HEALTH ORGANIZATIONS

 

REQUIRED FILINGS IN VIRGINIA                                                            Filings Made During the Year 2015

 

NOTICE:  THE FOLLOWING REPRESENTS, IN GENERAL, THE ANNUAL RENEWAL AND RELATED FILINGS REQUIRED IN VIRGINIACOMPANIES FILING THE HEALTH BLANK MAY HAVE ADDITIONAL VIRGINIA SUPPLEMENTAL FILING REQUIREMENTS AS DETAILED ON THE LH OR PC CHECKLISTS. EACH LICENSED COMPANY WILL FIND SPECIFIC REQUIRED FILINGS LISTED IN THE ANNUAL LICENSE RENEWAL AND FINANCIAL FILING SUBMISSION PORTAL.

 

(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

Domestic

Foreign

 

 

 

State

NAIC

State

 

 

 

 

 

I.  NAIC FINANCIAL STATEMENTS

 

 

 

 

 

 

 

1

Annual Statement (8½ "x14")

1

EO

See Note O

3/1

NAIC

A,B,E,F,G,H,I,J,K,M,O

 

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

 

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

 

 

II.  NAIC SUPPLEMENTS

 

 

 

 

 

 

 

10

Accident & Health Policy Experience Exhibit

1

EO

See Note O

4/1

NAIC

A,B,E,F,J,K,M,O

 

11

Actuarial Opinion

1

EO

See Note O

3/1

Company

A,B,E,F,G,I,J,K,O

 

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

 

13

Health Care Exhibit's Allocation Report Supplement

1

EO

See Note O

4/1

NAIC

A,B,E,F,J,K,M,O

 

14

Investment Risks Interrogatories

1

EO

See Note O

4/1

NAIC

A,B,E,F,J,K,M,O

 

15

Life Supplemental Data due March 1

1

EO

See Note O

3/1

NAIC

A,B,E,F,J,K,M,O

 

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

 

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

 

18

Life Supplement Data due April 1

1

EO

See Note O

4/1

NAIC

A,B,E,F,J,K,M,O

 

19

Long-Term Care Experience Reporting Forms

1

EO

See Note O

4/1

NAIC

A,B,E,F,J,K,M,O

 

20

Management Discussion & Analysis

1

EO

See Note O

4/1

Company

A,B,E,F,J,K,O

 

21

Medicare Supplement Insurance Experience Exhibit

1

EO

See Note O

3/1

NAIC

A,B,E,F,J,K,M,O

 

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

 

23

Property/Casualty Supplement due March 1

1

EO

See Note O

3/1

NAIC

A,B,E,F,J,K,M,O

 

24

Property/Casualty Supplement due April 1

1

EO

See Note O

4/1

NAIC

A,B,E,F,J,K,M,O

 

25

Risk-Based Capital Report

1

EO

N/A

3/1

NAIC

A,B,E,F,G,J,K

 

26

Schedule SIS

1

N/A

N/A

3/1

NAIC

A,B,E,F,J,K,M

 

27

Supplemental Compensation Exhibit

1

N/A

N/A

3/1

NAIC

A,B,E,F,J,K

 

 

III  ELECTRONIC FILING REQUIREMENTS

 

 

 

 

 

 

 

60

Annual Statement Electronic Filing

N/A

1

EO

3/1

NAIC

 

 

61

March .PDF Filing

N/A

1

EO

3/1

NAIC

 

 

62

Risk-Based Capital Electronic Filing

N/A

1

EO

3/1

NAIC

 

 

63

Risk-Based Capital .PDF Filing

N/A

1

EO

3/1

NAIC

 

 

64

Supplemental Electronic Filing

N/A

1

EO

4/1

NAIC

 

 

65

Supplemental .PDF Filing

N/A

1

EO

4/1

NAIC

 

 

66

Quarterly Statement Electronic Filing

N/A

1

EO

5/15, 8/15, 11/15

NAIC

 

 

