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 |
1 |
3/1 |
NAIC |
A,B,E,F,G,H,I,J,K,M |
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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 (8 ½” x 14”) |
1 |
EO |
N/A |
5/15, 8/15, 11/15 |
NAIC |
A,B,E,F,G,H,I,J,K,N,O |
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II. NAIC SUPPLEMENTS |
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10 |
Accident & Health Policy
Experience Exhibit |
1 |
EO |
1 |
4/1 |
NAIC |
A,B,E,F,J,K,M,O |
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11 |
1 |
EO |
1 |
3/1 |
Company |
A,B,E,F,G,I,J,K,O |
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12 |
Investment Risks Interrogatories |
1 |
EO |
1 |
4/1 |
NAIC |
A,B,E,F,J,K,M |
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13 |
1 |
EO |
N/A |
3/1 |
NAIC |
A,B,E,F,J,K,M |
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14 |
Life Supp Statement Non-Guaranteed Elements - Exh.5, Int. #3 |
1 |
EO |
1 |
3/1 |
Company |
A,B,E,F,J,K,M |
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15 |
Life Supp Statement On Par/Non Par Policies - Exh.5, Int. #1.1 |
1 |
EO |
1 |
3/1 |
Company |
A,B,E,F,J,K,M |
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16 |
Life Supplement Data due April 1 |
1 |
EO |
1 |
4/1 |
NAIC |
A,B,E,F,J,K,M |
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17 |
Long-Term Care Experience Reporting Forms |
1 |
EO |
N/A |
4/1 |
NAIC |
A,B,E,F,J,K,M |
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18 |
1 |
EO |
1 |
4/1 |
Company |
A,B,E,F,J,K,O |
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19 |
Medicare Supplement Insurance Experience Exhibit |
1 |
EO |
N/A |
3/1 |
NAIC |
A,B,E,F,J,K,M |
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20 |
Medicare Part D Coverage
Supplement |
1 |
EO |
N/A |
3/1, 5/15, 8/15, 11/15 |
NAIC |
A,B,E,F,J,K,M |
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21 |
1 |
EO |
1 |
3/1 |
NAIC |
A,B,E,F,J,K,M,O |
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22 |
Property/Casualty Supplement due April 1 |
1 |
EO |
N/A |
4/1 |
NAIC |
A,B,E,F,J,K,M,O |
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23 |
1 |
EO |
N/A |
3/1 |
NAIC |
A,B,E,F,G,J,K |
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24 |
Schedule SIS |
1 |
N/A |
N/A |
3/1 |
NAIC |
A,B,E,F,J,K,M |
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25 |
Supplemental Compensation Exhibit |
1 |
N/A |
N/A |
3/1 |
NAIC |
A,B,E,F,J,K |
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III ELECTRONIC FILING REQUIREMENTS |
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40 |
Annual Statement Electronic Filing |
N/A |
1 |
N/A |
3/1 |
NAIC |
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41 |
March .PDF Filing |
N/A |
1 |
N/A |
3/1 |
NAIC |
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42 |
Risk-Based Capital Electronic Filing |
N/A |
1 |
N/A |
3/1 |
NAIC |
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43 |
Risk-Based Capital .PDF Filing |
N/A |
1 |
N/A |
3/1 |
NAIC |
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44 |
Supplemental Electronic Filing |
N/A |
1 |
N/A |
4/1 |
NAIC |
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45 |
Supplemental .PDF Filing |
N/A |
1 |
N/A |
4/1 |
NAIC |
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46 |
June .PDF Filing |
N/A |
1 |
N/A |
6/1 |
NAIC |
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47 |
Quarterly Electronic Filing |
N/A |
1 |
N/A |
5/15, 8/15, 11/15 |
NAIC |
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48 |
Quarterly .PDF Filing |
N/A |
1 |
N/A |
5/15, 8/15, 11/15 |
NAIC |
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IV. AUDITED FINANCIAL STATEMENTS |
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61 |
1 |
N/A |
1 |
6/1 or 6/30 |
Company |
A,B,E,F,J,O |
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62 |
1 |
EO |
N/A |
6/1 or 6/30 |
Company |
A,B,E,F,J,K,N,O |
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63 |
1 |
N/A |
1 |
3/1 |
State |
A,B,E,F,J,O |
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64 |
Independent CPA Designation |
1 |
N/A |
1 |
Within 5 business days of change |
Company |
A,B,E,F,J,O |
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65 |
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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66 |
1 |
N/A |
1 |
Within 60 days after the filing of audited financial statements |
Company |
A,B,E,F,O |
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67 |
Request for Exemption to File |
1 |
N/A |
1 |
3/1 |
Company |
A,B,E,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 |
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105 |
1 |
N/A |
N/A |
3/1, 5/15, 8/15, 11/15 |
State |
A,B,E,F,J |
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106 |
1 |
N/A |
1 |
3/1 |
State |
A,B,E,F,J |
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107 |
1 |
N/A |
1 |
3/1 |
State |
A,B,E,F,J |
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108 |
N/A |
N/A |
1 |
3/1 |
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A,B,E,F,J |
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109 |
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 |
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110 |
1 |
N/A |
N/A |
4/30 |
Company |
A,B,E,F,J |
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111 |
Managed Care Health Insurance Plan (“MCHIP”) Description of Virginia Operations |
1 |
N/A |
1 |
3/1 |
Company |
A,B,E,F,J,O |
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112 |
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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113 |
1 |
N/A |
1 |
6/1 |
Company |
A,B,E,F,J |
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114 |
Premium Tax/Assessments Filings: SEPARATE FILING—DIFFERENT ADDRESS |
1 |
N/A |
1 |
3/1 |
State |
See Note D |
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115 |
1 |
N/A |
1 |
3/1 |
Company |
A,B,E,F |
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116 |
Report of Assets Pledged, Hypothecated or Encumbered |
1 |
N/A |
N/A |
3/1 |
State |
A,B,E,F,J |
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117 |
1 |
N/A |
N/A |
3/1 |
State |
A,B,E,F,J |
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118 |
1 |
N/A |
1 |
3/1 |
State |
A,B,E,F,J |
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119 |
1 |
N/A |
1 |
3/1, 5/15, 8/15, 11/15 |
State |
A,B,E,F,J |
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120 |
1 |
N/A |
1 |
3/1 |
NAIC |
A,B,E,F |
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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 Statement and Related Filings Mailing Address: State Corporation Commission Financial Regulation Division P.O. Box 1157 Richmond, VA 23218 |
Annual Statement 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/division/boi/webpages/boiinstaxinsurancecoinfo.htm 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: Wachovia Bank/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: Wachovia Bank/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: |
The Signed Jurat will NOT be accepted in lieu of an Annual Statement from a Foreign Company. |
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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:
Beginning in 2009, all foreign companies, excluding HMO's, are required to file their annual audited financial report and quarterly financial statements with the NAIC instead of a hardcopy with the Virginia State Corporation Commission, Bureau of Insurance. |
N/A |
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O |
Foreign Company Filing Requirements:
Beginning in 2009, all foreign companies, excluding HMO's, are required to file their annual audited financial report and quarterly financial statements with the NAIC instead of a hardcopy with the Virginia State Corporation Commission, Bureau of Insurance. |
All items filed should include the Company’s NAIC Group Code along with the Company Code. Schedule E-Part 3-Special Deposits is required to be filed by companies filing a certificate of deposit to support a deposit under Section 38.2-1049 of the Code of Virginia. ------------------------------------------------------------- The |
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.
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.