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2012 LOSS RATIO REPORT SUBMISSIONS - Sections 3231(e)(1) and 4308(c) of the Insurance Law (community rated products)

These loss ratio reports are for use by insurers and HMOs that have submitted rate applications pursuant to section 3231(e)(1) and/or section 4308(c) of the Insurance Law ("community rated products").

This Web site also provides specific instructions for filing the annual loss ratio report required by sections 3231(e)(1) and 4308(c). A copy of the instructions is available as indicated below.

The Department of Financial Services recommends that companies download the forms packet and return the loss ratio report using SERFF. A company may contact the Department of Financial Services as indicated below and request a copy of the instructions.

Loss Ratio Report - Specific Filing Information

The Loss Ratio Report Submission INSTRUCTIONS AND FORMS PACKET is a self extracting zipped file; after downloading file, run EXE to obtain the following files. The Instructions are in PDF format.

FORMS included for Download and/or Print:

To view full instructions for unzipping compressed files, please select this link.


The Loss Ratio Report for Medicare Supplemental policies is due to the Department by May 1, 2013 (annual reporting form and refund calculation form). The Loss Ratio Report for all other community rated products is due to the Department by June 30, 2013.

It is recommended that the loss ratio reports be submitted using SERFF. Refer to the Instructions for the SERFF Filing Type Code to use.

If the material is submitted by paper, it is recommended that the submission include an electronic version of the Loss Ratio Report on a compact disc (unless sent electronically via email), and is to be sent to the address below.

Medicare Supplement Loss Ratio Report

New York Department of Financial Services
Health Bureau
1 Commerce Plaza
Attention: K. Gloria Dee, Assistant Chief Actuary
Albany, New York 12257

All Other Loss Ratio Reports

New York Department of Financial Services
Health Bureau
One State Street
Attention: Gary Teitel, Assistant Chief Actuary
New York, New York 10004-2319


If you need help filling out your forms, contact: Health Bureau, Mr. Gary Teitel (212) 480-7709, mail to: or Ms. K. Gloria Dee (518) 473-7716, mail to:

Updated 03/12/2013

Department of Financial Services


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