The NAIC Annual Statement – Health is the yearly financial report that every health insurance company, HMO, and limited-scope health entity files to show its full financial condition to state insurance regulators. You file it once a year, and the main copy is due by March 1 for the prior calendar year. Health insurers and HMOs file the Health Annual Statement Blank (often called the “Orange Blank”) along with the Health Annual Statement Instructions that explain each page.
This guide walks you through the 2025 data-year blank, which is the version filed by March 1, 2026. Getting a number wrong is not a small thing. A late or flawed filing can trigger fines, a regulatory exam, or even a hold on your license, and many states fine companies $100 or more per day for a late annual statement. Across the country, thousands of regulated entities file each year, and a single math error on a key schedule can flag your company for extra review by your state’s Industry Financial Filing reviewers.
Here is what you will learn in this guide:
- 📋 What the Health Annual Statement is, who must file it, and the law behind it
- 📂 The exact documents and ID numbers to gather before you open the blank
- ✍️ A line-by-line walkthrough of the Jurat, Assets, Liabilities, Revenue, Schedule H, and Schedule T
- 🧾 Three full filled-out examples using real-world filer scenarios
- ⚠️ The most common mistakes that get statements rejected and how to dodge them
What the Form Is and Who Must File It
The NAIC Annual Statement – Health is a standardized financial report. It captures a health entity’s assets, liabilities, revenue, expenses, capital, and surplus for the calendar year. The form lets regulators check that a company holds enough money to pay claims and stay solvent. The National Association of Insurance Commissioners (NAIC) designs the blank, but your state insurance department is the agency that legally requires you to file it.
You must file the Health blank if you are a risk-bearing health entity. This includes health maintenance organizations (HMOs), comprehensive major medical insurers, dental-only and vision-only plans, and many managed care organizations. The rule comes from each state’s insurance code, which adopts the NAIC annual statement by reference. For example, a California HMO files under the rules enforced by the California Department of Insurance or the Department of Managed Health Care, depending on its license type.
The statute behind the form matters. Most state insurance codes say a licensed insurer “shall annually file” a statement in the form the commissioner prescribes, and the commissioner prescribes the NAIC blank. If you ignore this rule, the consequence is direct: your state can fine you, suspend your certificate of authority, or place you under supervision. A real-world example is a small dental plan that skips a filing year, gets flagged as “delinquent,” and then cannot renew its license until it files and pays penalties. A common misconception is that the NAIC itself enforces the filing. It does not. The NAIC collects and stores the data, but your domiciliary state holds the legal power to penalize you.
The Health blank also connects to other key filings. These include the quarterly statements (due 45 days after each quarter), the Risk-Based Capital (RBC) report, the Management’s Discussion and Analysis, and the audited financial report. Each one shares data with the annual statement, so your annual numbers must tie to these companion filings.
Before You Start: Documents and Information You Need
Filling out the Health blank is much smoother when you gather your records first. The statement pulls from your full set of statutory books, so you want every supporting schedule ready before you open the software. Missing one item can stall the whole filing and force you to refile.
Here is your pre-filing checklist. Gather each item below before you start, because a gap in any one of them creates a hole in the statement that reviewers will catch.
- NAIC Company Code (CoCode). This is your unique five-digit ID; without it the NAIC cannot match your filing, and a new entity must request one through the Company Code Application.
- NAIC Group Code. This links your entity to its holding company group; if you leave it blank or use the wrong code, your data will not roll up correctly.
- Federal Employer ID Number (FEIN). Regulators cross-check this against federal records, and a wrong FEIN can flag your filing as a possible duplicate.
- Prior-year annual statement. You need last year’s ending balances to fill the “prior year” columns; without it your year-over-year columns will not tie.
- Trial balance and general ledger. These feed every dollar figure on the Assets, Liabilities, and Revenue pages, and a ledger that is not closed produces wrong totals.
- Claims data and IBNR estimates. You need paid claims plus incurred-but-not-reported reserves for the Liabilities page and Schedule H, and a missing IBNR figure understates your reserves.
- Premium records by state. Schedule T requires premiums broken out by every state, so a missing state allocation will throw off the schedule’s total.
- Investment schedules. Bonds, stocks, and cash detail feed the asset pages and Schedule D; without them your invested assets will not reconcile.
- Reinsurance contracts. Schedule S needs your ceded and assumed reinsurance detail, and a missing treaty distorts your net risk picture.
- List of officers and directors. The Jurat page requires current names and titles, and an outdated list can make the signature page invalid.
Take time to confirm your books are closed and reconciled before you begin. If you open the blank with an unbalanced ledger, every downstream page inherits the error. That turns a one-hour review into a multi-day cleanup.
