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286-A (Supplemental Health Insurance Reporting Form)
940 (Health Insurance Annual Data Report)
945 (Maine Annual Report Supplement)
Short Form - Completed by companies with less than $5 million in direct written Health insurance premium for major medical and stop loss combined Long Form - Completed by companies with $5 million or more in direct written Health insurance premium for major medical and stop loss combined
Aggregate Workers' Compensation Benefits Paid Report
Insurance Carrier Aggregate Benefits Paid Report
- Carrier Workers' Compensation Aggregate Benefits Paid Report Form (XLSX)
- Instructions (PDF)
- Title 26 Chapter 4 §61
- Search for Maine License Number
Self-Insurance Aggregate Benefits Paid Report
- Self-Insurance Aggregate Benefits Paid Report (XLSX)
- Instructions (PDF)
- Title 26 Chapter 4 §61(1-A)
- Search for Maine License Number
Any Willing Pharmacy - Bulletin 377
- Any Willing Pharmacy Requirements (PDF)
- Any Willing Pharmacy Report Form (DOCX)
- Bulletin 377 (PDF)
- Title 24-A Chapter 56-A §4317
- Title 24-A Chapter 32 §2673-A(3)
Carrier Report
Comparable Health Care Service Incentive Program Report
Only carriers offering small group plans compatible with a Health Savings Account should file this report. Notices will be sent to those companies that must file it.
- Comparable Health Care Service Incentive Program Report Form (XLSX)
- Comparable Health Care Service Incentive Program Report Instructions (PDF)
Credit Disability Insurance Experience Report
Credit Life Insurance Summary Report
Cybersecurity Information
Dental Loss Ratios
Only Companies offering a dental plan in effect during the preceding calendar year should file these reports.
Employee Benefit Excess Insurance
Only Companies with written premium for Stop Loss should file this report. Notices will be sent to those companies that must file.
- Employee Benefit Excess Insurance Report Form (XLSX)
- Instructions (PDF)
- Rule 135 (DOCX)
- Title 24-A Chapter 9 §707(3)
Fraud and Abuse Annual Report
- Fraud and Abuse Report Form (XLSX)
- Instructions (PDF)
- Rule 920 (DOCX)
- Title 24-A Chapter 23 §2186
- Search for Maine License Number
Health Plans Providing Prescription Drug Benefits Report
Only carriers that issue health plans with prescription drug benefits need to complete this form.
Health Report Card Survey
Liquor Liability
- Liquor Liability Report Form (XLSX)
- Instructions (PDF)
- Bulletin 149 (PDF)
- Title 28-A Chapter 100 §2517
- Search for Maine License Number
Long-Term Care Insurance Reporting (Rule 425)
- Rule 425 (DOCX)
- Long-Term Care Report Form (XLSX)
- Instructions (PDF)
- Search for Maine License Number
Mandated Benefits
Medical Malpractice Liability Claim Report
NQTL Reporting Requirement - 24-A M.R.S. § 4320-T(4)
- NQTL Report Form (DOCX)
- NQTL Report Form Instructions (PDF)
- Guidance for NQTL Comparative Analyses (PDF)
Physician Tiering
- Physician Performance Measurement, Reporting and Tiering Programs - Registration Form
- Title 24-A §2694-A
Self-Insurance Annual Payroll and WC Aggregate Benefits Paid Reports
Self-Insurance Annual Payroll Report
- Self-Insurance Annual Payroll Report (XLSX)
- Instructions (PDF)
- Title 39-A Chapter 9 §409
- Search for Maine License Number
Self-Insurance Aggregate Benefits Paid Report
- Self-Insurance Aggregate Benefits Paid Report (XLSX)
- Instructions (PDF)
- Title 26 Chapter 4 §61(1-A)
- Search for Maine License Number
Tickborne Disease Report
Title 24-A M.R.S. § 4303-E Report (Denials, Downcoding, Network Data)
Applies only to health carriers with more than 1,000 Maine covered lives as reported in reports required by Rules 940 and 945.
Workers' Compensation Insurance Market Survey
The documents on this page are also available in hard copy by contacting the Bureau.