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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 $5 million or more in direct written health insurance premium in Maine for major medical and stop loss combined must file the Long form. Long form edit checks should be completed before submitting the report. Companies with lower amounts of written premium must file the Short form.Companies with no written health premium in Maine should complete the Short form and 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 link provides access to the 945 forms, instructions and edit checks: http://www.maine.gov/pfr/insurance/forms/index.htm. Scroll down to Maine Annual Report Supplement (Rule 945)

  • 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 form and instructions:
   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)}: For more 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 February 1st.

The following link provides access to the form and instructions: http://www.maine.gov/pfr/insurance/forms/index.htm. Scroll down to Carrier Report – Health Claims Paid by Plan Sponsor. You need to know your license number and access code to complete the report. This will be provided in an e-mail notification.

  • 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 link provides access to the form, instructions and the rule:
   http://www.maine.gov/pfr/insurance/forms/index.htm. Scroll down to Health Insurance Annual Data Report (Rule 940).

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

Applies to all Property and Casualty companies. Due Date March 1st.

The following link provides access to the form, bulletin and law:
   http://www.maine.gov/pfr/insurance/forms/index.htm. Scroll down to Liquor Liability Form. You must have your license number and access code to complete the report. This will be provided in an e-mail notification.

Applies to all active insurance companies in Maine at any time during the prior calendar year must complete the form. Due Date is March 1st.

The following link provides access to the form, instructions and the rule:
   http://www.maine.gov/pfr/insurance/forms/index.htm. Scroll down to Fraud and Abuse Annual Report. You must have your license number and access code to complete the report. This will be provided in an e-mail notification.

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.  

Applies to 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.  

The following link provides access to the form and instructions:
   http://www.maine.gov/pfr/insurance/forms/index.htm. Scroll down to Mandated Benefits.You need your license number and access code to complete the report. This will be provided in an e-mail notification.

  • 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.

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.

Applies to 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.

The following link provides access to the form, instructions, edit checks and bulletin:
   http://www.maine.gov/pfr/insurance/forms/index.htm. Scroll down to Supplemental Health Insurance Report Form - 286-A. You must have your license number and access code to complete the report. This will be provided in an e-mail notification.

  • 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.

The following link provides access to the form, bulletin and law:
   http://www.maine.gov/pfr/insurance/forms/index.htm. Scroll down to Tick Borne Disease Report. You must have your license number and access code to complete the report. This will be provided in an e-mail notification.

    • 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

Applies to all companies writing workers' compensation insurance must complete the form. Due Date is March 1st.

The following link provides access to the form and instructions:
   http://www.maine.gov/pfr/insurance/forms/index.htm. Scroll down to Workers' Compensation Paid Benefits Report. You must have your license number and access code to complete the report. This will be provided in an e-mail notification.

 

 

 

Last Updated: November 5, 2014