I.  NAIC FINANCIAL STATEMENTS

EF***

EO

EF***

EO

EF***

EO

II.  NAIC SUPPLEMENTS

EF***

EO

EF***

EO

EF***

EO

EF***

EO

N/A

EF***

EO

EF***

EO

EO

1

N/A

EF***

EO

EF***

EO

III.  ELECTRONIC FILING REQUIREMENTS

xxx

EO

xxx

EO

xxx

EO

xxx

EO

xxx

EO

xxx

EO

xxx

EO

xxx

EO

xxx

EO

IV.  AUDIT/INTERNAL CONTROL
RELATED REPORTS

EF***

EO

EF***

EO

1

N/A

EF***

EO

1

N/A

1

N/A

1

N/A

1

EO

1

EO

1

EO

1

N/A

1

N/A

V.  STATE REQUIRED FILINGS

EF***

N/A

EF***

N/A

1

N/A

1

N/A

1

N/A

1

N/A

1             

N/A

1

N/A

1

N/A

1

N/A

1

N/A

1

N/A

110

1

N/A

5/31

1

N/A

1

N/A

1

 N/A

1

 N/A

1

 N/A

Ms. Soo Kim, Health Bureau 
New York State Department of Financial Services
1 State Street
New York, NY 10004
(212) 480-5211
E-mail: [email protected]

When answering by email, please include telephone number.

Department filings must be filed online no later than the indicated due date. Companies are not required to submit hard copies of filings unless requested by the Department. In addition to filing to the NAIC, all companies are also required to file PDF copies of the fully executed Jurat pages and Certification of Compliance etc. of the Annual and Quarterly filings directly with this Department via the DFS portal.  See Notes L and P of this Checklist for the specific instructions.

If a due date falls on a weekend or a legal holiday, the filing must be submitted by the end of the next business day.

Failure to timely file any component of an annual, quarterly or NY supplement filing subject company to penalties set forth in NY Insurance Law Sections 307 and 308.

New York statute does not provide for any extensions in the filing deadlines for Annual Statements. Further, extensions for the filing of audited financial statements are only provided upon written application by the company to the superintendent, and such extension is only granted if the superintendent finds that compliance would constitute a financial or organizational hardship, as provided in Section 307(b)(3) of the Insurance Law.

“Wet” or electronic signatures are required.

See Note L for further instructions.

Appropriate notarization required.

See Note L for further instructions.

Companies must obtain the Department’s prior approval before submitting any amended statements.

All amendments to the Annual and Quarterly Statements and/or New York Supplement are required to be filed electronically with the NAIC.

Note: For Amended New York Supplement filings, the entire electronic filing is required to be filed with the NAIC.

The NAIC Annual Statement and New York Supplement require the use of bar codes on the jurat page and certain other pages and forms.

In addition, the Department requires the Audited Financial Statements and the documents submitted pursuant to Regulation 118 (11 NYCRR 89) to be bar coded.

General Bar Coding instructions and a full listing of New York required bar coded forms are included on the web site.

Instructions concerning internet filing alternative to filing diskette with New York for New York Supplement are set forth in Insurance Circular Letter No. 4 (2001)

All companies  must file national form filings (as identified in Lines 61, 62, 63, 64, 65, 66, 67, 68 and 69 in the checklist) with the NAIC preferably via the Internet.  By filing over the Internet with the NAIC a company will have fulfilled its electronic filing requirement for national forms with New York.

Companies are required to file online via the Department’s portal under the appropriate category.

Companies must file, with its annual statement filing, by the indicated due date, both its request for relief and the domiciliary state’s approval of that request with the New York State Department of Financial Services and the NAIC.

Lines 88 through 91: New York domestic company wishing to apply for the New York State Department of Financial Services (DFS)’s approval of the indicated relief must do so in accordance with the requirements set forth in New York Regulation No. 118 (11 NYCRR 89) and/or NYIL 307.

Line 88: The application for relief from the rotation requirement (line 88) must be made to DFS via the Department’s Filing Portal above at least 30 days before the end of the calendar year.

\Line 91: Any application for exemption to file pursuant to New York Insurance Regulation 118 (11 NYCRR 89) and/or NYIL 307 must be filed with the Superintendent through the Department’s Filing Portal above prior to the event or period for which the exemption is being requested.

Line 92: Companies must provide written notice within 30 days of any change in membership of the audit committee.  The notice shall include a description of the reason for the change.

Companies are required to file ORSA, Group Capital Calculation, and Form F through the Department’s insurance entity filings portal: (“the Portal”).  Furthermore, companies are strongly encouraged to file Corporate Governance Annual Disclosure, Form HC-1, and Form IR via the DFS Portal under the appropriate category.

An ORSA Summary Report is required to be filed annually by a New York domestic company that meets a specified premium threshold and/or where the New York domestic company is a member of a group that meets a specified premium threshold. The ORSA Summary Report is a state filing only and should not be submitted by the company to the NAIC. For more information, please refer to Regulation 203 (11 NYCRR 82).

A Form F filing is required to be filed annually by a New York domestic company that is not part of a group and meets a specified premium threshold. For groups, it must be filed by the ultimate holding company for an Article 15 group and by the parent domestic company in an Article 17 group. Consistent with the Form B filing requirements, the Form F is a state filing only and should not be submitted by the company to the NAIC. For more information, please refer to Regulation 203 (11 NYCRR 82).

The Corporate Governance Annual Disclosure is required to be filed annually by authorized companies. The Corporate Governance Annual Disclosure is a state filing only and should not be submitted by the company to the NAIC. For more information, please refer to Regulation 215 (11 NYCRR 90).

Pursuant to Section 89.5(e)(2) of Insurance Regulation 118:

“The company shall attach a statement to its audited annual financial statement, when filed, that the CPA does not function in the role of management, does not audit his or her own work, and does not serve in an advocacy role for company.”

Provide updated information (name, address, telephone number and e-mail address of the new CPA) within 60 days of any change in CPA.

The company shall obtain a letter from the CPA, and file a copy with the superintendent, stating that the CPA is aware of the provisions of the insurance law and the regulations thereunder of the state of domicile that relate to accounting and financial matters and affirming that the CPA will express his or her opinion on the financial statements in terms of their conformity to the statutory accounting practices prescribed or otherwise permitted by that insurance department, specifying such exceptions as the CPA may believe appropriate.

In addition, Companies must comply with the reporting requirements of Regulation 118, Section 89.4(c) in an event that its CPA is dismissed or resigns. 

File online via the DFS portal.

If there is a change in actuary, the Company shall notify the New York State Department of Financial Services within five business days of the event in accordance with the NAIC Annual Statement Instructions. 

File online via the DFS portal.

Attestation to Segregation of Funds

Insurance Circular Letter No. 7 (2013): Segregation of Funds for Certain Abortion Services on the Exchange for Enrollees who Receive Federal Funds | Department of Financial Services (ny.gov)

Under the United States Department of Health and Human Services (“HHS”) regulation a Qualified Health Plan (“QHP”) issuer must file an annual assurance with the Superintendent attesting that the QHP issuer has complied with 42 USC §18023 and all applicable regulations.

The company may file online via the DFS portal. noted in Note Q.