The NAIC Life, Accident & Health/Fraternal Annual Statement is the official yearly financial report that every licensed life insurer, accident and health insurer, and fraternal benefit society must file with state regulators and the National Association of Insurance Commissioners. It uses the 2025 Annual Statement Blank — Life/Fraternal for reporting year 2025, due March 1, 2026, and it shows whether your company holds enough assets and surplus to pay future claims.
This filing is not a tax form, and it is not optional. State insurance departments use it to confirm solvency, and a single broken cross-check or a missing officer signature can flip your filing from accepted to rejected inside the NAIC system. More than 750 life and fraternal entities file this blank each year, and a meaningful share get follow-up letters because of math edits that fail on the first pass. This guide walks you through it the way a 30-year statutory accountant would.
Here is what you will learn:
- 📋 What the Annual Statement is, who must file it, and the law behind it
- 🗂️ Every document and number you must gather before you open the blank
- ✍️ A line-by-line walkthrough of the Jurat Page, Assets, Liabilities, and key exhibits
- 🧾 Three full filled-out scenarios for a stock insurer, a fraternal society, and a separate-accounts filer
- ⚠️ The mistakes that trigger rejections, fines, and regulator follow-up letters
What the Form Is and Who Must File It
The NAIC Annual Statement — Life, Accident & Health/Fraternal (often called the “Life Blue Book” or “the Yellow Book” by older preparers) is a standardized statutory financial statement. It reports your company’s assets, liabilities, surplus, premiums, reserves, and investments on a statutory accounting basis as of December 31. Regulators read it to judge whether you can pay policyholders for decades to come.
You must file it if you are a life insurance company, an accident and health insurer, or a fraternal benefit society licensed in any U.S. state. Filing is required in your state of domicile and in every state where you hold a license, which is why the form is built to one national standard. The legal hook is each state’s insurance code, modeled on the NAIC’s Annual Financial Reporting Model Regulation (Model #205) and the Model Audit Rule, which most states adopt almost word for word.
The agency that receives the electronic copy is the NAIC, which then shares it with each state through its filing system. The deadline is set by statute at March 1 following the reporting year, so the 2025 statement is due March 1, 2026. If you ignore the deadline, the consequence is direct: states charge per-day late fines, can suspend your certificate of authority, and can place your company under regulatory supervision.
A common misconception is that small insurers or newly licensed companies are exempt. They are not. If you held a certificate of authority for even one day of the year, you file a full statement, even if you wrote zero premium.
Before You Start: Documents and Information You Need
Pull every record below before you open the blank, because the form’s automated edits will reject a statement with internal gaps. Statutory reporting cross-checks hundreds of lines against each other, so a missing source number does not just leave one box blank — it breaks the whole filing.
- Prior-year Annual Statement. Every page carries a “prior year” column, and the system compares it to your last filing; a mismatch triggers a Blanks edit.
- Trial balance on a statutory basis. Without it, your Assets and Liabilities pages will not foot, and the statement will fail to balance.
- Your NAIC Company Code and Group Code. These five-digit numbers identify you in the system, and a wrong code routes your filing to the wrong company record.
- Federal Employer Identification Number (FEIN). Regulators match it to federal records, and a mismatch flags the Jurat Page.
- Investment schedules (bonds, stocks, mortgages). These feed Schedule D, Schedule A, and Schedule B; missing detail breaks the asset cross-checks.
- Reinsurance treaties and balances. These feed Schedule S, and missing data understates or overstates your reserves.
- Actuarial reserve valuation and the Actuarial Opinion. Exhibit 5 and the signed opinion both depend on it, and the statement cannot be certified without it.
- Officer names, titles, and notary information. The Jurat Page is void without them, and an unsigned Jurat means the filing is treated as never made.
Gather your appointed actuary’s contact details and engagement early too. The Actuarial Opinion is a separate signed PDF, and a late or missing opinion is one of the most common reasons a domiciliary state issues a deficiency notice.
Where to Get the Form and How to Access It
You do not type the Annual Statement into a paper booklet. Almost every filer uses NAIC-approved vendor software (for example, the systems sold by the major statutory reporting vendors) that loads the official 2025 Annual Statement Blank — Life/Fraternal and the matching 2025 Annual Statement Instructions. The blank carries a printed revision year, so confirm you are using the 2025 version for the 2025 reporting year before you key a single number.
The official line titles, column headings, and page numbers come straight from the NAIC, and you may not rename or renumber them. The instruction book explains every line, and the NAIC Industry Financial Filing page hosts the Blanks Working Group revisions you must apply each year. Reading both is not optional, because the blank changes annually through the maintenance process.
Once your software produces the filing, you submit it electronically to the NAIC and, as required, to each state. Your domiciliary state may also ask for a hard-copy or PDF through its own portal, so check your state’s annual filing checklist. California filers, for example, follow the California Department of Insurance checklist in addition to the NAIC electronic filing.
