Insurer Forms
Financial Affairs Division Form
Annual Statement Forms and Instructions
Tax Forms and Instructions
Certificate of Authority Application Information
Acquisitions and Holding Company Registration, Deposit Forms, Senior Residential Entrance Fee Contract Provider and Other Forms
UCAA Retaliatory Info
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Rate and Form Filing
Life and Health Filing Instructions, Exemptions, Forms and Checklists
Property and Casualty Checklists, Filing Forms and Filing Instructions
Life and Health Filing Instructions, Exemptions, Forms and Checklists
INSTRUCTIONS:
General Instructions
HCSO Filing Instructions
Rate Filing Instructions
Checklist Instructions
EXEMPTIONS:
Exempt Notice to Insurers
2003 Docket No. 03A-143-INS: Life and Disability Form Filing Exemptions; Group Long Term Care Form Filing Exemptions
FILING FORMS:
Advertising Transmittal Form
HCSO and Other Managed Care Transmittal Form
HIV Testing Consent Form
Life and Health Transmittal Form
Readability Certification (Form P-123)
Certification of Qualified Actuary (Form P-124)
Long Term Care Partnership Program Insurer Certification Form
Long Term Care Partnership Program Pre-Purchase Notice Form
Long Term Care Partnership Program Post-Purchase Notice Form
CHECKLISTS:
Accountable Health Plan - HIPAA Checklist
Annuities Checklist
Credit Life & Disability Checklist
Health Care Service Organizations Checklists
Health Insurance Rate Filings Checklist
HIV Testing Consent Form Checklist
Hospital, Medical, Dental, and Optometric Service Corporation Checklist
Individual Health Indemnity Checklist
Life Insurance Checklist
Long Term Care Insurance Checklist
Medicare Supplement Insurance Checklist
Prepaid Dental Checklist
Long Term Care Insurance Pre-Rate Stabilization Rate Checklist
Long Term Care Insurance Post-Rate Stabilization Rate Checklist
Property and Casualty Checklists, Filing Forms and Filing Instructions
Determine Whether a Filing is Required
2013 Docket No. 13A-071-INS Amended Order with Exhibits A, B and C (amended)
2013 Docket No. 13A-071-INS: Property and Casualty Rate and Form Filing Exemptions; Commercial Non-Cancellation Restriction Exemptions; Recognized Surplus Lines
When a Filing is Required
P&C General Instructions (02/19/2014)
P&C Transmittal Forms (PDF version)
P&C Transmittal Forms Instructions
Uniform P&C Product Coding Matrix
Checklists Required in Filings and Other Related Documents
Combination Private Passenger Auto and Homeowners Checklist (12/03/09)
Commercial Automobile Checklist Line 19.4 and 21.2 (12/03/09)
Credit Property Checklist (12/03/09)
Credit Unemployment Checklist (12/03/09)
2013 Docket 13A 007 INS Loss Ratio Standards and Prima Facie rates for Credit Property and Credit Unemployment insurance.
Consumer Credit Certification CU 1621 (11/20/09)
Homeowners Checklist (HO); Line 4 (12/03/09)
Financial Guaranty-Fildelity-Surety Checklists (12/03/09)
Medical Malpractice Checklist(MM), Line 11 (03/18/10)
Mortgage Guaranty Checklist Line 6 (02/18/10)
P&C Article 4.1 Checklist (12/03/09)
Private Passenger Auto Checklist (12/03/09)
Title Checklist (12/03/09)
Workers' Compensation, Line 16 (9/13/2012)
Industrial Insured Certification Form
Consent to Rate Filings
Consent to rate instructions 4.1 04-2014
Consent to Rate CTRF AZ 385-1 4.1 10-07
Consent to Rate CTRF AZ 385-2 4.1 10-07
Consent to rate instructions WC 4 04-2014
Consent to Rate CTRF AZ 357-1 WC 10-07
Consent to Rate CTRF AZ 357-2 WC 10-07
Loss Cost Filing Forms
Reference Filling Adoption Form 1024A (PDF version) (Word 2003 version)
Calculation of Company Loss Cost Multiplier 1024B(PDF version - fillable) (Word 2003 version)
Life and Health Division Reporting Forms
HIPAA data report and instructions
HIPAA report on products offered in the individual marketplace
HIPAA report on earned premium volumes and covered individuals
HIPAA report on products/marketing materials avalable to eligible individuals
Credit Life, Disability and Unemployment Report - Form A
Credit Property Report - B
ADOI Survey and Other Reporting Forms (Annual Market Analysis Survey Forms)

(The Market Analysis forms are in Excel 2013 (.xlsx) format.)

To download a file right click and choose "save as" or "save target as...", and open on your local drive. If you are unable to download the file, empty your cache and try again.

MVNR Cover Letter
MVNR (Motor Vehicles Non-Renewal Report)
AZ Annual Health Plans Survey Cover Letter
AZ Annual Health Plans Survey
Health Care Appeals Forms
Health Care Appeals Transmittal Form
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