Skip Maine state header navigation

Agencies | Online Services | Help

Skip First Level Navigation | Skip All Navigation

Maine.gov > PFR Home > Insurance Regulation > Company Services > Annual Statement Filing Notes & Instructions

Annual Statement Filing Notes & Instructions

A

Required Filings Contact Person:

Annual & Quarterly Statements: 
Foreign Companies: Andrew R. Perry  207-624-8489  Andrew.R.Perry@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

USPS Express overnight deliveries
Maine Bureau of Insurance
Financial Analysis Division
34 State House Station
Augusta, ME 04333-0034

Deliveries such as FedEx and UPS
Maine Bureau of Insurance
Financial Analysis Division
76 Northern Ave.
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.

D

Contact Information for Exam Fees:

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

E

Mailing Address & Contact for Premium Tax Payments, Questions & Forms:

If enclosing a check, make check payable to Treasurer, State of Maine and MAIL WITH RETURN TO: Maine Revenue Services, PO Box 1065, Augusta, ME 04332-1065.

If NOT enclosing a check, MAIL RETURN TO: Maine Revenue Services, PO Box 1064, Augusta, ME  04332-1064.

Phone: 207-624-9753 e-mail:  corporate.tax@maine.gov or  Carlotta Larrabee 207-626-8538. http://www.maine.gov/revenue/forms/insurance/2014.htm

F

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.

G

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.

H

Original Signatures:

Original signatures required on all filings from Domestic Companies.  Foreign companies should follow the instructions in the NAIC Annual Statement instructions.

I

Signature/Notarization/Certification:

The following officers are required to sign the annual statement: CEO, President, & Treasurer for domestic companies. 

J

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.  Maine is a Retaliatory State. If the foreign domestic state charges a fee, the greater amount is required.

K

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.

L

Bar Codes (State or NAIC)

Not Used

M

Signed Jurat

Signed Jurat pages are NOT required for foreign or alien insurers.  They are required for domestic insurers.

N

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.

O

Filings new, discontinued, modified since last year:

None

P

Required by the State of Maine

Should be filed separately from the annual statement:

  • Advertising Certification required under Maine Rule 140 §11(B):  Sarah Hewett, 207-624-8412, submit electronically to Sarah.Hewett@maine.gov.

 Applies ONLY to companies writing health insurance that also disseminates advertisements for health insurance during the preceding statement year. http://www.maine.gov/sos/cec/rules/02/031/031c140.doc

  • Annual Report Supplement (Rule 945):  For information about completing the form, contact Bradford Brown at 207-624-8478 or Bradford.L.Brown@maine.gov. Applies to all health insurers and HMOs writing or renewing health insurance coverage.  Companies with no written health premium should fill in only the company and contact information at the top of the form and then 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

  • Long-Term Care Report required under Maine Rule 425:  For information about completing the form,

     contact Sandra Darby at 207-624-8428 or Sandra.C.Darby@maine.gov Applies to all individual and group long-term
     care insurance policies; and to long-term care insurance group certificates. The reporting applies to any such
     instrument delivered or issued for delivery in this state on and after 7/1/2004. Companies having active Health          
     authority in Maine will receive notice to complete the report. Companies with no in-force policies must complete the 
     company and contact information, indicate that they had no policies in-force and return the report. Companies with
     in force policies must complete the entire report. Due Date is June 30th. The rule is currently being reviewed, it should
     be finalized in 2014.The following link provides access to the forms, instructions and the law:
     http://www.maine.gov/pfr/insurance/forms/index.htm . Scroll down to Long-Term Care Insurance Reporting (Rule
    Chapter 425).

     Carrier Reporting Form {24-A M.R.S.A. § 4302(4)}: Contact Bradford Brown, 207-624-8478 or by email at
     Bradford.L.Brown@maine.gov.  All insurance companies having active Health insurance authority in
    Maine at any time during the prior calendar year must complete the form. Due Date is February 1st.

Instructions: http://www.maine.gov/pfr/insurance/forms/index.htm. Scroll down to Carrier Report – Health Claims Paid by Plan Sponsor
Form: https://www.pfr.maine.gov/Insurance/Filing.aspx. 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: to request a Certificate of Deposit from Maine please contact the State Treasurers office. www.maine.gov/treasurer  Not required from Foreign Companies.
  • Consumer Complaint Contact Update:  Applies to all Property/Casualty, Life, Accident, Health, Annuity and Credit Insurers. Property/Casualty -submit annually, all others, submit only if the information has changed since your last submission.

For Life/Accident/Health/Annuity/Credit Insurance, contact Sarah Hewett at 207-624-8412 or by email at Sarah.Hewett@maine.gov
For Property/Casualty Insurers, contact Cynthia Willey at 207-624-8423 or by email at Cynthia.L.Willey@maine.gov
Forms:  http://www.maine.gov/pfr/insurance/forms/word/CompanyComplaintContact.docWord) or
http://www.maine.gov/pfr/insurance/forms/pdf/CompanyComplaintContact.pdf (PDF)

  • Downstream Risk Arrangement Disclosure required {24-A M.R.S.A. §4336 B(2)}:  Kendra L. Coates, 207-624-8495, or by email at Kendra.L.Coates@maine.gov  Applies to Health Maintenance Organizations.

