2021 ANNUAL STATEMENT and NEW YORK SUPPLEMENT
Life Insurer - General Filing Instructions
IMPORTANT FILING REMINDER:
Schedule G is to be submitted in its own 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.
You are required to file ONLY ONE HARD COPY of the 2021 ANNUAL FILING. Please refer to the Department’s guidance for electronic signatures, transactions and filings.
New York State Department of Financial Services
One State Street
New York, NY 10004 Do NOT mail to Albany.
We are providing for your use the LIFE Annual Statement Checklist & Instructions. This checklist provides filing requirements for submission to the NAIC and the New York 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.
Life Insurer - Specific Filing Information
The Life Insurer Filing INSTRUCTIONS AND FORMS PACKET is a compressed zipped file; after downloading, unzip to obtain the following files.
FORMS included for Download and/or Print:
- NEW YORK STATE LIFE & A&H SUPPLEMENT 2021
- NAIC Life Annual Checklist & Instructions
- SCHEDULE S ADDENDUM
- BAR CODE INSTRUCTIONS
- Annual Electronic Filing Requirement Letter
- Schedule Q Worksheets
- Schedule Q Report and Schedule Q Interrogatories
- Schedule Q Supporting Instructions
- Health Insurance Claims Payable (NY) Quarterly Report (Excel Form)
- Certificate of Compliance – Regulation 74
When printing the blanks, be sure to use legal size paper (8 1/2" X 14"). Each of the Blanks is bookmarked for on-line viewing.
For the full listing of Life Insurers authorized in New York State as of Dec. 31, 2021 (Schedule S), select Schedule S ADDENDUM.
The NEW YORK STATE LIFE & A&H SUPPLEMENT 2021 (in PDF Format) is also available on the NY Supplement Blanks Page.
For any company that is an accredited reinsurer in New York and meets the definition of a reinsurer contained in the Dodd-Frank legislation, there is no need to file a New York Supplement.
Certificate of Compliance (Regulation 74)
Section 53-1.4(b) of Regulation 74 requires all licensed life insurers to submit a certificate of compliance with respect to the company’s cost disclosures and sales illustrations for life insurance products. The certificate is included in the forms packet on this page and should be filed via SERFF according to Note U of the checklist.
Exhibit of Captive Reinsurance Transactions
All licensed life insurers are required to report reinsurance transactions between companies in the insurer's holding company system.
Health Insurance Claims Payable (Quarterly)
The Health Insurance Claims Payable report, which is part of the New York Supplement is required to be submitted quarterly by all companies writing Accident and Health insurance in New York State.
Schedule Q Forms, Instructions & Worksheets
The Schedule Q packet necessary for filing of the 2021 New York Supplement, to be filed by all life insurance companies licensed to do business in New York, consists of the following:
- Schedule Q Report (2 pages) and Schedule Q Interrogatories (2 pages)
To be filed with the New York Supplement
- Schedule Q Worksheets (13 pages)
Not to be submitted but must be retained by the Company for six years; and
Questions on the Schedule Q filing should be directed to Mr. James MacDonald, Supervising Actuary, at (212) 480-4933.
Separate Schedule Q filings for participating and non-participating business are not required.
DUE DATE & MAILING:
Please refer to the LIFE Annual Statement Checklist & Instructions.
For NAIC Numbers and Company Names:
To view the company listing for this blank type, select Life Companies (Schedule S).
PROBLEMS AND QUESTIONS:
If you need help filling out your forms, call: Mr. Stephen Pallas, Life Bureau at (212) 480-4765. For diskette related questions, contact Information Systems & Technology Bureau, Albany (518) 473-3775.
For NAIC forms, contact:
National Association of Insurance Commissioners
2301 McGee, Suite 800
Kansas City, MO 64108-2604
Please see the LIFE Annual Statement Checklist & Instructions due dates and other related information.