Where to Get the Form and How to Access It
You do not type the Health blank into a blank document by hand. Almost every filer uses NAIC-approved statement software, but the official blank and instructions are free to download. You can pull the current Health Annual Statement Blank and the matching Health Annual Statement Instructions directly from the NAIC publications library at no cost.
Most companies prepare the statement using third-party vendor software. Common tools include Wolters Kluwer (Booke), Eagle Technology Management, and similar statutory reporting platforms. This software builds the blank in the exact NAIC format, runs the cross-checks, and produces the electronic file the NAIC accepts. You enter your numbers, and the software maps them to the correct pages, lines, and columns.
The blank changes a little every year. The Blanks (E) Working Group adopts modifications each cycle, so a line that existed last year may move or change. The consequence of using an old version is real: the NAIC will reject a file built on a prior-year template. A mini-example is a filer who reuses 2024 software for the 2025 data year and finds the submission bounced because a supplement was renumbered. A common misconception is that the form never changes. It does change yearly, so always confirm you have the current data-year version before you start.
Step-by-Step: How to Fill Out the Health Annual Statement Line by Line
This is the heart of the filing. The Health blank has many pages, but a handful drive most of the review and most of the errors. Below, each major page or schedule gets its own walkthrough. Enter every page in the order it appears in the blank, and let your software carry forward totals where it can.
1. Jurat Page (Title Page)
The Jurat page asks who you are, where you are based, and who is signing under oath that the statement is true. It is the cover and the legal certification of the whole filing.
To answer it, enter your full legal company name exactly as it appears on your certificate of authority. Then enter the NAIC Group Code and NAIC Company Code in the boxes at the top, the FEIN, your state of domicile, the date you commenced business, and your statutory home office address. For a U.S. insurer, enter US in the Country of Domicile field, as the Jurat instructions direct.
For a specific example, Bay Health Plan, Inc. writes its company code 95123, its group code 0850, its FEIN 94-1234567, and lists CA as its state of domicile, then prints and signs the page. An officer signs under oath, and the signed page is scanned with OCR-enabled software before it joins the PDF, per the NAIC annual filing directive.
A nuance arises with addresses. Your statutory home office may differ from your mailing address, and a P.O. Box is allowed for the mailing line but not for the statutory home office. A common mistake on this page is entering the wrong NAIC Company Code, which causes the NAIC to fail to match your filing to your company and shows you as a non-filer. A misconception is that initials are acceptable for officer names; they are not, and the full name and title are required for each signer.
2. Assets Page (Page 2)
The Assets page asks what your company owns and how much of it counts toward solvency. It lists bonds, stocks, cash, premiums receivable, and other assets, then splits them into “admitted” and “non-admitted” amounts.
To answer it, pull each asset class from your general ledger and Schedule D and Schedule E detail. Enter the gross asset in Column 1, the non-admitted portion in Column 2, and the net admitted asset in Column 3. The admitted total flows to your statement of net worth, so it must tie to your supporting schedules.
For example, Bay Health Plan enters $42,500,000 in bonds, $8,200,000 in cash and short-term investments, and $3,100,000 in uncollected premiums, then reports $1,400,000 of that premium balance as non-admitted because it is over 90 days past due.
A nuance is the non-admitted rule. Statutory accounting forces you to non-admit certain assets, such as furniture, prepaid expenses, and overdue receivables, because they cannot reliably pay claims. A common mistake is admitting a premium receivable that is more than 90 days old, which overstates your surplus and can trigger a restatement. A misconception is that all assets count toward solvency; under statutory accounting, many do not.
3. Liabilities, Capital and Surplus Page (Page 3)
This page asks what your company owes and what is left over as capital and surplus. The biggest line for a health entity is usually unpaid claims, including the incurred-but-not-reported (IBNR) reserve.
To answer it, enter claims unpaid, unpaid claims adjustment expenses, premiums received in advance, general expenses due, and any other payables. Then the page subtracts total liabilities from total admitted assets to compute capital and surplus. Your claims unpaid figure must agree with the underwriting detail and with Schedule H.
For example, Bay Health Plan reports $11,800,000 in claims unpaid, $650,000 in unpaid claims adjustment expenses, and $900,000 in premiums received in advance, leaving capital and surplus of $26,300,000.
A nuance is the IBNR estimate. Claims unpaid is not just claims you have already received; it includes a reserve for care already given but not yet billed. A common mistake is understating IBNR, which inflates surplus today and forces a painful reserve strengthening later. A misconception is that claims unpaid equals the checks you have not yet cut; in truth it must also capture the unknown, unreported claims.
