-
Advertising Certification required under Maine Rule
140 §11(B): Lisa Lewis, (207) 624-8417, electronically to lisa.a.lewis@maine.gov. Applies to all companies writing Health.
http://www.maine.gov/sos/cec/rules/02/031/031c140.doc
-
Annual Report Supplement (Rule 945) : Marti Hooper (207) 624-8449, electronically to mary.m.hooper@maine.gov Applies to all companies writing or renewing medical or stop loss health insurance. NULL reports need not be submitted. Due Date is March 1st.
The Bureau is planning to collect data for these reports directly through a new web-based data entry program. The new program has not been finalized at this time. Please check our website before completing this report for updated instructions or check with the listed contact person. The following links are provided as an example of the data required to be filed.
Rule 945 Reporting Forms:
http://www.maine.gov/pfr/insurance/forms/excel/Rule945.xls - for companies with $2 million or more in premium
http://www.maine.gov/pfr/insurance/forms/excel/Rule945_short.xls - for companies with less than $2 million in premium
-
Carrier Reporting Form (formally the Administrative
Services Only Claims Report) {24-A M.R.S.A. § 4302(4)}: Marti Hooper (207) 624-8449, electronically to mary.m.hooper@maine.gov
All insurance carriers with a HEALTH authority must file with
the Superintendent of the Maine Bureau of Insurance by February
1st.
The Bureau is planning to collect data for these reports directly through a new web-based data entry program. The new program has not been finalized at this time. Please check our website before completing this report for updated instructions or check with the listed contact person. The following links are provided as an example of the data required to be filed.
Carrier self-funded ERISA claims reporting by plan sponsor.
http://www.maine.gov/pfr/insurance/forms/word/Carrier_Reporting_Form.doc (Microsoft Word)
http://www.maine.gov/pfr/insurance/forms/pdf/Carrier_Reporting_Form.pdf (Adobe Acrobat)
- Consumer Complaint Contact Update
For Life/Accident/Health/Annuity/Credit Insurance, contact Lisa Lewis at (207)624-8417 or by email at lisa.a.lewis@maine.gov
For Property/Casualty Insurer, contact Cynthia Willey at (207)624-8423 or by email at cynthia.l.willey@maine.gov
Applies to all Property/Casualty, Life, Accident, Health, Annuity and Credit Insurers.
http://www.maine.gov/pfr/insurance/forms/word/CompanyComplaintContact.doc (Word)
http://www.maine.gov/pfr/insurance/forms/pdf/CompanyComplaintContact.pdf (PDF)
-
Downstream Risk Arrangement Disclosure required under
§4336 B(2): Kendra L. Godbout, (207) 684-8495,
electronically at kendra.l.godbout@maine.gov Applies to Health Maintenance Organizations.
-
Filing Fees: Ingrid Garand (207) 624-8465 ingrid.e.garand@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): Marti Hooper (207) 624-8449, electronically to mary.m.hooper@maine.gov Applies to all companies writing or renewing small group or individual Medical Insurance. Null reports need not be submitted. Due Date is April 30th.
The Bureau is planning to collect data for these reports directly through a new web-based data entry program. The new program has not been finalized at this time. Please check our website before completing this report for updated instructions or check with the listed contact person. The following links are provided as an example of the data required to be filed.
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, electronically to joanne.rawlings-sekunda@maine.gov Applies to all companies with enrollees in health
insurance at any point during 2007.
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)
-
Liquor Liability Report: Thomas Michaud
(207) 624-8440, electronically to thomas.r.michaud@maine.gov Applies to all Property and Casualty companies.
The Bureau is planning to collect data for these reports directly through a new web-based data entry program. The new program has not been finalized at this time. Please check our website before completing this report for updated instructions or check with the listed contact person. The following links are provided as an example of the data required to be filed.
Liquor Liability Form: http://www.maine.gov/pfr/insurance/forms/word/liquor.doc (Word) http://www.maine.gov/pfr/insurance/forms/pdf/liquor.pdf (PDF)
-
Maine Fraud and Abuse Annual Report: Kelly
E. Rogers (207) 624-8438, electronically to kelly.e.rogers@maine.gov Applies to all companies and Electronic Submissions are Encouraged.
The Bureau is planning to collect data for these reports directly through a new web-based data entry program. The new program has not been finalized at this time. Please check our website before completing this report for updated instructions or check with the listed contact person. The following links are provided as an example of the data required to be filed.
Maine Fraud and Abuse Annual Report Form: http://www.maine.gov/pfr/insurance/forms/fraud_report_instructions.htm
-
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: Marti Hooper (207) 624-8449, electronically to mary.m.hooper@maine.gov Applies to all companies writing or renewing Health. NULL reports need not be submitted. Due Date is April 30th.
The Bureau is planning to collect data for these reports directly through a new web-based data entry program. The new program has not been finalized at this time. Please check our website before completing this report for updated instructions or check with the listed contact person. The following links are provided as an example of the data required to be filed.
Mandated Benefit Experience Reporting Form:
http://www.maine.gov/pfr/insurance/forms/excel/mandated_benefits.xls
Mandated Benefit Experience Bulletin: http://www.maine.gov/pfr/insurance/bulletins/292.htm
- 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
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 Godbout at (207)-624-8495 or electronically to kendra.l.godbout@maine.gov
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: Lauri Cooper (207) 624-8464, electronically to laurelyn.s.cooper@maine.gov
Due March 1st. Forms can be sent with the Annual Statement or separately.
-
Supplemental Health Insurance Report: Marti Hooper (207) 624-8449, electronically to mary.m.hooper@maine.gov Applies to all companies writing or renewing Health.
NULL reports need not be submitted. Due Date is April 1st.
The Bureau is planning to collect data for these reports directly through a new web-based data entry program. The new program has not been finalized at this time. Please check our website before completing this report for updated instructions or check with the listed contact person. The following links are provided as an example of the data required to be filed.
Supplemental Health Reporting Form:
http://www.maine.gov/pfr/insurance/forms/excel/SuppHealthPremiumForm.xls
Supplemental Health Bulletin: http://www.maine.gov/pfr/insurance/bulletins/286a.htm
-
Workers Compensation Benefits Report: Thomas
Michaud (207) 624-8440, electronically to thomas.r.michaud@maine.gov Applies to all companies writing workers' compensation.
The Bureau is planning to collect data for these reports directly through a new web-based data entry program. The new program has not been finalized at this time. Please check our website before completing this report for updated instructions or check with the listed contact person. The following links are provided as an example of the data required to be filed.
Workers Compensation Paid Benefits Report Form: http://www.maine.gov/pfr/insurance/forms/word/wcbeneft.doc
http://www.maine.gov/pfr/insurance/forms/pdf/wcbeneft.pdf