Bureau of Insurance
OTHER PFR AGENCIES
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Annual Statement Filing Notes & Instructions
NOTES
AND INSTRUCTIONS (A-K APPLY TO ALL FILINGS) |
| A |
Required Filings Contact Person: |
Annual and Quarterly Statements:
Foriegn Companies:
Lauri Cooper 207-624-8464 Laurelyn.S.Cooper@maine.gov
Domestic Companies: Nichole Bilodeau 207-624-8592 Nichole.L.Bilodeau@maine.gov |
| B |
Mailing Address: |
Regular Mail:
Maine Bureau of Insurance
Financial Analysis Division
#34 State House Station
Augusta, ME 04333-0034 |
Courier:
Maine Bureau of Insurance
Financial Analysis Division
76 Northern Avenue
Gardiner, ME 04345 |
| C |
Mailing Address for Filing Fees: |
Annual Statement filing fees will be billed on
or before July 1 of each year. DO NOT send fees at this time.
If the domestic company has elected to pay examination assessment
fees based on Title 24-A, M.R.S.A., § 228 (3), please include
your payment with the filing of your annual statement. If you
have any questions with regards to the exam fees, please contact
Stuart Turney 207-624-8468 or Email Stuart.E.Turney@maine.gov |
| D |
Mailing Address & Contact for Premium Tax Payments, Questions
& Forms: |
Maine Revenue Services, PO Box 9120, Augusta,
ME 04333-9120, Phone: Carlotta Larrabee 207-624-9753.
http://www.maine.gov/revenue/forms/insurance/2009.htm |
| E |
Delivery Instructions: |
All filings must be postmarked no later than the indicated
due date. If the due date falls on a weekend or holiday, then the
deadline is extended to the next business day. |
| F |
Late Filings: |
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. |
| G |
Original Signatures: |
Original signatures required on all filings from Domestic Companies. Foreign companies should follow the instructions in the NAIC Annual Statement instructions. |
| H |
Signature/Notarization/Certification: |
The following officers are required to sign the annual
statement: CEO, President, & Treasurer for domestic companies. |
| I |
Amended Filings: |
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
*As changes occur. |
| J |
Exceptions from normal filings: |
- 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.
|
| K |
Bar Codes (State or NAIC) |
Not Used |
| L |
Signed Jurat |
Signed Jurat pages are NOT required for foreign or
alien insurers. They are required for domestic insurers. |
| M |
NONE Filings: |
Supplemental exhibits & schedules as listed
in the annual statement interrogatories are not required to be
filed if your response in the supplemental exhibits & schedules
interrogatories is a "NONE" report. |
| N |
Filings new, discontinued, modified since last year: |
None |
| O |
Required by the State of Maine
Should be filed separately from the annual statement |
| |
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Advertising Certification required under Maine Rule
140 §11(B): Lisa Lewis, 207-624-8417, electronically to Lisa.A.Lewis@maine.gov. Applies to all companies writing Health.
http://www.maine.gov/sos/cec/rules/02/031/031c140.doc
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Annual Report Supplement (Rule 945) : For information about completing the form, contact Bradford Brown at 207-624-8478 or Bradford.L.Brown@maine.gov. For specific questions about definitions or the law, contact Mary Hooper at 207-624-8449 or Mary.M.Hooper@maine.gov .Applies to all health insurers and HMOs writing or renewing Health insurance coverage. Companies with no written health premium should fill in the only the company information at the top and the contact information at the bottom and submit the report. Due Date is March 1st. The following links provide access to the forms, instructions and the law:
Rule 945 Instructions: http://www.maine.gov/pfr/insurance/forms/word/945Instructions.doc (Word) or http://www.maine.gov/pfr/insurance/forms/pdf/945Instructions.pdf (PDF)
Rule 945 Form for companies with $2 million or more in premium
http://www.maine.gov/pfr/insurance/forms/excel/Rule945.xls
Rule 945 Form for companies with less than $2 million or more in premium
http://www.maine.gov/pfr/insurance/forms/excel/Rule945_short.xls
Rule Chapter 945: http://www.maine.gov/sos/cec/rules/02/031/031c945.doc
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Carrier Reporting Form (formally the Administrative
Services Only Claims Report) {24-A M.R.S.A. § 4302(4)}: Bradford Brown 207-624-8478, Bradford.L.Brown@maine.gov.
All insurance carriers with a HEALTH authority must file with
the Superintendent of the Maine Bureau of Insurance by February
1st. Companies with no written health premium should fill in the only the company information at the top and the contact information at the bottom and submit the report. The following links provide access to the new online form, instructions and the law:
Carrier Report Instructions: http://www.maine.gov/pfr/insurance/forms/word/CarrierReportInstructions.doc (Word) or http://www.maine.gov/pfr/insurance/forms/pdf/CarrierReportInstructions.pdf (PDF)
Carrier Report Form: Online Reporting Form. Please have your license number and access code ready to enter.
Carrier Report Law: http://www.mainelegislature.org/legis/statutes/24-A/title24-Asec4302.html (see section 4)
Certificates of Deposit: For Domestic Companies contact Nichole Bilodeau at 207-624-8592, Nichole.L.Bilodeau@maine.gov. Not required from Foreign Companies.
