Annual Statement Filing Notes & Instructions

NOTES AND INSTRUCTIONS (A-K APPLY TO ALL FILINGS)

Annual and Quarterly Statements: Lauri Cooper (207) 624-8464 Laurelyn.S.Cooper@maine.gov

The following items must be filed within 10 days of their amendment, along with an explanation of the amendments.
*Bylaws (certified) $25.00 filing fee, *Articles $25.00 filing fee, *Biographical affidavits(domestics only)
Domestic Form B Statements are Due 5/1. Form B Holding Company Registration Statement amendments are due on the 15th of the month following the change.

CHECK PAYABLE TO TREASURER STATE OF MAINE

• Foreign companies must supply a written copy of any exemption or extension received by its state of domicile at least 10 days prior to the filing due date to receive such from Maine. Domestic companies should apply at least 30 days prior to the due date.
• Foreign or alien insurers are only required to file an Annual Statement at the request of the Superintendent of Insurance.

None

• Advertising Certification required under Maine Rule 140 §11(B): Tracy Cunningham, (207) 624-8436, electronically to tracy.a.cunningham@maine.gov. Applies to all companies writing Health.

  http://www.maine.gov/sos/cec/rules/02/031/031c140.doc

• Annual Report Supplement (Rule 945) : David Stetson (207) 624-8435, electronically to david.g.stetson@maine.gov Applies to all companies writing or renewing medical or stop loss health insurance. NULL reports need not be submitted. Due Date is March 1st.
  The Bureau is planning to collect data for these reports directly through a new web-based data entry program. The new program has not been finalized at this time. Please check our website before completing this report for updated instructions or check with the listed contact person. The following links are provided as an example of the data required to be filed.

  Rule 945 Reporting Forms:
  http://www.maine.gov/pfr/insurance/forms/excel/Rule945.xls - for companies with $2 million or more in premium
  http://www.maine.gov/pfr/insurance/forms/excel/Rule945_short.xls - for companies with less than $2 million in premium

• Carrier Reporting Form (formally the Administrative Services Only Claims Report) {24-A M.R.S.A. § 4302(4)}: William Bremer (207) 624-8476, william.a.bremer@maine.gov.
  All insurance carriers with a HEALTH authority must file with the Superintendent of the Maine Bureau of Insurance by February 1st.
  The Bureau is collecting data for these reports directly through a new web-based data entry program. Please click on the following link to access the online reporting system.

  Online Reporting Form

• Consumer Complaint Contact Update

  For Life/Accident/Health/Annuity/Credit Insurance, contact Lisa Lewis at (207)624-8417 or by email at lisa.a.lewis@maine.gov
  For Property/Casualty Insurer, contact Cynthia Willey at (207)624-8423 or by email at cynthia.l.willey@maine.gov
  Applies to all Property/Casualty, Life, Accident, Health, Annuity and Credit Insurers.
  http://www.maine.gov/pfr/insurance/forms/word/CompanyComplaintContact.doc (Word)
  http://www.maine.gov/pfr/insurance/forms/pdf/CompanyComplaintContact.pdf (PDF)

• Downstream Risk Arrangement Disclosure required under §4336 B(2): Kendra L. Godbout, (207) 684-8495, electronically at kendra.l.godbout@maine.gov Applies to Health Maintenance Organizations.

• Filing Fees: Ingrid Garand (207) 624-8465 ingrid.e.garand@maine.gov
  Fees will be billed on or before July 1 of each year. DO NOT send fees at this time

• Health Insurance Annual Data Report (Rule 940): David Stetson (207) 624-8435, electronically to david.g.stetson@maine.gov Applies to all companies writing or renewing small group or individual Medical Insurance. Null reports need not be submitted. Due Date is April 30th.
  The Bureau is planning to collect data for these reports directly through a new web-based data entry program. The new program has not been finalized at this time. Please check our website before completing this report for updated instructions or check with the listed contact person. The following links are provided as an example of the data required to be filed.

  Rule 940 Reporting Form: http://www.maine.gov/pfr/insurance/forms/excel/Rule940Report.xls
  Rule 940: http://www.maine.gov/sos/cec/rules/02/031/031c940.doc

• Health Report Card Survey: Joanne Rawlings-Sekunda, (207) 624-8472, electronically to joanne.rawlings-sekunda@maine.gov Applies to all companies with enrollees in health insurance at any point during 2007.

