HEALTH ORGANIZATIONS
REQUIRED FILINGS IN
NOTICE: THE FOLLOWING REPRESENTS, IN GENERAL, THE ANNUAL
RENEWAL
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(1) Check-list |
(2) Line # |
(3)
REQUIRED FILINGS FOR THE ABOVE STATE |
(4) NUMBER OF COPIES |
(5)
DUE DATE |
(6) FORM SOURCE |
(7) APPLICABLE NOTES |
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Domestic |
Foreign |
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State |
NAIC |
State |
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I. NAIC FINANCIAL STATEMENTS |
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1 |
1 |
EO |
See Note O |
3/1 |
NAIC |
A,B,E,F,G,H,I,J,K,M,O |
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1.1 |
Printed Investment Schedule detail (Pages E01 - E27) |
1 |
EO |
See Note O |
3/1 |
NAIC |
A,B,E,F,J,K,M,O |
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2 |
Quarterly Financial Statement (8½ "x14") |
1 |
EO |
See Note O |
5/15, 8/15, 11/15 |
NAIC |
A,B,E,F,G,H,I,J,K,O |
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II. NAIC SUPPLEMENTS |
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10 |
Accident & Health Policy
Experience Exhibit |
1 |
EO |
See Note O |
4/1 |
NAIC |
A,B,E,F,J,K,M,O,P |
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11 |
1 |
EO |
See Note O |
3/1 |
Company |
A,B,E,F,G,I,J,K,O,P |
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12 |
Health Care Exhibit (Parts 1,2 and 3) Supplement |
1 |
EO |
See Note O |
4/1 |
NAIC |
A,B,E,F,J,K,M,O,P |
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13 |
Health Care Exhibit's Allocation Report Supplement |
1 |
EO |
See Note O |
4/1 |
NAIC |
A,B,E,F,J,K,M,O,P |
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14 |
Investment Risks Interrogatories |
1 |
EO |
See Note O |
4/1 |
NAIC |
A,B,E,F,J,K,M,O,P |
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15 |
1 |
EO |
See Note O |
3/1 |
NAIC |
A,B,E,F,J,K,M,O,P |
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16 |
Life Supp Statement Non-Guaranteed Elements - Exh.5, Int. #3 |
1 |
EO |
See Note O |
3/1 |
Company |
A,B,E,F,J,K,M,O |
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17 |
Life Supp Statement On Par/Non Par Policies - Exh.5, Int. #1 & 2 |
1 |
EO |
See Note O |
3/1 |
Company |
A,B,E,F,J,K,M,O |
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18 |
Life Supplement Data due April 1 |
1 |
EO |
See Note O |
4/1 |
NAIC |
A,B,E,F,J,K,M,O,P |
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19 |
Long-Term Care Experience Reporting Forms |
1 |
EO |
See Note O |
4/1 |
NAIC |
A,B,E,F,J,K,M,O,P |
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20 |
1 |
EO |
See Note O |
4/1 |
Company |
A,B,E,F,J,K,O,P |
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21 |
Medicare Supplement Insurance Experience Exhibit |
1 |
EO |
See Note O |
3/1 |
NAIC |
A,B,E,F,J,K,M,O,P |
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22 |
Medicare Part D Coverage
Supplement |
1 |
EO |
See Note O |
3/1, 5/15, 8/15, 11/15 |
NAIC |
A,B,E,F,J,K,M,O |
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23 |
1 |
EO |
See Note O |
3/1 |
NAIC |
A,B,E,F,J,K,M,O,P |
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24 |
Property/Casualty Supplement due April 1 |
1 |
EO |
See Note O |
4/1 |
NAIC |
A,B,E,F,J,K,M,O,P |
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25 |
1 |
EO |
N/A |
3/1 |
NAIC |
A,B,E,F,G,J,K,P |
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26 |
Schedule SIS |
1 |
N/A |
N/A |
3/1 |
NAIC |
A,B,E,F,J,K,M,P |
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27 |
Supplemental Compensation Exhibit |
1 |
N/A |
N/A |
3/1 |
NAIC |
A,B,E,F,J,K,P |
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III ELECTRONIC FILING REQUIREMENTS |
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50 |
Annual Statement Electronic Filing |
N/A |
1 |
N/A |
3/1 |
NAIC |
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51 |
March .PDF Filing |
N/A |
1 |
N/A |
3/1 |
NAIC |
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52 |
Risk-Based Capital Electronic Filing |
N/A |
1 |
N/A |
3/1 |
NAIC |
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53 |
Risk-Based Capital .PDF Filing |
N/A |
1 |
N/A |
3/1 |
NAIC |
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54 |
Supplemental Electronic Filing |
N/A |
1 |
N/A |
4/1 |
NAIC |
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55 |
Supplemental .PDF Filing |
N/A |
1 |
N/A |
4/1 |
NAIC |
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56 |
Quarterly Statement Electronic Filing |
N/A |
1 |
N/A |
5/15, 8/15, 11/15 |
NAIC |
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57 |
Quarterly .PDF Filing |
N/A |
1 |
N/A |
5/15, 8/15, 11/15 |
NAIC |
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58 |
June .PDF Filing |
N/A |
1 |
N/A |
6/1 |
NAIC |
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IV. AUDITED FINANCIAL STATEMENTS |
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71 |
1 |
EO |
See Note N |
6/1 or 6/30 |
Company |
A,B,E,F,J,O,P |
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72 |
1 |
EO |
See Note O |
6/1 or 6/30 |
Company |
A,B,E,F,J,K,O,P |