4. Statement of Revenue and Expenses (Page 4)
This page asks how much premium you earned and how much you spent on care and operations. It is the health-industry version of an income statement.
To answer it, enter net premium income, then medical and hospital claims incurred, claims adjustment expenses, and general administrative expenses. The page nets these to a net underwriting gain or loss, then adds net investment income to reach net income. These figures must agree with the Underwriting and Investment Exhibit.
For example, Bay Health Plan reports $98,400,000 in net premium income, $83,600,000 in hospital and medical claims incurred, and $9,200,000 in administrative expenses, producing a net underwriting gain near $5,600,000 before investment income.
A nuance is the treatment of capitation. If you pay providers a fixed per-member amount, that capitation belongs in claims incurred, not in administrative expense. A common mistake is misclassifying capitation as admin cost, which distorts your medical loss ratio and your Schedule H. A misconception is that premium income equals cash collected; it is earned premium, adjusted for the change in unearned premium.
5. Schedule H – Accident and Health Exhibit
Schedule H asks for a detailed analysis of your health premiums, claims, and expenses by line of business. It is the schedule regulators use to test your loss ratios and underwriting results.
To answer it, break your earned premiums and incurred claims into the proper lines, such as comprehensive, Medicare Supplement, dental, and vision. Report claims on an incurred basis and compute the loss ratio for each line. The totals must tie back to the Statement of Revenue and Expenses.
For example, Bay Health Plan shows comprehensive earned premium of $90,000,000 with incurred claims of $77,400,000, a loss ratio of 86 percent, plus a smaller dental block reported on its own line.
A nuance is the incurred-claims definition, which equals paid claims plus the change in claim reserves, not just claims paid in cash. A common mistake is reporting paid claims instead of incurred claims, which makes your loss ratio look wrong and invites questions. A misconception is that Schedule H is optional detail; regulators rely on it heavily to judge pricing adequacy.
6. Schedule T – Premiums Allocated by State
Schedule T asks where you wrote your business, listing premiums by each state and territory. States use it to verify premium tax and to confirm you are licensed everywhere you write business.
To answer it, report premiums on a written basis, gross of reinsurance, for every state where you have direct business, as the Schedule T instructions require. Enter the state’s two-letter code, the direct premiums written there, and mark whether you are licensed in that state. The grand total must equal your total direct written premium.
For example, Bay Health Plan reports $96,000,000 of direct premium written in CA and small amounts in NV and AZ, with a license status flag for each state.
A nuance is the alien or non-licensed business rule, which requires separate reporting if you wrote premium in a state where you are not licensed. A common mistake is allocating premium to the wrong state, which can cause a premium tax underpayment and a state audit. A misconception is that Schedule T uses earned premium; it uses written premium, gross of reinsurance.
7. General Interrogatories and Notes to Financial Statements
This section asks yes-or-no questions about your operations and requires written notes that explain your numbers. The interrogatories cover ownership, affiliates, investments, and compliance items.
To answer it, respond to each numbered interrogatory truthfully and complete every applicable note, including Note 1 on significant accounting policies and any note that explains a deviation from standard rules. If you depart from a reporting rule, disclose it in Note 1 to the extent it affects the numbers.
For example, Bay Health Plan answers Yes to a question about being part of a holding company group and attaches an organizational chart, then completes its note on claim reserve methods.
A nuance is materiality, since some notes are only required when an item crosses a dollar or percentage threshold. A common mistake is leaving an interrogatory blank, which the software flags as an incomplete answer and can bounce the filing. A misconception is that the notes are boilerplate; reviewers read them closely to understand unusual items.
Three Filled-Out Examples Using Real Scenarios
Below are three filers who each complete the Health blank from start to finish. Each table shows what that filer enters in the key sections so you can see how different entity types fill the same form.
Scenario 1: Maria Lopez, CFO of a single-state HMO (Bay Health Plan, Inc.)
| Form Section | What Bay Health Plan Enters |
|---|---|
| Company name and CoCode | Bay Health Plan, Inc., code 95123 |
| State of domicile | CA |
| Total admitted assets | $53,800,000 |
| Claims unpaid (incl. IBNR) | $11,800,000 |
| Net premium income | $98,400,000 |
| Hospital and medical claims | $83,600,000 |
| Schedule H comprehensive loss ratio | 86 percent |
| Schedule T top state | CA, $96,000,000 |
Scenario 2: Marcus Reed, controller of a multi-state comprehensive health insurer (National Care Assurance Co.)
