Applicant must submit a transmittal letter with a check for $25,000 made payable to “Florida HMO Consumer Assistance Plan”
to cover the special assessment required by Section 641.228(1), Florida Statutes.

Mail the check to:

Thomas A. Range, Plan Manager
Akerman LLP
201 E. Park Ave, Suite 300
Tallahassee, FL 32301

Submit a copy of the transmittal letter and a copy of the check with your application filing to:

Office of Insurance Regulation
200 E. Gaines St,
Tallahassee, FL 32399