A frequent error is downloading last year’s blank because it is still bookmarked. The consequence is a structural mismatch that the NAIC system rejects on upload, costing you days you may not have before March 1.
Step-by-Step: How to Fill Out the Life, Accident & Health Annual Statement Line by Line
The statement is built in a fixed order: the Jurat Page first, then the financial pages (Assets, Liabilities, Summary of Operations, Capital and Surplus), then the exhibits and schedules. Complete it in that order, because later pages pull totals from earlier ones. Below is a walkthrough of the spine of the form plus the schedules that cause the most trouble.
1. The Jurat Page (Page 1)
What it asks in plain English. The Jurat Page is the cover and the sworn oath; it asks who you are, where you are located, and which officers swear the numbers are true.
How to answer it. Enter your exact legal company name, NAIC Company Code, NAIC Group Code, FEIN, state of domicile, and incorporation date, then list officers and directors and have at least two officers sign before a notary. Use your legal name exactly as the state licensed it, in the same spelling and punctuation.
Example entry. Evergreen Life Insurance Company, NAIC Company Code 12345, Group Code 0999, FEIN 94-1234567, State of Domicile California.
Nuance or edge case. If your company is a member of a holding group, the Group Code must match the group’s assigned number; a solo company with no group still enters its own assigned code or 0000 where instructed.
Common mistake and consequence. Signing without notarization or with only one officer voids the oath, and the NAIC treats an unsworn statement as not filed, which can start late penalties even though you uploaded on time.
Misconception. Many preparers think an electronic signature alone always satisfies the oath; some states still require a wet signature or a notarized PDF, so confirm your domiciliary state’s rule first.
2. Assets Page (Page 2)
What it asks in plain English. This page lists everything your company owns and assigns each item an “admitted” value the regulator allows you to count toward solvency.
How to answer it. Enter Column 1 (Assets), Column 2 (Nonadmitted Assets), and Column 3 (Net Admitted Assets, which is Column 1 minus Column 2) for each line such as bonds, stocks, cash, and premiums due. The bottom line, Total Assets, must equal your Total Liabilities plus Surplus on Page 3.
Example entry. Evergreen reports bonds of $420,000,000 in Column 1, $0 nonadmitted, and $420,000,000 net admitted on the bond line.
Nuance or edge case. Agents’ balances over 90 days due are nonadmitted, so they belong in Column 2; counting them as admitted overstates your surplus.
Common mistake and consequence. Forgetting to nonadmit ineligible assets inflates surplus, and when the regulator catches it, you face a restated filing and possible RBC consequences.
Misconception. Preparers often think “admitted” equals “owned.” It does not; statutory accounting excludes assets regulators view as not readily available to pay claims.
3. Liabilities, Surplus and Other Funds Page (Page 3)
What it asks in plain English. This page lists what you owe — chiefly policy reserves and claims — and then shows your capital and surplus, the cushion that protects policyholders.
How to answer it. Enter aggregate reserve for life contracts, accident and health reserves, claims liabilities, and other liabilities, then capital and surplus lines, and total the page. Total Liabilities plus Capital and Surplus must equal Total Admitted Assets from Page 2.
Example entry. Evergreen reports aggregate reserve for life contracts of $355,000,000 and total capital and surplus of $48,000,000.
Nuance or edge case. Asset valuation reserve (AVR) and interest maintenance reserve (IMR) are required statutory liabilities for life filers; leaving them out is a common edit failure.
Common mistake and consequence. Pulling reserves from the actuarial report into the wrong line breaks the tie to Exhibit 5, and the cross-check edit fails on upload.
Misconception. New preparers think surplus is “profit.” It is not; it is the net worth cushion regulators measure against risk-based capital.
4. Summary of Operations (Page 4)
What it asks in plain English. This is the statutory income statement; it asks how much premium and investment income came in and how much went out for benefits and expenses.
How to answer it. Enter premiums and annuity considerations, net investment income, benefits paid, increase in reserves, commissions, and general expenses, then show net gain from operations and net income. Each premium figure must agree with the Exhibit of Premiums.
Example entry. Evergreen reports total premiums and annuity considerations of $72,000,000 and net income of $3,400,000.
Nuance or edge case. Realized capital gains flow here, but the IMR-deferrable portion is removed and amortized through the IMR liability instead.
Common mistake and consequence. Reporting gross premium instead of net of reinsurance ceded overstates income and breaks the tie to Schedule S, triggering a regulator question.
Misconception. Filers assume net income drives solvency; regulators care more about the Capital and Surplus Account on Page 4 and your RBC ratio.
5. Capital and Surplus Account (Page 4, lower section)
What it asks in plain English. This section reconciles last year’s surplus to this year’s surplus, line by line.
