2022 Health Maintenance Organizations Annual Statement and New York Supplement

General Filing Instructions

Schedule G must be submitted in its own separate PDF file, separate from the New York Supplement PDF file. 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.

Mailing Address

Mail your NAIC Quarterly Statement and New York Quarterly Supplement Hard Copies and Disks to:

Thomas Dudek, 11th Floor
New York State Department of Financial Services
One State Street
New York, New York 10004

Do not mail the statement to Albany.


Instructions concerning internet filing alternatives to diskette with New York for New York Supplement are set forth in the Department's Circular Letter No. 4 (2001).

All companies are strongly encouraged to file national form filings with the NAIC via their website at www.naic.org. By filing over the internet or via disk with the NAIC, an insurer will have fulfilled its electronic filing requirement for national forms with New York and therefore should not file a diskette with the Department of Financial Services.

The Health Maintenance Organization Annual Statement Checklist & Instructions provides filing requirements for submission to the NAIC and the Department of Financial Services. This website also provides specific instructions for filing the New York Supplement and supplemental forms with DFS.

HMOs subject to these filing requirements are strongly encouraged to submit copies of all annual and quarterly statement filings with the NAIC. The following 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 disk with New York.

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

HMO - Specific Filing Information

The HMO Filing Instructions and Forms Packet is a compressed zipped file; after downloading, unzip to obtain the following files.

  • New York State HMO Annual Supplement 2022
  • New York State HMO Quarterly Supplement 2023
  • New York State Electronic Filing Directive 2022
  • NAIC Health Maintenance Organization Annual Checklist & Instructions
  • Annual Electronic Filing Requirement Letter
  • Barcode Instructions

When printing Blanks, be sure to use legal size paper (8 1/2" X 14"). Each Blank is bookmarked for viewing online.

The New York State HMO Supplement 2022 (PDF) is also available on the NY Supplement Instructions and Forms Page.

Special Instructions for Filing Schedule G

For-profit HMOs are now required to complete Schedule G for ALL personnel described in the instructions at the top of the schedule. No longer should you leave Column 2 blank for employees other than directors, trustees or senior officers.

Due Date and Mailing

Please refer to the Health Maintenance Organization Annual Statement Checklist & Instructions.

NAIC Numbers and Company Names:

To view the company listing for this blank type, select Health Maintenance Organization List.

NAIC Forms

National Association of Insurance Commissioners
2301 McGee, Suite 800
Kansas City, MO 64108-2604
(816) 842-3600


For  assistance call Thomas Dudek at (212) 480-5037.