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73 |
1 |
N/A |
1 |
3/1 |
State |
A,B,E,F,J,O |
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74 |
Communication of Internal Control Related Matters Noted in Audit |
1 |
N/A |
1 |
within 60 days of filing the annual Audited Financial Report |
Company |
A,B,E,F,J,K,M,O,P |
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75 |
Independent CPA (Change) |
1 |
N/A |
1 |
Within 5 business days of change |
Company |
A,B,E,F,J,O |
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76 |
Management's Report of Internal Control Over Financial Reporting |
1 |
N/A |
N/A |
within 60 days of filing the annual Audited Financial Report |
Company |
A,B,E,F,J,K,M,N,O,P |
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77 |
Notification of Adverse Financial Condition |
1 |
N/A |
1 |
Within 5 business days of receipt |
Company |
A,B,E,F,O |
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78 |
Request for Exemption to File |
See Line 73 |
N/A |
See Line 73 |
3/1 |
Company |
A,B,E,F,J,O |
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79 |
Relief from the five-year rotation requirement for lead audit partner |
1 |
EO |
1 |
3/1 |
Company |
A,B,E,F,J,O |
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80 |
Relief from the one-year cooling off period for independent CPA |
1 |
EO |
1 |
3/1 |
Company |
A,B,E,F,J,O |
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81 |
Relief from the Requirements for Audit Committee |
1 |
EO |
1 |
3/1 |
Company |
A,B,E,F,J,O |
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V. STATE REQUIRED FILINGS |
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101 |
Filings Checklist (with Column 1 completed) |
N/A |
N/A |
N/A |
3/1 |
State |
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XXXX |
102 |
State Filing Fees |
N/A |
N/A |
N/A |
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XXXX |
103 |
Signed Jurat |
N/A |
N/A |
N/A |
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L |
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104 |
1 |
N/A |
N/A |
3/15 |
Company |
A,B,E,F,J,P |
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105 |
1 |
N/A |
N/A |
3/1, 5/15, 8/15, 11/15 |
State |
A,B,E,F,J,P |
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106 |
1 |
N/A |
1 |
3/1 |
State |
A,B,E,F,J,O,P |
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107 |
N/A |
N/A |
1 |
3/1 |
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A,B,E,F,J,O,P |
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108 |
Costs of HMO's Indemnification and Nonparticipating Referral Provider Arrangements |
1 |
N/A |
1 |
3/1, 5/15, 8/15, 11/15 |
State |
A,B,E,F,J,P |
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109 |
1 |
N/A |
N/A |
4/30 |
Company |
A,B,E,F,J,P |
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110 |
Managed Care Health Insurance Plan ("MCHIP") Description of Virginia Operations |
1 |
N/A |
1 |
3/1 |
Company |
A,B,E,F,J,O,P |
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111 |
Managed Care Health Insurance Plan ("MCHIP")
List of Providers |
1 |
N/A |
1 |
3/1 |
Company |
A,B,E,F,J,O |
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112 |
1 |
N/A |
1 |
6/1 |
Company |
A,B,E,F,J,P |
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113 |
Premium Tax/Assessments Filings: SEPARATE FILING - DIFFERENT ADDRESS |
1 |
N/A |
1 |
3/1 |
State |
See Note D |
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114 |
1 |
N/A |
See Note N |
3/1 |
Company |
A,B,E,F,N,O,P |
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115 |
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1 |
N/A |
N/A |
3/1 |
State |
A,B,E,F,J,P |
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116 |
1 |
N/A |
N/A |
3/1 |
State |
A,B,E,F,J,P |
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117 |
1 |
N/A |
1 |
3/1 |
State |
A,B,E,F,J,P |
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118 |
1 |
N/A |
1 |
3/1, 5/15, 8/15, 11/15 |
State |
A,B,E,F,J,P |
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NOTES AND INSTRUCTIONS (A-K APPLY TO ALL FILINGS) |
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A |
Required Filings Contact Person:
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B |
Annual Renewal and Related Filings Mailing Address: State Corporation Commission Financial Regulation Division P.O. Box 1157 Richmond, VA 23218
NEW THIS YEAR: We have a portal which will allow the electronic submission of many of these required documents at
Annual License Renewal and Financial Filing Submission Portal.
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Annual Renewal and Related Filings Courier Delivery: State Corporation Commission 1st Floor Mailroom 1300 East Main Street Richmond, VA 23219 |
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C |
Mailing Address for Filing Fees: |
N/A |
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D |
Information for Premium Tax/Assessments Filings: www.scc.virginia.gov/boi/co/tax/filing.aspx The tax packet is a SEPARATE filing and SHOULD NOT be submitted with the Annual Statement and its related filings.
