ANNUAL STATEMENT and NEW YORK SUPPLEMENT
Accident & Health Insurer Filing
on the Life 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.
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 Life 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 LIFE & A&H 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.
2012 New York Supplement Blanks (in PDF Format) are also available from the SUPPLEMENT
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.
NAIC forms, contact:
National Association of Insurance Commissioners
2301 McGee, Suite 800
Kansas City, MO 64108-2604
Please see the Accident & Health Annual Statement Checklist & Instructions due dates and other related information.