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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. In addition, forms and instructions are provided below for annual reports due to the bureau.

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

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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
  • Carrier Report -- Health Claims Paid by Plan Sponsor
  • 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 Insurance Annual Data Report (Rule 940)
  • Health Report Card Survey - Word or Adobe PDF
  • Liquor Liability Form - Online Reporting Form
  • Long-Term Care Insurance Reporting (Rule 425)
  • Maine Annual Report Supplement (Rule 945)
    • Rule Chapter 945 - Current rule is undergoing revision
    • 945 Short Form - Completed by companies with less than $5 million in direct written Health insurance premium for major medical and stop loss combined - Excel
    • 945 Short Form Instructions - For companies completing the 945 Short Form - PDF
    • 945 Long Form - Completed by companies with $5 million or more in direct written Health insurance premium for major medical and stop loss combined - Check back for link to revised form
    • 945 Long Form Instructions - For companies completing the 945 Long Form - Check back for link to revised instructions
    • 945 Long Form Edit Checks - For companies completing the 945 Long Form- Check back for link to revised edit checks
  • Mandated Benefits
  • Medical Malpractice Liability Claim Report
  • Service of Process - Adobe PDF
  • Supplemental Health Insurance Reporting Form - 286-A
  • Tick Borne Disease Report
  • Workers' Compensation Insurance Market Survey
  • Workers' Compensation Paid Benefits Report
  • Viatical and Life Settlement Provider

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: October 21, 2014