  Health Report Card Survey Form: http://www.maine.gov/pfr/insurance/forms/word/report_card_survey_form.doc (Word) http://www.maine.gov/pfr/insurance/forms/pdf/report_card_survey_form.pdf (PDF)

• Liquor Liability Report: Thomas Michaud (207) 624-8440, thomas.r.michaud@maine.gov.
  Applies to all Property and Casualty companies.
  The Bureau is collecting data for these reports directly through a new web-based data entry program. Please click on the following link to access the online reporting system.

  Online Reporting Form

• Maine Fraud and Abuse Annual Report: Kelly E. Rogers (207) 624-8438, kelly.e.rogers@maine.gov.
  Applies to all companies.
  The Bureau is collecting data for these reports directly through a new web-based data entry program. Please click on the following link to access the online reporting system.

  Online Reporting Form

• Managing General Agent Report: Barbra Garboski (207) 624-8489, electronically to barbra.l.garboski@maine.gov
  Applies to only those companies utilizing an MGA.
  Managing General Agent Reporting Form:
  http://www.maine.gov/pfr/insurance/producer/word/AnnualMGAReportingForm.doc (Word)
  http://www.maine.gov/pfr/insurance/producer/pdf/AnnualMGAReportingForm.pdf (PDF)

• Mandated Benefit Experience Report: David Stetson (207) 624-8435, electronically to david.g.stetson@maine.gov Applies to all companies writing or renewing Health. NULL reports need not be submitted. Due Date is April 30th.
  The Bureau is planning to collect data for these reports directly through a new web-based data entry program. The new program has not been finalized at this time. Please check our website before completing this report for updated instructions or check with the listed contact person. The following links are provided as an example of the data required to be filed.

  Mandated Benefit Experience Reporting Form:
  http://www.maine.gov/pfr/insurance/forms/excel/mandated_benefits.xls
  Mandated Benefit Experience Bulletin: http://www.maine.gov/pfr/insurance/bulletins/292.htm

• Reasonableness of Assumptions Certification

  Reasonableness & Consistency of Assumptions Certification
  For the above, contact Kendra Godbout at (207)-624-8495 or electronically to kendra.l.godbout@maine.gov
  Actuarial certifications required for equity indexed annuities as found in Actuarial Guideline XXXV, Appendix C of the Accounting Practices and Procedures Manual

• Reasonableness of Assumptions Certifications for Implied Guaranteed Rate Method

  Reasonableness & Consistency of Assumptions Certification (Updated Average Market Value)

  Reasonableness & Consistency of Assumptions Certification (Updated Market Value)
  For all of the above, contact Kendra Godbout at (207)-624-8495 or electronically to kendra.l.godbout@maine.gov
  Actuarial certifications required for equity indexed life insurance policies as found in Actuarial Guideline XXXVI, Appendix C of the Accounting Practices and Procedures Manual.

• Supplemental Compensation Exhibit: Lauri Cooper (207) 624-8464, electronically to laurelyn.s.cooper@maine.gov
  Due March 1st. Forms can be sent with the Annual Statement or separately.

• Supplemental Health Insurance Report: Marti Hooper (207) 624-8449, electronically to mary.m.hooper@maine.gov Applies to all companies writing or renewing Health. NULL reports need not be submitted. Due Date is April 1st.
  The Bureau is planning to collect data for these reports directly through a new web-based data entry program. The new program has not been finalized at this time. Please check our website before completing this report for updated instructions or check with the listed contact person. The following links are provided as an example of the data required to be filed.

  Supplemental Health Reporting Form:
  http://www.maine.gov/pfr/insurance/forms/excel/SuppHealthPremiumForm.xls
  Supplemental Health Bulletin: http://www.maine.gov/pfr/insurance/bulletins/286a.htm

• Tick Borne Disease Report: Diane Williams (207) 624-8453, diane.m.williams@maine.gov.
  Applies to all companies. Due Date is February 1st.
  The Bureau is collecting data for these reports directly through a new web-based data entry program. Please click on the following link to access the online reporting system.

  Online Reporting Form

• Workers Compensation Benefits Report: Thomas Michaud (207) 624-8440, thomas.r.michaud@maine.gov.
  Applies to all companies writing workers' compensation.
  The Bureau is collecting data for these reports directly through a new web-based data entry program. Please click on the following link to access the online reporting system.

  Online Reporting Form