How to answer it. Start with prior-year surplus, add net income, then add or subtract changes in AVR, unrealized gains, paid-in capital, dividends to stockholders, and other surplus adjustments. The ending line must equal capital and surplus on Page 3.
Example entry. Evergreen begins at $45,100,000, adds $3,400,000 net income, subtracts a $500,000 AVR increase, and ends at $48,000,000.
Nuance or edge case. A change in accounting principle posts here as a direct surplus adjustment, not through net income.
Common mistake and consequence. Omitting the change-in-AVR line leaves the account out of balance, and the page will not tie to Page 3, which is a hard stop.
Misconception. Many think dividends to policyholders and dividends to stockholders go on the same line; they are separate, and mixing them misstates the surplus roll-forward.
6. Exhibit of Premiums and Annuity Considerations
What it asks in plain English. This exhibit breaks your premium income into lines of business — life, annuities, and accident and health.
How to answer it. Report direct, assumed, and ceded premium by line, then net premium, matching the totals you placed on the Summary of Operations. Follow the exact line titles from the Annual Statement Instructions.
Example entry. Evergreen reports ordinary life direct premium of $40,000,000 and group A&H direct premium of $18,000,000.
Nuance or edge case. Single-premium annuity deposits classified as deposit-type contracts may bypass the Summary of Operations and post directly to reserves.
Common mistake and consequence. Misclassifying a line of business throws off the Analysis of Operations by Lines of Business and forces an amended exhibit.
Misconception. Filers think this exhibit is informational only; it directly feeds guaranty-fund assessments and premium-tax cross-checks.
7. Exhibit 5 — Aggregate Reserve for Life Contracts
What it asks in plain English. This exhibit details your life reserves by product and valuation method, and it is where your actuary’s numbers live.
How to answer it. Enter reserves by valuation basis and interest rate, and answer Interrogatories 1, 2, and 3, which require separate signed Actuarial Opinions on participating, non-participating, and non-guaranteed-element policies. The total must equal the aggregate reserve line on Page 3.
Example entry. Evergreen reports $355,000,000 in Exhibit 5, tying exactly to the Liabilities page.
Nuance or edge case. Principle-based reserves under VM-20 require the separate VM-20 Reserves Supplement and a PBR Actuarial Report.
Common mistake and consequence. A penny difference between Exhibit 5 and Page 3 fails the cross-check edit, and the statement cannot be finalized.
Misconception. Preparers assume the actuary owns this page entirely; the preparer still must tie it to the financial pages and file the supporting opinions.
8. Schedule S — Reinsurance
What it asks in plain English. Schedule S lists every reinsurance treaty, showing what you ceded to and assumed from other carriers.
How to answer it. Report each reinsurer by name, NAIC code, and balances for reserves ceded and assumed, splitting authorized, unauthorized, and certified reinsurers. Ceded amounts must reconcile to the premium and reserve credits taken elsewhere.
Example entry. Evergreen lists Gibraltar Re, cedes $60,000,000 of reserves, and takes a matching reserve credit.
Nuance or edge case. Credit for unauthorized reinsurers requires collateral such as a letter of credit or funds held; without it, you must establish a provision for reinsurance.
Common mistake and consequence. Taking reserve credit for an unauthorized reinsurer with no collateral inflates surplus and forces a Schedule S penalty provision.
Misconception. Filers think reinsurance always reduces required surplus; uncollateralized cessions to unauthorized reinsurers can increase your liabilities instead.
9. Schedule T — Premiums by State
What it asks in plain English. Schedule T shows how your direct premium is spread across every state and territory where you write business.
How to answer it. List each jurisdiction, mark whether you are licensed there, and report direct premium written, with a total that ties to your direct premium on the Exhibit of Premiums.
Example entry. Evergreen reports $22,000,000 of direct premium allocated to California and lists every other state where it is licensed.
Nuance or edge case. Premium on risks in states where you are not licensed must still be reported and explained, often in the General Interrogatories.
Common mistake and consequence. A Schedule T total that does not equal total direct premium triggers a state allocation edit and delays premium-tax reconciliation.
Misconception. Filers think Schedule T only matters to the home state; every state reads its own line to verify your premium-tax base.
10. Notes to Financial Statements and General Interrogatories
What it asks in plain English. The Notes explain accounting choices in narrative form, and the General Interrogatories ask yes/no compliance questions about ownership, investments, and operations.
How to answer it. Answer every numbered note and interrogatory; do not leave blanks, and use “None” or “N/A” where a topic does not apply. Several interrogatories require dollar amounts or attached exhibits.
Example entry. For the interrogatory on ownership, Evergreen answers Yes and discloses its parent, Evergreen Financial Group.
Nuance or edge case. Interrogatory 9 and related reinsurance disclosures may require a separate supplemental filing in some statement types.
