2012 ANNUAL STATEMENT and NEW YORK SUPPLEMENT
Accident & Health Insurer Filing on the Health Blank - General Instructions

IMPORTANT FILING REMINDER:

Schedule G is to be submitted in its own PDF file, separate from the New York Supplement PDF file. This follows the practice of recent years. Both pdf files MUST be contained in one zip file. If Schedule G is included in the New York Supplement PDF, the filing will be rejected.

You are required to file ONLY ONE HARD COPY of the 2012 ANNUAL FILING.

Mail to:
Health Bureau
New York State Department of Financial Services
25 Beaver Street
New York, NY 10004        Do NOT mail to Albany.

It is no longer necessary to file a redacted version of Schedule G. Schedule G for the 2012 reporting year contains numerous changes, please follow the instructions on the form when completing the schedule. Only one hard copy and one electronic copy are required to be filed.

We are providing for your use the Accident & Health Annual Statement Checklist & Instructions. This checklist provides filing requirements for submission to the NAIC and the New York State Department of Financial Services. This Web site also provides specific instructions for filing the New York Supplement and supplemental forms with our Department. Copies of the New York Supplement and supplemental forms are available in the Download section of this Web site.

Insurers subject to these filing requirements are strongly encouraged to submit copies of all annual and quarterly statement filings electronically with the NAIC. The following electronic submissions to the NAIC will fulfill the electronic filing requirements of New York:

• National Form Annual Statement via the internet or diskette.
• National Form Quarterly Statement via the internet or diskette.
• New York Supplement via the internet.

Any statements not filed as above will require the filing of a diskette with New York.

In all cases, hard copies must still be filed in accordance with the Accident & Health Annual Statement Checklist & Instructions.

Accident & Health Insurer Filing on the Health Blank - Specific Filing Information

The Accident & Health Insurer Filing INSTRUCTIONS AND FORMS PACKET is a self-extracting zipped file; after downloading file, run EXE to obtain the following PDF (Acrobat) files. You will need the Adobe Acrobat Reader to view or print PDF files. When printing the blanks, be sure to use legal size paper (8 1/2"X14"). Each of the Blanks is bookmarked with a full table of contents for on-line viewing.

FORMS included for Download and/or Print:

• NEW YORK STATE HEALTH SUPPLEMENT 2012
• HEALTH INSURANCE CLAIMS PAYABLE (NY) QUARTERLY REPORT (Excel Form) - Click here for filing instructions
• NAIC Accident & Health Annual Checklist & Instructions
• SCHEDULE S
• BAR CODE INSTRUCTIONS
• Annual Electronic Filing Requirement Letter

To view full instructions for unzipping compressed files, please select this link.

All 2012 New York Supplement Blanks (in PDF Format) are also available from the SUPPLEMENT BLANKS PAGE.

DUE DATE & MAILING:
Please refer to the Accident & Health Annual Statement Checklist & Instructions.

For NAIC Numbers and Company Names:
To view the company listing for this blank type, see Page 4 (Authorizied Accident & Health Companies) of Schedule S.

PROBLEMS AND QUESTIONS:
If you need help filling out your forms, call: Mr. Charles Lovejoy, Health Bureau, New York City (212) 480-5045. For electronic filing related questions, contact Information Systems & Technology Bureau, Albany (518) 473-3775.

MAILING INSTRUCTIONS:
Please see the Accident & Health Annual Statement Checklist & Instructions due dates and other related information.