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DEPARTMENT OF INSURANCE
Reporting

All insurer carriers offering one of the following types of programs: GAP, prompt pay, long-term care, Medicare supplement, or data are required to submit reports on quarterly or annually basis.


Reporting
Prompt Pay Supporting Data Template   --
Prompt Payment Spreadsheet (03/2007)   --
Prompt Pay Supporting Data Instructions   --
Pharmacy Benefit Manager Annual Report Instructions   --
HL-MS-1 - Refund Calculation Form   --
Medicare Supplement Rate Data Sheet 2010   --
Service Area Expansion Enclosure   --
Provider Adequacy and Accessibility Reporting   --
New Service Area Enclosure   --
HIPMC-BHP1 (07/2008) - Basic Health Benefit Plan Annual Report    --
Data Report Capitation Payment Sheet   --
Data Report Health Benefit Plan Questionnaire   --
DIPR-PPR1 (07/2018) - Prompt Pay Reporting Manual   --
HIPMC-LTC 11 (09/2008) - Replacement and Lapse Reporting Form   --
HIPMC-LTC 3 (09/2008) - Rescission Reporting Form   --
HIPMC-LTC 4 (09/2001) - Claims Denial Reporting Form   --
HIPMC-DR1 - Data Reporting Manual   --
HIPMC-GAP ERF-M-1 & A-1 Monthly and Annual Report Format    --
HIPMC-GAP-AFF-1 (06/01) - Guaranteed Acceptance Program (GAP) Affidavit   --
HIPMC-GAP-C-1GAP (12-2000) - Guaranteed Acceptance Program (GAP) Certification Form   --
HIPMC-GAPQR-2 (04/01) - Supporting Insurer's and Stop-Loss Carrier's Quarterly Report   --
Geo Enclosure 1 Revision 513   --
Geo Enclosure 2 Revision 114   --
Limited Health Service Benefit Plan Enclosure 1   --
Limited Health Service Benefit Plan Enclosure 2   --
HIPMC-STE-1 Step Therapy Exceptions Annual Report Instructions    --
HIPMC-STE-1 Step Therapy Exception Report    --
Data Reporting Template-21   --