Skip Maine state header navigation

Agencies | Online Services | Help

Skip First Level Navigation | Skip All Navigation

Maine.gov > PFR Home > Insurance Regulation > Company Information > Forms

Forms & Information

The Bureau of Insurance makes available forms and information to help companies become licensed in Maine and to help already licensed companies to keep their license current.

On this page: Captives | Port of Entry | Certificate of Authority | Reinsurer of Work Comp | Company Reporting Requirements | Status Change Forms | Credit for Reinsurance | Surplus Lines Company

Get the Adobe Acrobat Reader to access PDF files.

Company Reporting Requirements

  • Address Change Form - Word or Adobe PDF

    Electronic Address Submission Now Available: ALMSOnline - This is an internal application that allows the licensee to submit an address change to Maine only.

  • Assumption Reinsurance Transactions - Word or Adobe PDF
  • Billing
  • Consumer Complaint Contact - Word or Adobe PDF
  • Credit Disability Insurance Experience Report - Excel
  • Credit Life Insurance Summary Report - Excel
  • Fraud and Abuse Annual Report
  • Health Claims Not Paid within 90 Days
  • Health Claims Paid by Plan Sponsor - Reported by Carrier (Carrier Reporting Form)
  • Health Insurance Annual Data Report (Rule 940) - Excel
  • Health Report Card Survey - Word or Adobe PDF
  • Liquor Liability Form - Word or Adobe PDF
  • Maine Annual Report Supplement (Rule 945)
    • For those companies required to complete the Long Form, we have developed a comparison spreadsheet which can be used to assist you in accurately completing the form. It is NOT necessary to submit the comparison spreadsheet. It is only intended to assist you in completing the 945 Report.
      Maine Annual Report Supplement (Rule 945) Long Form Comparison - Excel
    • Maine Annual Report Supplement (Rule 945) - to be filled out by companies with $2 million or more in premium - Excel
    • Maine Annual Report Supplement Short Form (Rule 945) - to be filled out by companies with less than $2 million in premium - Excel
  • Mandated Benefits
  • Medical Malpractice Liability Claim Report
  • Service of Process - Word or Adobe PDF
  • Supplemental Health Insurance Reporting Form - Bulletin 286-A - Excel or Adobe PDF
  • Workers' Compensation Paid Benefits Report - Word or Adobe PDF

Status Change Forms - Name Change, Merger, Redomestication, Etc.

Captive Insurance Companies

Certificate of Authority

Credit for Reinsurance - Rule 740

A list of Maine cedants is required, along with a certified copy of the current year annual statement.

Port of Entry

An alien insurer that has been authorized by the superintendent to use the State as its port of entry for the transaction of business in the United States is considered a domestic insurer to the extent provided in the statute. A rule has also been established that provides additional information.

Reinsurer of Workers' Compensation Self-Insurance - Rule 730

Surplus Lines Company Eligibility

 

Last Updated: July 16, 2008