Annual Data Report Forms


All carriers writing hospital, surgical and medical expense and major medical business in the individual, small group and large group markets in North Dakota are required by law to submit annual data report forms (N.D.C.C. § 26.1-36.4-06 and N.D. Admin. Code § 45-06-06.1-11).

Please complete the forms below and return them to the Department no later than March 15. If a form is not applicable, no submission is required.

Small group annual actuarial certifications must also be received on March 15. The certification must be filed as a rate filing and must address all aspects of N.D.C.C. § 26.1-36.3-04(2). Please note also that there is a substantial penalty for small group data forms received after March 15.

Companies with no business to report are not required to file these forms.

Please address all questions and forms to the North Dakota Insurance Department.