Official Government Website

Reporting & Checklists

Annual, Quarterly and Financial Filing Requirement Checklists:

Holding Company Forms (Form A through F). Attachments to IDAPA 18.07.01

  • Form A– Acquisition of Control or Merger with Domestic Insurer
  • Form B – Insurance Holding Company System Annual Registration
  • Form C – Summary of Registration Statement
  • Form D – Prior Notice of a Transaction
  • Form E – Pre-Acquisition Notification and Impact of Merger/Acquisition with Non-Domiciliary Insurer
  • Form F – Enterprise Risk Report

Biographical Affidavit and Third Party Verifications

For insurer notifications regarding changes and appointments of Directors, Officers, or Key Managers, the NAIC Biographical Affidavit form and resources for third party verification services are available here:

Surveys and Reports

We have made the required Health Forms, the Assessment Survey, the Health Insurance Survey, and the Self-Funded Health Plan Survey electronic in the hopes of making the process easier for Carriers and TPA’s.

If you have any questions please feel free to email us.

Surveys and reporting available from this page:

  • Immunization Assessment Survey – Due March 15
  • Rescission Reporting for Long-Term Care Policies – Due March 1
  • Reporting Medicare Supplement Policies – Due March 1
  • Medicare Supplement Refund Calculation Form – Due May 31
  • Assessment Survey – Required for all Licensed Accident and Health Disability Insurers – Due March 1
  • Health Survey (Carriers AND TPAs) – Open March 1, Due May 1 Instructions for 2023 Health Survey Instructions and 2023 Self-Funded Survey Instructions
  • Long-Term Care Suitability of Sale – Due May 31
  • Replacement and Lapse Reporting for Long-Term Care Insurance – Due June 30
  • Claims Denial Reporting for Long-Term Care Insurance – Due June 30

Other Tools & Entity Types with Forms or Checklists

Have more questions?

Contact the Company Activities team:

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