- 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 Insurers, 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)
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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.
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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
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Health Insurance Annual Data Report (Rule 940): For information about completing the form, contact Bradford Brown at 207-624-8478 or Bradford.L.Brown@maine.gov. For specific questions about definitions or the law, contact Mary Hooper at 207-624-8449 or Mary.M.Hooper@maine.gov. Applies to all companies writing or renewing small group or individual Medical Insurance. Due Date is April 30th. Companies with no written small group or individual Medical Insurance premium should fill in only the company information and the contact information at the top and submit the report The following links provide access to the forms, instructions and the law:
Rule 940 Instructions: http://www.maine.gov/pfr/insurance/forms/word/940Instructions.doc (Word) or http://www.maine.gov/pfr/insurance/forms/pdf/940Instructions.pdf (PDF)
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
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Health Report Card Survey: Joanne Rawlings-Sekunda,
207-624-8472, electronically to Joanne.Rawlings-Sekunda@maine.gov Applies to all companies with Maine enrollees in health
insurance at any point during 2009.
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)
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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
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Maine Fraud and Abuse Annual Report:Bradford.L.Brown 207-624-8478, Bradford.L.Brown@maine.gov. Applies to all companies with written premium in Maine during the prior calendar year. The following links provide access to the new online form, instructions and the law:
Instructions: http://www.maine.gov/pfr/insurance/forms/word/FraudAbuseInstructions.doc (Word) or http://www.maine.gov/pfr/insurance/forms/pdf/FraudAbuseInstructions.pdf (PDF)
Form: Online Reporting Form. Please have your license number and access code ready to enter.
Law: http://www.mainelegislature.org/legis/statutes/24-A/title24-Asec2186.html (see section 4)
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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)
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Mandated Benefit Experience Report: For information about completing the form, contact Bradford Brown at (207)-624-8478 or Bradford.L.Brown@maine.gov. For specific questions about definitions or the bulletins or laws, contact Mary Hooper at (207)-624-8449 or Mary.M.Hooper@maine.gov . Applies to all companies writing or renewing Health insurance coverage. Companies with no written health premium should fill in the only the company information at the top and the contact information at the bottom and submit the report. Due Date is April 30th. The following links provide access to the form, instructions and the law:
Mandated Benefit Experience Reporting Form: http://www.maine.gov/pfr/insurance/forms/excel/mandated_benefits.xls (Excel)
Mandated Benefit Experience Reporting Instructions: http://www.maine.gov/pfr/insurance/forms/word/MandatedBenefitsInstructions.doc (Word) or http://www.maine.gov/pfr/insurance/forms/pdf/MandatedBenefitsInstructions.pdf (PDF)
Mandated Benefit Experience Bulletin: http://www.maine.gov/pfr/insurance/bulletins/292.htm
- Preferred Provider Arrangement Annual Registration: Joanne Rawlings-Sekunda, 207-624-8472, due March 1, 2010, by mail to: 34 State House Station, Augusta, ME 04333 or by courier 76 Northern Avenue, Gardiner, ME 04345. Applies to all PPOs with approved Maine PPA registrations in effect for at least six months as of March 1.
Preferred Provider Arrangement Annual Registration Form: http://www.maine.gov/pfr/insurance/producer/word/PPO_annual.doc (Word)
- 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
Applies only to domestic Life Companies
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
Applies only to domestic Life Companies
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: Nichole Bilodeau 207-624-8592, electronically to Nichole.L.Bilodeau@maine.gov
Due March 1st. Forms can be sent with the Annual Statement or separately.
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Supplemental Health Insurance Report:
For information about completing the form, contact Bradford Brown at 207-624-8478 or Bradford.L.Brown@maine.gov. For specific questions about definitions or the law, contact Mary Hooper at 207-624-8449 or Mary.M.Hooper@maine.gov Applies to all companies writing or renewing Health insurance coverage. Companies with no written health premium should fill in the only the Company information and Completed by Sections at the top and submit the report. The following links provide access to the form, instructions and the law:
Supplemental Health Form, Law and Instructions:
Form: http://www.maine.gov/pfr/insurance/forms/excel//SuppHealthPremiumForm.xls
Bulletin: http://www.maine.gov/pfr/insurance/bulletins/286a.htm
Instructions: http://www.maine.gov/pfr/insurance/forms/word/SupplementalHealthInstructions.doc (Word) or http://www.maine.gov/pfr/insurance/forms/pdf/SupplementalHealthInstructions.pdf (PDF)
- Tick Borne Disease Report: Bradford Brown 207-624-8478, Bradford.L.Brown@maine.gov.
Applies to all Health insurance companies. Due Date is February 1st.
The Bureau is collecting data for these reports directly through a new web-based data entry program.
The following links provide access to the form, instructions and the law:
Tick Borne Disease Form, Law and Instructions:
Form: Online Reporting Form. Please have your license number and access code ready to enter.
Law: http://www.mainelegislature.org/legis/statutes/24-A/title24-Asec4302.html (see section 5)
Instructions: http://www.maine.gov/pfr/insurance/forms/word/TickborneInstructions.doc (Word) or http://www.maine.gov/pfr/insurance/forms/pdf/TickborneInstructions.pdf (PDF)
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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
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Last Updated:
November 19, 2009
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