Health Insurers

Below you will find a listing of every state-specific form that applies to health insurers under the Financial Reporting and Tax Requirements section of the North Dakota Insurance Department website. Please refer to the general information under the Filing Requirements for Licensed Companies section.

Renewal Statement For Admitted Companies

The Renewal Statement for Admitted Companies must be submitted using the North Dakota Insurance Department's enhanced Online Renewal System.

The Online Renewal System requires payment of the company's renewal fees by one of the following options:

  • ACH credit - your financial institution or accounting department must originate payment; see the Online Renewal System for further instructions.
  • Wire transfer - see the Online Renewal System for further instructions.
  • Payment by check - a completed copy of the renewal statement must be included along with the company's check and postmarked by March 1 to avoid penalties.

If you have questions regarding the ACH credit or wire transfer processes, please contact the Department.

Please note that the Online Renewal System is designed to accept only originally filed renewal statements. Amended renewal forms cannot be submitted electronically. They must be mailed to the Department. Please contact the Department if you need an amended renewal form.

Forms

Health Company Abstract of Statement (SFN 53892)

  • Electronic filing of the company's abstract form is required.
  • March 1 is the deadline for submitting the electronic abstract form.
  • A filing fee of $30 is imposed by N.D.C.C. § 26.1-01-07.
  • Publication fees are imposed under N.D.C.C. § 26.1-03-10 and N.D.C.C. § 46-05-03 and are billed directly to the insurance company by the North Dakota Newspaper Association.
  • If amended abstract forms are filed after the March 1 deadline, an additional $30 filing fee and any applicable re-publication fees will be payable.

Health Entities Checklist (SFN 52094)

Estimated Premium Tax Statement (SFN 11051)

Reconciled Tax Statement (SFN 11050)