2020 Annual Statement and New York Supplement
Article 42 Accident & Health Insurer
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 2020 Annual Filing and Mail it to:
Mr. Thomas Dudek, Health Bureau
New York State Department of Financial Services
One State Street
New York, NY 10004
Do NOT mail to Albany.
Insurers 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 disk.
- National Form Quarterly Statement via the internet or disk.
- New York Supplement via the internet.
The Annual Statement Checklists & Instructions for A&H Insurer filing on Health Blank and A&H Insurer filing on Life Blank provides filing requirements for submission to the NAIC and the New York State Department of Financial Services.
Any statements not filed as above will require the filing of a disk with New York.
Specific Filing Information
To follow are 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 on the Supplement Blanks page.
The Accident & Health Insurer Filing Instructions and Forms Zip File is a compressed zipped file; after downloading, unzip to obtain the following files:
- New York State Health Annual Supplement 2020
- New York State Health Quarterly Supplement 2021
- NAIC Accident & Health Annual Checklist & Instructions
- Schedule S
- Bar Code Instructions
- Annual Electronic Filing Requirement Letter
When printing the blanks, be sure to use legal size paper (8 1/2" X 14"). Each of the Blanks is bookmarked for viewing online.
All 2020 New York Supplement Blanks (in PDF Format) are also available from the NY Supplement Instructions and Forms Page.
Due Date and Mailing
NAIC Numbers and Company Names
To view the company listing for this blank type, see Page 4 (Authorized Accident & Health Companies) of Schedule S.
If you need help filling out forms, call Mr. Warren Youngs at (212) 480-3883.
For NAIC forms contact National Association of Insurance Commissioners or call (816) 842-3600.