions
• Individual fee $100 per provider and $40 per course annually
• Limited fee $25 per provider and $25 per course annually with a limit of 3 courses of no more than 3 credits each

Authorized Provider Official: rovide the name and title of one individual with whom we should communicate for all business matters. This person must have the authority to execute agreements on behalf of the provider. The authorized provider official is the individual responsible for the provider’s compliance with Ohio’s continuing education regulations as outlined on page 4.

Facsimile Signature: You may provide a facsimile signature stamp for the Authorized Provider Official if you intend to use a signature stamp for course applications, roster submissions and course completion certificates.

Provider Official Contact Information: Provide the phone number, including the area code, and email address where the Department or PSI may contact the Authorized Provider Official.

Signature/Certification: The Authorized Provider Official must sign the provider application, certifying that the applying organization will abide by all Ohio laws and Department of Insurance regulations, policies and guidelines regarding insurance continuing education.

Submission: Submit all applications packets to PSI Services by either email or courier mail.

Provider Application by Email: After placing your application order on this page, submit the completed provider approval application documents and the payment receipt for your application fee to: ohins-processing@psionline.com.

Provider Application by Mail: Submit the completed provider approval application, any supporting documents, and the appropriate fee in the form of a company check, cashier’s check, or money order to:

PSI Services
Attn: Continuing Education Dept.
3210 E. Tropicana Ave.
Las Vegas, NV. 89142

If the provider submits an incomplete application, the application will be returned with a letter indicating the areas that must be addressed. If the requested information is not received by the response due date, the filing will be considered abandoned. All fees are non-refundable and non-transferable.