| Form Section | What National Care Assurance Enters |
|---|---|
| Company name and CoCode | National Care Assurance Co., code 81277 |
| State of domicile | TX |
| Total admitted assets | $610,000,000 |
| Claims unpaid (incl. IBNR) | $142,000,000 |
| Net premium income | $1,250,000,000 |
| Hospital and medical claims | $1,070,000,000 |
| Schedule H comprehensive loss ratio | 85.6 percent |
| Schedule T states reported | 18 states, TX largest |
Scenario 3: Aisha Khan, accounting manager at a limited-scope dental plan (BrightSmile Dental, Inc.)
| Form Section | What BrightSmile Dental Enters |
|---|---|
| Company name and CoCode | BrightSmile Dental, Inc., code 77041 |
| State of domicile | FL |
| Total admitted assets | $9,400,000 |
| Claims unpaid (incl. IBNR) | $1,150,000 |
| Net premium income | $14,200,000 |
| Dental claims incurred | $10,650,000 |
| Schedule H dental loss ratio | 75 percent |
| Schedule T top state | FL, $14,200,000 |
These three filers show the same blank flexing for very different sizes. Janet Pierce, a consultant who reviews all three, checks that each company’s Schedule T total equals its direct written premium before sign-off. That single tie-out catches most premium errors before the statement leaves the building.
How to File the Completed Form
The Health Annual Statement is filed through two channels at once: an electronic data file to the NAIC and a copy to your state of domicile. You must complete both, because the NAIC stores the data while the state holds the legal authority to accept it. Plan your timeline so both arrive on or before the deadline.
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NAIC electronic filing. You submit the electronic file (and a signed, OCR-scanned PDF) through the NAIC’s filing system described on the Industry Financial Filing page. The annual statement filing fee is due March 1, 2026, and you pay it following the NAIC’s filing fee instructions. Keep the confirmation receipt the system generates as your proof of filing.
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State of domicile filing. Your home state may require a paper or electronic copy in addition to the NAIC submission, and rules vary by state. Check your state insurance department’s filing page for the exact address or portal, any state-specific fee, and accepted payment methods. Keep a stamped copy or electronic confirmation as proof.
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Companion filings. Quarterly statements are due 45 days after each quarter end, and other supplements have their own dates on the filing deadlines schedule. File these on time so your annual data ties to the rest of the year.
The expected processing time for the electronic file is short; the system validates the file within minutes and reports errors back to you. State review can take weeks. Always retain your NAIC confirmation, your fee receipt, and the signed Jurat page together as your complete proof-of-filing package.
What Happens After You File
After you submit, the NAIC runs automated validation checks on your file. If a cross-check fails, the system returns an error report, and you must correct and refile. A clean file is accepted and stored in the NAIC’s financial database, where regulators and analysts can pull it.
Your state insurance department then performs financial analysis. Analysts review your surplus, your loss ratios on Schedule H, your reserve adequacy, and your RBC results. If your numbers raise a flag, the state may send a follow-up letter asking for an explanation, or it may schedule a financial examination. A real-world example is an HMO whose surplus drops below a trigger, prompting the state to request a corrective action plan.
You may also need to file amendments. If you find an error after filing, you submit an amended statement with a cover page that explains the change, as the annual filing directive describes. The consequence of ignoring a known error is serious: filing a statement you know is wrong can be treated as a false filing and draws penalties. A common misconception is that acceptance by the NAIC means your state has approved the statement; acceptance only means the file passed format checks, not that your state agrees with the numbers.
Mistakes to Avoid When Filling Out the Form
Each field on the Health blank is its own chance for error, so review carefully. Below are the most common mistakes and the direct outcome of each.
- Entering the wrong NAIC Company Code, which makes the NAIC unable to match your filing and lists you as a non-filer.
- Leaving the NAIC Group Code blank, which breaks the roll-up of your data to your holding company group.
- Using a prior-year software template, which causes the NAIC to reject the file outright.
- Admitting premium receivables over 90 days old, which overstates surplus and forces a restatement.
- Understating IBNR in claims unpaid, which inflates current surplus and triggers later reserve strengthening.
- Reporting paid claims instead of incurred claims on Schedule H, which distorts your loss ratio.
- Misclassifying capitation as administrative expense, which skews your medical loss ratio.
- Allocating premium to the wrong state on Schedule T, which can cause premium tax underpayment and a state audit.
- Using earned premium on Schedule T instead of written premium, which makes the schedule fail its tie-out.
- Leaving a General Interrogatory blank, which the software flags as incomplete and can bounce the filing.
- Forgetting to scan a signed Jurat page, which makes the PDF filing invalid.
- Filing after March 1 without an approved extension, which exposes you to per-day late penalties.