Premium Tax/Assessment Filings Mailing Address: Wells Fargo/State Corporation Commission TAA Insurance 2 P.O. Box 759064 Baltimore, MD 21275-9064 |
Contact Administrative Tax Division, 804-371-9096 , with any questions.
Premium Tax Packet Courier Delivery: Wells Fargo/State Corporation Commission TAA Insurance 2 Lockbox 759064 7175 Columbia Gateway Drive Columbia, MD 21046 |
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E |
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 postmark deadline is extended to the next business day. |
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F |
Late Filings:
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Late filings are subject to penalties pursuant to § 38.2-218 of the Code of Virginia. |
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G |
Original Signatures:
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A printer's reproduction of "live" signatures is acceptable. |
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H |
Signature/Notarization/Certification:
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Statements must be signed by at least two principal officers of the company. |
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I |
Amended Filings:
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Any signature requirements for the original filing must be followed for amendments. |
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J |
Exceptions from normal filings:
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Exemptions or extensions are not automatically granted to any company. Requests must be made prior to the filing due date. |
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K |
Bar Codes (State or NAIC): |
NAIC Annual Statement Instructions should be followed. |
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L |
Signed Jurat: |
N/A |
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M |
NONE Filings: |
NAIC Annual Statement Instructions for Supplemental Interrogatories should be followed. |
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N |
Filings new, discontinued or modified materially since last year: |
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O |
Foreign Company Filing Requirements:
All foreign companies and accredited reinsurers, excluding Health Maintenance Organizations (HMOs) and Dental Plan Organizations (DPOs), that file their NAIC annual statement blank, annual audited finanical reports, quarterly financial statements and any supplements related to these documents with the NAIC are exempt from filing a hard copy of these items with this office. These filings should be submitted to the NAIC via electronic media in accordance with the due dates established by the NAIC.
A CERTIFICATE OF COMPLIANCE from the Insurance Commissioner of your domiciliary state is required to be filed. The Certificate must indicate that the company is (i) licensed and in good standing in that state and (ii) in compliance with all applicable laws of that state. The Certificate must also give the classes of business the company is authorized to transact and have been issued within three(3) months of the filing date.
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All items filed should include the Company's NAIC Group Code along with the Company Code. |
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P |
NEW THIS YEAR:
We have a portal which will allow the electronic submission of many of these required documents at
Annual License Renewal and Financial Filing Submission Portal.
Notarization is no longer required for Virginia-specific renewal forms.
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General Instructions
For Companies to Use Checklist
VIRGINIA
Please Note: This checklist represents, IN GENERAL, the annual renewal and related filings required in Virginia. Each licensed company was sent specific filing instructions by letter in December. The NAIC will not be sending their own checklist.
Electronic filing is intended to include filing via the Internet or via diskette with the NAIC. Companies that file with the NAIC via the Internet are not required to submit diskettes to the NAIC. Companies are not required to file hard copy filings with the NAIC.
Column (1) (Checklist)
Companies may use the checklist to submit to a state, if the state requests it. Companies should copy the checklist and place an "x" in this column when mailing information to the state. Virginia does not request the checklist.
Column (2) (Line #)
Line # refers to a standard filing number used for easy reference. This line number may change from year to year.
Column (3) (Required Filings)
Name of item or form to be filed.
The Annual Statement Electronic Filing includes the annual statement data and all supplements due March 1, per the Annual Statement Instructions. This includes all detail investment schedules and other supplements for which the Annual Statement Instructions exempt printed detail.
The March .PDF Filing is the .pdf file for annual statement data, detail for investment schedules, and supplements due March 1.
The Risk-Based Capital Electronic Filing includes all risk-based capital data.
The Risk-Based Capital .PD Filing is the .pdf file for risk-based capital data.
The Supplemental Electronic Filing includes all supplements due April 1, per the Annual Statement Instructions.
The Supplemental .PDF Filing is the .pdf file for all supplemental schedules and exhibits due April 1.
The Quarterly Electronic Filing includes the quarterly statement data.
The Quarterly .PDF Filing is the .pdf file for quarterly statement data.
The June .PDF Filing is the .pdf file for the Audited Financial Statements and Accountants Letter of Qualification.
Column (4) (Number of Copies)
Indicates the number of copies that each foreign or domestic company is required to file for each type of form. If N/A appears in this column, the filing is not required. "EO" indicates electronic only filing required.
Column (5) (Due Date)
Indicates the date on which the company must file the form.
Column (6) (Form Source)
If this column contains "NAIC," the company must obtain the forms from the appropriate vendor. If this column contains "State," Virginia will provide the forms with the filing instructions. If this column contains "Dom. State," the form should be obtained from the state of domicile. If this column contains "Company," the company, or its representative (e.g., its CPA firm), is expected to provide the form based upon the appropriate state instructions or the NAIC Annual Statement Instructions.
Column (7) (Applicable Notes)
This column contains references to the Notes to the Instructions that apply to each item listed on the checklist. The company should carefully read these notes before submitting a filing.