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Annual Statement Filing Notes & Instructions

NOTES AND INSTRUCTIONS (A-K APPLY TO ALL FILINGS)
A Required Filings Contact Person:

Annual and Quarterly Statements:
Foreign Companies: Barbra Garboski 207-624-8489 Barbra.L.Garboski@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 Avenue
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: Maine Revenue Services, PO Box 9120, Augusta, ME 04333-9120, Phone: Carlotta Larrabee 207-626-8538.
http://www.maine.gov/revenue/forms/insurance/2011.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.
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
 

  • Downstream Risk Arrangement Disclosure required under §4336 B(2): Kendra L. Coates, 207-684-8495, electronically at Kendra.L.Coates@maine.gov Applies to Health Maintenance Organizations.

  • Filing Fees: Brenda Cadwallader 207-624-8434 Brenda.Cadwallader@maine.gov
    Fees will be billed on or before July 1 of each year. DO NOT send fees at this time

  • Health Insurance Annual Data Report (Rule 940): Contact Bradford Brown at 207-624-8478 or electronically at 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 Health insurance premium should complete and submit a null report (with contact information but with data fields left blank). 

    Instructions and Form: The Maine 940 reporting form and instructions are temporarily unavailable. This form might be revised and moved to our online reporting system. Please check the following website at a later date for more information:http://www.maine.gov/pfr/insurance/forms/index.htm. Scroll down to Health Insurance Annual Data Report (Rule 940).

  • Health Report Card Survey: Joanne Rawlings-Sekunda, 207-624-8472, electronically to Joanne.Rawlings-Sekunda@maine.gov Applies to all companies with Maine enrollees in health insurance at any point during 2011.

    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): Lisa Lewis, 207-624-8417, electronically to Lisa.a.lewis@maine.gov. Applies to 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: Bradford Brown 207-624-8478, Bradford.L.Brown@maine.gov.
    Applies to all Property and Casualty companies.

    Form:The Bureau is collecting data for this report directly through a web-based data entry program.  Please click on the following link to access the online reporting system. Have your license number and access code ready to enter.
     https://www.pfr.maine.gov/Insurance/Filing.aspx

  • Maine Fraud and Abuse Annual Report {24-A M.R.S.A. § 2186(4)}: Contact Kelly Rogers at 207-624-8438 or electronically at Kelly.E.Rogers@maine.gov or contact Bradford L. Brown at 207-624-8478, or electronically at Bradford.L.Brown@maine.gov.  Applies to all companies with written premium in Maine during the prior calendar year. The following links provide access to the instructions, online form, and the law:

Instructions: http://www.maine.gov/pfr/insurance/forms/index.htm. Scroll down to Fraud and Abuse Annual Report.
Form: The Bureau is collecting data for this report directly through a web-based data entry program.  Please click on the following link to access the online reporting system. Have your license number and access code ready to enter.
https://www.pfr.maine.gov/Insurance/Filing.aspx.

  • Managing General Agent Report: Barbra Garboski 207-624-8489, electronically to Barbra.L.Garboski@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: Contact Bradford Brown at (207)-624-8478 or electronically at Bradford.L.Brown@maine.gov. Applies to all companies writing or renewing Health insurance coverage. Companies with no written health premium should complete Part A (select and attach a contact) and then scroll to the bottom of the form and click on the Submit button. Due Date is April 30th.

    Instructions: http://www.maine.gov/pfr/insurance/forms/index.htm. Scroll down to Mandated Benefits.
    Form: The Bureau is collecting data for this report directly through a web-based data entry program.  Please click on the following link to access the online reporting system. Have your license number and access code ready to enter.
    https://www.pfr.maine.gov/Insurance/Filing.aspx.

  • 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 Godbout at 207-624-8495 or electronically to Kendra.L.Godbout@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 the three items listed directly above, contact Kendra Godbout at 207-624-8495 or electronically to Kendra.L.Godbout@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, electronically to 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: Contact Bradford Brown at 207-624-8478 or electronically at Bradford.L.Brown@maine.gov. Applies to all companies writing or renewing Health insurance coverage. Companies with no written Health insurance premium should complete and submit a null report (with contact information but with data fields left blank).

    Forms and Instructions: The Maine 286-A Supplemental Health Insurance Report form and instructions are temporarily unavailable. This form will be moved to our online reporting system. Please check the following website at a later date for more information:http://www.maine.gov/pfr/insurance/forms/index.htm. Scroll down to Supplemental Health Insurance Report Form.

  • Tick Borne Disease Report: Contact Bradford Brown 207-624-8478 or electronically 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. Due Date is February 1st.

    Instructions: http://www.maine.gov/pfr/insurance/forms/index.htm. Scroll down to Tick Borne Disease Report
    Form: The Bureau is collecting data for this report directly through a web-based data entry program.  Please click on the following link to access the online reporting system. Have your license number and access code ready to enter.
    https://www.pfr.maine.gov/Insurance/Filing.aspx.

  • Workers Compensation Benefits Report: Bradford Brown 207-624-8478, Bradford.L.Brown@maine.gov.
    Applies to all companies writing workers' compensation.
    Instructions: http://www.maine.gov/pfr/insurance/forms/index.htm. Scroll down to Workers Compensation Paid Benefits Report.
    Form: The Bureau is collecting data for this report directly through a web-based data entry program.  Please click on the following link to access the online reporting system. Have your license number and access code ready to enter.
    https://www.pfr.maine.gov/Insurance/Filing.aspx.

Last Updated: January 24, 2012