Do’s and Don’ts
Keep these habits in mind as you prepare and submit the statement.
Do’s
- Do close and reconcile your general ledger before you begin, so every page starts from clean numbers.
- Do confirm you have the current data-year blank, because the form changes each year.
- Do tie Schedule T to your total direct written premium, since a mismatch flags an error.
- Do reconcile claims unpaid to Schedule H, because regulators compare the two.
- Do keep your NAIC confirmation and signed Jurat as proof, in case your state asks.
- Do file companion quarterly statements on time, so your annual numbers tie to the year.
Don’ts
- Don’t admit assets that statutory rules require you to non-admit, or you overstate surplus.
- Don’t guess at IBNR; use a sound actuarial estimate, because a low reserve catches up with you.
- Don’t reuse last year’s software, since the NAIC will reject an old template.
- Don’t leave any interrogatory or required note blank, because incomplete answers stall the filing.
- Don’t allocate premium to a state where you are not licensed without proper disclosure.
- Don’t wait until March 1 to start, since errors surface late and refiling takes time.
Pros and Cons of Filing on Your Own vs. With Professional Help
Many entities debate whether to prepare the statement in-house or hire a statutory reporting firm. The right choice depends on your size, staff, and complexity.
Pros of filing in-house
- Lower direct cost, because you avoid consultant fees.
- Faster turnaround on edits, since your team knows the numbers.
- Better institutional knowledge, as your staff learns the blank year over year.
- Direct control over the timeline, so you set the pace.
- Closer tie to your ledger, because the preparers also keep the books.
Cons of filing in-house
- Higher error risk if your staff is new to statutory accounting.
- Time burden during a busy close, which strains a small team.
- Software cost and training, which can be steep for one filing a year.
- Hard-to-judge reserve estimates without actuarial support.
- Exposure to penalties if a key schedule is wrong and no one catches it.
FAQs
Is the Health Annual Statement due on the same date every year?
Yes. The main annual statement is due March 1 for the prior calendar year, and the NAIC filing fee is due the same day for the 2025 data year.
Do I have to file electronically with the NAIC?
Yes. You submit an electronic file plus a signed, OCR-scanned PDF through the NAIC filing system, and your state may require its own copy as well.
Is the NAIC the agency that fines me for a late filing?
No. Your state insurance department holds the legal power to fine, suspend, or supervise you, while the NAIC only collects and stores the data.
Do I write my NAIC Company Code or my FEIN in the top boxes of the Jurat?
Yes to both, in their own fields; the NAIC Company Code, the NAIC Group Code, and the FEIN each have a separate box on the Jurat page.
Do I report claims unpaid using only checks I have not yet cut?
No. Claims unpaid must also include the IBNR reserve for care already given but not yet reported, or your reserves will be understated.
Do I use written or earned premium on Schedule T?
No earned premium here; Schedule T uses written premium, gross of reinsurance, allocated by each state and territory.
Do I report capitation payments as an administrative expense?
No. Capitation belongs in medical and hospital claims incurred, not administrative expense, because it pays for member care.
Do I have to non-admit a premium receivable that is over 90 days old?
Yes. Statutory accounting requires you to non-admit overdue premium balances, and admitting them overstates your surplus.
Do I need to put my full name and title on the Jurat signature line?
Yes. Initials are not accepted; each officer must show a full name and title, and the page must be signed under oath.
Can I reuse last year’s statement software for this year’s filing?
No. The blank changes each data year, and the NAIC will reject a file built on a prior-year template.
Do I file an amendment if I find an error after submitting?
Yes. You file an amended statement with an explanation cover page, because filing a known error can be treated as a false filing.
Does NAIC acceptance mean my state has approved my statement?
No. Acceptance only means your file passed format checks; your state still reviews and judges the actual numbers separately.
Do dental-only and vision-only plans file the Health blank?
Yes. Limited-scope dental and vision plans that bear risk file the Health Annual Statement, reporting their lines on Schedule H.
Do I need an NAIC Company Code before I can file at all?
Yes. A new risk-bearing entity must request a code through the NAIC Company Code Application, or the system cannot process the filing.
Related reading
- How to Fill Out NAIC Form F (w/Examples) + FAQs
- How to Fill Out the NAIC Annual Statement Blank – Fraternal
- How to Fill Out the NAIC Annual Statement Blank
- How to Fill Out the NAIC Annual Statement — Life and Accident & Health + FAQs
- How to Fill Out the NAIC Annual Statement – Property and Casualty + FAQs
- How to Fill Out NAIC MAR Filing (w/Examples) + FAQs
- How to Fill Out NAIC Form C (w/Examples) + FAQs