 

  • Filing Fees: Ann Tarr, 207-624-8434 or by email at Ann.Tarr@maine.gov   Fees will be billed on or before July 1st of each year. DO NOT send fees at this time.
  • 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. 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

  • Health Report Card Survey: Joanne Rawlings-Sekunda, 207-624-8472, or by email at

Joanne.Rawlings-Sekunda@maine.gov   Applies to all companies with Maine enrollees in health insurance at any point during 2014

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)

  • Life Insurance Illustration Certifications required under Maine Rule 910 (11):  Sarah Hewett, 207-624-8412, or by email at Sarah.Hewett@maine.gov. All group and individual life insurance policies and certificates, except variable life; individual and group annuity contracts; credit life insurance; or life insurance policies with no illustrated death benefits on any individual exceeding $10,000. http://www.maine.gov/sos/cec/rules/02/031/031c910.doc

 

  • Liquor Liability Report:  

Contact: Barbra Garboski, 207-624-8440 or by email at Barbra.L.Garboski@maine.gov.
All Property and Casualty companies. Due Date March 1st.

Instructions: http://www.maine.gov/pfr/insurance/forms/index.htm. Scroll down to Liquor Liability Form.
Form: https://www.pfr.maine.gov/Insurance/Filing.aspx. Data is reported using an online, web-based data entry program. Have your license number and access code ready to enter.

  • Maine Fraud and Abuse Annual Report {24-A M.R.S.A. § 2186(4)}: 

Contact Kelly Rogers, 207-624-8438 or by email at Kelly.E.Rogers@maine.gov or contact Barbra Garboski, 207-624-8440 or by email at Barbra.L.Garboski@maine.gov. All active insurance companies in Maine at any time during the prior calendar year must complete the form. Due Date is March 1st.

Instructions: http://www.maine.gov/pfr/insurance/forms/index.htm. Scroll down to Fraud and Abuse Annual Report.
Form: https://www.pfr.maine.gov/Insurance/Filing.aspx. Data is reported using an online, web-based data entry
program. Have your license number and access code ready to enter.

  • Managing General Agent Report:  Andrew R. Perry, 207-624-8489 or by email to Andrew.R.Perry@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:  For information about completing the form, contact Bradford Brown, 207-624-8478 or by email at Bradford.L.Brown@maine.gov.  All insurance companies having active Health insurance authority in Maine at any time during the prior calendar year must complete the form. Due Date is April 30th.  

Instructions: http://www.maine.gov/pfr/insurance/forms/index.htm. Scroll down to Mandated Benefits.
Form: https://www.pfr.maine.gov/Insurance/Filing.aspx. Data is reported using an online, web-based data entry program. Have your license number and access code ready to enter.

  • Medical Loss Ratio Reporting and Rebates {24-A M.R.S.A. §4319 and Rule 940, Sec 13}: Contact Marti Hooper, 207-624-8449 or by email at Mary.M.Hooper@maine.gov All health carriers in the large group, small group, and individual markets to the extent required by the federal Affordable Care Act.  All reporting forms relating to MLR and rebates under the ACA that are required to be filed with the U.S. Department of Health and Human Services must be submitted to the Superintendent on or before the earlier of the date the forms are filed with the U.S. DHHS under the ACA. Due Date is June 1st.

     http://www.mainelegislature.org/legis/statutes/24-A/title24-Asec4319.html
    http://www.maine.gov/sos/cec/rules/02/031/031c940.doc

  • Preferred Provider Arrangement Annual Registration: Joanne Rawlings-Sekunda, 207-624-8472, -- due March 1 annually-- 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 Coates at 207-624-8495 or by email at Kendra.L.Coates@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 Coates at 207-624-8495 or by email at Kendra.L.Coates@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 or by email at  Nichole.L.Bilodeau@maine.gov Due March 1st.  Forms can be sent with the Annual Statement or separately. Applies to domestic companies only.

 

  • 286-A Supplemental Health Insurance Report (Bulletin 286-A):

Contact Bradford Brown at 207-624-8478 or by email at Bradford.L.Brown@maine.gov.  All insurance companies having active Health insurance authority in Maine at any time during the prior calendar year must complete the form. Due Date is April 1st.

Instructions: http://www.maine.gov/pfr/insurance/forms/index.htm. Scroll down to Supplemental Health Insurance Reporting Form – 286-A
Form: https://www.pfr.maine.gov/Insurance/Filing.aspx. Data is reported using an online, web-based data entry program. Have your license number and access code ready to enter.

  • Tick Borne Disease Report {24-A M.R.S.A. § 4302(5)}: 

Contact Barbra Garboski, 207-624-8440 or by email at Barbra.L.Garboski@maine.gov. Applies to all Health insurance companies. Due Date is February 1st.

Instructions: http://www.maine.gov/pfr/insurance/forms/index.htm. Scroll down to Tick Borne Disease Report
Form: https://www.pfr.maine.gov/Insurance/Filing.aspx.  Data is reported using an online, web-based data entry program. Have your license number and access code ready to enter.

    • Workers Compensation Paid Benefits Report {26 M.R.S.A. § 61}: 

Contact Barbra Garboski, 207-624-8440 or by email at Barbra.L.Garboski@maine.gov
All companies writing workers' compensation insurance must complete the form. Due Date is March 1st.

Instructions: http://www.maine.gov/pfr/insurance/forms/index.htm. Scroll down to Workers Compensation Paid Benefits Report.
Form: https://www.pfr.maine.gov/Insurance/Filing.aspx . Data is reported using an online, web-based data entry program. Have your license number and access code ready to enter.

 

 

Last Updated: May 9, 2014