NOTES
AND INSTRUCTIONS (A-K APPLY TO ALL FILINGS) |
| A |
Required Filings Contact Person: |
Annual and Quarterly Statements: Tracy
Cunningham (207) 624-8436 Tracy.A.Cunningham@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
124 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/2007.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: |
Consumer Complaint Contact Update – New Filing
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)
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. |
| O |
Required by the State of Maine
Should be filed separately from the annual statement |
| |
-
Advertising Certification required under Maine Rule
140 §11(B): Karma Lombard, (207) 624-8540, Send
certificates electronically to karma.y.lombard@maine.gov. Applies to all companies writing Health.
http://www.maine.gov/sos/cec/rules/02/031/031c140.doc
-
Annual Report Supplement (Rule 945) : Marti Hooper (207) 624-8449, electronically to mary.m.hooper@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.
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)}: Marti Hooper (207) 624-8449, electronically to mary.m.hooper@maine.gov
All insurance carriers with a HEALTH authority must file with
the Superintendent of the Maine Bureau of Insurance by February
1st.
Carrier self-funded ERISA claims reporting by plan sponsor.
http://www.maine.gov/pfr/insurance/forms/word/Carrier_Reporting_Form.doc (Microsoft Word)
http://www.maine.gov/pfr/insurance/forms/pdf/Carrier_Reporting_Form.pdf (Adobe Acrobat)
-
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): Marti Hooper (207) 624-8449, electronically to mary.m.hooper@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.
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, electronically to thomas.r.michaud@maine.gov Applies to all Property and Casualty companies.
Liquor Liability Form: http://www.maine.gov/pfr/insurance/forms/word/liquor.doc (Word) http://www.maine.gov/pfr/insurance/forms/pdf/liquor.pdf (PDF)
-
Maine Fraud and Abuse Annual Report: Kelly
E. Rogers (207) 624-8438, electronically to kelly.e.rogers@maine.gov Applies to all companies and Electronic Submissions are Encouraged.
Maine Fraud and Abuse Annual Report Form: http://www.maine.gov/pfr/insurance/forms/fraud_report_instructions.htm
-
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: 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 30th.
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
-
Supplemental Compensation Exhibit: Tracy
Cunningham (207) 624-8436 tracy.a.cunningham@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.
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
-
Workers Compensation Benefits Report: Thomas
Michaud (207) 624-8440, electronically to thomas.r.michaud@maine.gov Applies to all companies writing workers' compensation.
Workers Compensation Paid Benefits Report Form: http://www.maine.gov/pfr/insurance/forms/word/wcbeneft.doc
http://www.maine.gov/pfr/insurance/forms/pdf/wcbeneft.pdf
|