67

Quarterly .PDF Filing

N/A

1

EO

5/15, 8/15, 11/15

NAIC

 

 

68

June .PDF Filing

N/A

1

EO

6/1

NAIC

 

 

 

IV.  AUDIT/INTERNAL CONTROL RELATED REPORTS

 

 

 

 

 

 

 

81

Accountants Letter of Qualifications

1

EO

See Note O

6/1 or 6/30

Company

A,B,E,F,J,O

 

82

Audited Financial Reports

1

EO

See Note O

6/1 or 6/30

Company

A,B,E,F,J,K,O

 

83

Audited Financial Reports Exemption Affidavit

1

N/A

1

3/1

State

A,B,E,F,J,O

 

84

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,N,O

 

85

Independent CPA (Change)

1

N/A

1

Within 5 business days of change

Company

A,B,E,F,J,O

 

86

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,O

 

87

Notification of Adverse Financial Condition

1

N/A

1

Within 5 business days of receipt

Company

A,B,E,F,O

 

88

Request for Exemption to File

See Line 83

N/A

See Line 83

3/1

Company

A,B,E,F,J,O

 

89

Relief from the five-year rotation requirement for lead audit partner

1

EO

1

3/1

Company

A,B,E,J,O

 

90

Relief from the one-year cooling off period for independent CPA

1

EO

1

3/1

Company

A,B,E,J,O

 

91

Relief from the Requirements for Audit Committees

1

EO

1

3/1

Company

A,B,E,J,O

 

 

V.  STATE REQUIRED FILINGS

 

 

 

 

 

 

 

101

Filings Checklist

N/A

N/A

N/A

State

 

 XXXX

102

State Filing Fees

N/A

N/A

N/A

 

 

 

 XXXX

103

Signed Jurat

N/A

N/A

N/A

 

 

L

 

104

Actuarial Opinion Summary

1

N/A

N/A

3/15

Company

A,B,E,F,J

 

105

Analysis of Excess Capital & Surplus Investments Report

1

N/A

N/A

3/1, 5/15, 8/15, 11/15

State

A,B,E,F,J

 

106

Application for Renewal of License

1

N/A

1

3/1

State

A,B,E,F,J,N,O

 

107

Certificate of Compliance

N/A

N/A

1

3/1

Dom. State

A,B,E,F,J,N,O

 

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

 

109

Enterprise Risk Report (Form F)

1

N/A

N/A

4/30

Company

A,B,E,F,J,N

 

110

Insurance Holding Company System Annual Reg. Stmt.

1

N/A

N/A

4/30

Company

A,B,E,F,J

 

111

Managed Care Health Insurance Plan ("MCHIP") Description of Virginia Operations

1

N/A

1

3/1

Company

A,B,E,F,J,N,O

 

112

Managed Care Health Insurance Plan ("MCHIP") List of Providers

1

N/A

1

3/1

Company

A,B,E,F,J,O

 

113

Open Enrollment Statement

1

N/A

1

6/1

Company

A,B,E,F,J,N,O

 

114

Own Risk and Solvency Assessment (ORSA) Summary Report

1

N/A

N/A

8/1

Company

A,B,E,F,J,N

 

115

Premium Tax/Assessments Filings:

SEPARATE FILINGS - DIFFERENT ADDRESSES

1

N/A

1

3/1

State

See Note D

 

116

Rates of Compensation

1

N/A

See Note O

3/1

Company

A,B,E,F,O

 

117

[Report of Assets Pledged, Hypothecated or Encumbered]

1

N/A

N/A

3/1

State

A,B,E,F,J

 

118

Request for Information Regarding RIs

1

N/A

N/A

3/1

State

A,B,E,F,J

 

119

Statement of Material Changes

1

N/A

1

3/1

State

A,B,E,F,J

 

120

Supplementary Stmt. of Covered and Uncovered Expenses

1

N/A

1

3/1, 5/15, 8/15, 11/15

State

A,B,E,F,J

 


 

 

 

NOTES AND INSTRUCTIONS (A-K APPLY TO ALL FILINGS)

 

 

A

Required Filings Contact:

 

BOIFINFILING@SCC.VIRGINIA.GOV


 

B

Annual Renewal and Related Filings Mailing Address:

State Corporation Commission

Bureau of Insurance

Financial Regulation Division

P.O. Box 1157

Richmond, VA 23218



 

We now have a portal which will allow the electronic submission of many of these required documents at Annual License Renewal and Financial Filing Submission Portal. Insurers must go to the portal and log in to submit documents electronically.

