Annual Statement Notice
Adobe Acrobat Reader is required to view some of the documents on the Annual Statement Notice. A free copy of the Reader may be downloaded from the Adobe website.
Please be advised that there have been changes to these instructions from the prior year. Read this notice and all referenced instructions, checklists and notes carefully before proceeding with the filing.
This notice contains instructions for filing the 2022 Annual Statement with the Commonwealth of Massachusetts, Division of Insurance. Unless otherwise indicated, all filings must comply with 2022 NAIC Annual Statement Instructions for your type of company, including any required quarterly filings; and the NAIC’s Accounting Practices and Procedures Manual.
For any questions or information regarding filing with the NAIC, the 2022 NAIC Annual Statement Instructions, or the NAIC’s Accounting Practices and Procedures Manual, please refer to the NAIC website.
The required checklist for each company type specifies the filing dates for all required filings with the Commonwealth of Massachusetts. All schedules must be securely attached to the appropriate pages or bound separately.
All required Annual Statements must be subscribed and sworn before a notary by at least two principal officers of the company.
Company Renewal and Filing Fees
LICENSE RENEWAL & FILING FEE PAYMENT MAILING ADDRESS
Checks are to be made payable to the Commonwealth of Massachusetts Division of Insurance and mailed with a completed Lock Box and License Renewal Application Form (if applicable) to:
Division of Insurance
Annual Filing Fee / Company License Renewal
PO Box 370039
Boston, MA 02241-0739
ANNUAL STATEMENT FILING EMAIL ADDRESS
This address is to be used for regulatory filings except payments, lock box forms, and license renewal applications.
PENALTY
M.G.L. Chapter 175, Section 26, provides for a penalty of $100 per day if the Annual Statement, or any other related filings, are not received in the proper form and by the date required. In addition, any company that neglects to file in the proper form, and by the date required, may be required to cease writing new business as long as the filing deficiency continues.
REINSURANCE CREDIT
Credit for reinsurance must be recorded in accordance with the provisions of M.G.L. Chapter 175, Section 20A. For a list of Licensed and/or Approved Companies in Adobe click here, for Microsoft Excel click here.
CERTIFICATES OF COMPLIANCE
Domestic Insurance Companies that would like to request Certificates of Compliance to be effective January 1, 2023 should email their request to Amy Blue at the ANNUAL STATEMENT EMAIL ADDRESS (see above).
WORKERS’ COMPENSATION SCHEDULE C-1 and WORKERS’ COMPENSATION DEPOSITS
All foreign insurers authorized for Workers’ Compensation in Massachusetts that have an AM Best Rating of “A-“ or higher are not required to file a Workers’ Compensation Schedule C-1 and are not required to maintain a Workers’ Compensation deposit in accordance with the calculation in the Workers’ Compensation Schedule C-1. The required Workers’ Compensation deposit for these companies is $50,000.00.
All foreign insurers authorized for Workers’ Compensation in Massachusetts that have an AM Best Rating of “B++” or lower are required to file a Workers’ Compensation Schedule C-1 and are required to maintain a Workers’ Compensation deposit in accordance with the calculation in the Workers’ Compensation Schedule C-1.
Company Renewal and Filing Fees
|
NON REFUNDABLE FEES |
|
|---|---|
|
Domestic Companies |
No Fees Required |
|
Licensed Foreign Companies without Designation 51 or 54 |
|
|
Annual Filing Fee |
$150.00 |
|
License Renewal Fee |
$250.00 |
| $400.00 | |
|
Licensed Foreign Companies with Designation 51 or 54 |
|
|
Annual Filing Fee |
$150.00 |
|
License Renewal Fee |
$279.00 |
| $429.00 | |
|
Surplus Lines Insurers, Accredited Reinsurers, Approved Reinsurers, or Eligible Alien Unauthorized Insurers |
|
|
Annual Filing Fee |
$150.00 |
|
Fraternal Benefit Societies |
|
|
Annual Statement Filing Fee |
$ 6.00 |
|
License Renewal Fee |
$25.00 |
| $31.00 | |
| Risk Retention Groups | |
|
License Renewal Fee |
$125.00 |
|
Health Maintenance Organization (Due July 1, 2023) |
$1,000.00 |
Accredited Reinsurers - Filing Checklists & Instructions
Eligible Alien Unauthorized Insurers
Eligible Alien Unauthorized Insurers
Eligible Alien Unauthorized Insurers are required to file the following with the Massachusetts Division of Insurance:
All companies: CPA Audited Financial Report to be filed electronically 120 days after their fiscal year-end.
Companies that have a December 31st fiscal year-end must inform the Massachusetts Division of Insurance by March 31st whether they will:
- make a preliminary filing (balance sheet and income statement) by March 31st and make a complete filing (Jurat Page, IID Financial Filing Format, Interrogatories, Loss Certification) by July 31st; or
- forego the preliminary filing and make a complete filing (Jurat Page, IID Financial Filing Format, Interrogatories, Loss Certification) by May 15th.
For additional information e-mail Amy Blue of the Massachusetts Division of Insurance at Amy.Blue@mass.gov.
Fraternal Companies - Filing Checklists & Instructions
HMOs - Filing Checklists & Instructions
Health Entities - Filing Checklists & Instructions
Service Contract Providers - Filing Checklist & Instructions
(To be filed within 120 days of the close of the Company’s fiscal year)
A current financial statement that indicates a balance sheet and statement of operations on a GAAP basis, certified by an Independent Certified Public Accountant
A report listing the number of service contracts issued during the preceding fiscal year, the number of contracts canceled or expired during the preceding year, the number of contracts in effect at year-end, and the amount of service contract fees received during the year
Application for Registration as a Service Contract Provider
For additional information on filing please email to: companies.mailbox@mass.gov
Life Accident and Health Insurers - Filing Checklists & Instructions
Property and Casualty Insurers - Filing Checklists & Instructions
Risk Retention Groups - Filing Checklists & Instructions
Risk Retention Groups
RRGs are governed by their state of domicile and are generally required to file with Massachusetts whatever documents are required by their state of domicile. In addition RRGs are required to file NAIC Biographical Affidavits with the Commonwealth of Massachusetts, a revised Massachusetts Checklist, and any other additional information required by the Commonwealth of Massachusetts. However, if the RRG files its annual statement with the NAIC it is only required to submit a signed Jurat Page on or before March 1 (or later date if granted an extension by its state of domicile).
RRGs are not required to file quarterly statements with the Commonwealth of Massachusetts, Division of Insurance.
The following Renewal Application documents will be mailed to each RRG in the summer of each year.
Risk Retention Group Annual Registration Application Form
Supplement to the NAIC Uniform Group Registration Form for Registration as a Risk Retention Group
Risk Retention Group – Notice and Registration
For additional information e-mail Matthew Mancini at the Massachusetts Division of Insurance at Matthew.Mancini@mass.gov.
Self Insurance Groups - Filing Checklists & Instructions
2022 Annual SIG Statement Notice
For information please e-mail Brian Knowlton at the Massachusetts Division of Insurance at Brian.Knowlton@mass.gov