 

Annual Renewal and Related Filings Courier Delivery:

State Corporation Commission

Bureau of Insurance, Financial Regulation Division

1st Floor Mailroom

1300 East Main Street

Richmond, VA 23219

 

C

Mailing Address for Filing Fees:

N/A

 

D

Information for Premium Tax/Assessment Filings:

 

PREMIUM LICENSE TAX FORMS and ASSESSMENT FORMS should NOT be submitted with the Annual Statement and its related filings.

 

PREMIUM LICENSE TAX FORMS and ASSESSMENT FORMS are two separate filings per the information below.

 

The PREMIUM LICENSE TAX FORMS must be obtained from

www.tax.virginia.gov/insurance

and be submitted to the Department of Taxation(TAX). Contact TAX for the correct address.

 

ASSESSMENT FORMS and Instructions must be obtained from

www.scc.virginia.gov/boi/co/assess/filing.aspx

and be submitted to the Bureau of Insurance. See Instructions for the correct address.

 

Questions re: ASSESSMENT FILINGS should be directed to the State Corporation Commission's Assessments Division at 804-371-9096.

 

Questions re: PREMIUM LICENSE TAX FILINGS should be directed to the VA Dept of Taxation at 804-404-4163.

 

 

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.

 

F

Late Filings:

 

 

Late filings are subject to penalties pursuant to § 38.2-218 of the Code of Virginia.

 

G

Original Signatures:

 

A printer's reproduction of "live" signatures is acceptable.

 

H

Signature/Notarization/Certification:

 

Statements must be signed by at least two principal officers of the company.

 

I

Amended Filings:

 

 

Any signature requirements for the original filing must be followed for amendments.

 

J

Exceptions from normal filings:

 

 

Exemptions or extensions are not automatically granted to any company.  Requests must be made prior to the filing due date.

A CERTIFICATE OF DEPOSIT is ONLY required from insurers that do not maintain a deposit with the Treasurer of Virginia.

 

K

Bar Codes (State or NAIC):

NAIC Annual Statement Instructions should be followed.

 

L

Signed Jurat:

N/A

 

M

NONE Filings:

NAIC Annual Statement Instructions for Supplemental Interrogatories should be followed.

 

N

Filings new, discontinued or modified materially since last year:

 

All foreign and alien companies, excluding health maintenance organizations (HMOs) and dental plan organizations (DPOs), MUST submit eligible documents electronically via the portal. A Submit button is presented if the document is available for portal filing. If there is no Submit button presented, then documents should be sent by mail to this Office or to where specified in the portal or on this checklist.

See Lines 109 and 114

 

O

Foreign Company Filing Requirements:

 

All foreign and alien companies, excluding health maintenance organizations (HMOs) and dental plan organizations (DPOs), MUST submit eligible documents electronically via the portal. A Submit button is presented if the document is available for portal filing. If there is no Submit button presented, then documents should be sent by mail to this Office or to where specified in the portal or on this checklist.

 

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.

 

All items filed should include the Company's NAIC Group Code along with the Company Code.


General Instructions

For Companies to Use Checklist

VIRGINIA

 

Please Note:         This checklist represents, IN GENERAL, the annual renewal and related filings required in Virginia.   The NAIC will not be sending their own checklist.

 

Electronic filing is intended to be filings submitted to the NAIC via the NAIC Internet Filing Site which eliminates the need for a company to submit diskettes or CD-ROM 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.  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 Qualifications.

 

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.