Common mistake and consequence. Leaving an interrogatory blank instead of answering “None” fails a completeness edit and reads to regulators as an attempt to hide information.
Misconception. Filers treat the Notes as boilerplate; examiners read them closely, and a vague note invites a market-conduct or financial exam follow-up.
Three Filled-Out Examples Using Real Scenarios
Below are three named filers carried through the most important sections of the statement. Each table has two columns and shows what the company enters.
Scenario 1 — Evergreen Life Insurance Company (stock life insurer in California).
| Form Section | What Evergreen Enters |
|---|---|
| Legal name (Jurat) | Evergreen Life Insurance Company |
| NAIC Company / Group Code | 12345 / 0999 |
| State of domicile | California |
| Total Admitted Assets (Page 2) | $420,000,000 |
| Aggregate life reserve (Page 3) | $355,000,000 |
| Total capital and surplus (Page 3) | $48,000,000 |
| Net income (Page 4) | $3,400,000 |
| Schedule T — California premium | $22,000,000 |
Scenario 2 — Heartland Mutual Aid Society (fraternal benefit society).
| Form Section | What Heartland Enters |
|---|---|
| Legal name (Jurat) | Heartland Mutual Aid Society |
| Entity type | Fraternal Benefit Society |
| State of domicile | Iowa |
| Total Admitted Assets (Page 2) | $95,000,000 |
| Aggregate life reserve (Exhibit 5) | $80,000,000 |
| Unassigned funds / surplus (Page 3) | $9,500,000 |
| General Interrogatory — lodge system | Yes |
| Schedule T — total direct premium | $14,000,000 |
Scenario 3 — Summit National Life (insurer with separate accounts).
| Form Section | What Summit Enters |
|---|---|
| Legal name (Jurat) | Summit National Life Insurance Company |
| NAIC Company Code | 67890 |
| Separate Accounts filed? | Yes — separate statement attached |
| General-account admitted assets | $610,000,000 |
| Separate-account assets (Page 2 line) | $240,000,000 |
| Variable annuity reserves | $235,000,000 |
| Net income (Page 4) | $5,100,000 |
| Variable Annuities Supplement filed? | Yes — due April 1 |
Beyond these three, picture Maria Lopez, a controller at a small term-life carrier who writes $0 premium but still files a full blank, and David Chen, an appointed actuary signing the Exhibit 5 opinions for a mid-size annuity writer. Each filer hits the same pages but leans on different schedules.
How to File the Completed Form
The Annual Statement is filed electronically to the NAIC and to each state as required. There is no single paper booklet you mail to the NAIC; the electronic filing through your vendor software is the official channel.
- NAIC electronic filing. Submit the data file and PDF through the NAIC’s filing system using your vendor software, by March 1, 2026. There is no separate NAIC fee for the financial statement itself; vendor software is your main cost. Processing is immediate, and your proof of filing is the system confirmation and validation report — save both.
- State of domicile. File electronically and, if your state requires it, through its own portal or by PDF; California filers also follow the NAIC Industry Financial Filing standards plus the state checklist. Fees are set by each state’s code; keep the portal receipt as proof.
- Other licensed states. Most states accept the NAIC electronic copy and do not want a separate paper copy, but a handful still request a hard copy or a state-specific page; mail it with tracking and keep the certified-mail receipt.
Certain pieces have different deadlines. The Actuarial Opinion, Risk-Based Capital Report, and Separate Accounts Statement are due March 1, while the Variable Annuities Supplement, Long-Term Care Experience forms, and Management’s Discussion and Analysis are due April 1, 2026. The Audited Financial Report is due June 1.
What Happens After You File
Once you upload, the NAIC runs automated Blanks validation edits and cross-checks against your filing. If pages do not foot or an exhibit does not tie to a financial page, you get an edit report listing each failure, and you must correct and refile. A clean filing posts to the regulator’s database within hours.
State financial analysts then review your statement for solvency signals, comparing your risk-based capital to the action levels in the RBC Model Act. If your RBC ratio falls below a trigger, the state can require a corrective plan, increase monitoring, or, at the lowest levels, take control of the company. A strong filing with a healthy RBC ratio usually means no contact at all.
Your statement also feeds guaranty-fund assessments, premium-tax reconciliation, and any scheduled financial examination. Examiners pull your filed blank as the starting point, so the numbers you report now set the baseline for an exam that may occur years later.
Mistakes to Avoid When Filling Out the Form
- Using the prior year’s blank: the structure mismatch causes an immediate upload rejection.
- Leaving the Jurat unsigned or unnotarized: the statement is treated as never filed and late penalties can start.
- Reporting gross premium instead of net of reinsurance: it overstates income and breaks the Schedule S tie.
- Failing to nonadmit ineligible assets: surplus is overstated and a restatement follows.
- Omitting AVR or IMR: required life liabilities are missing and the edits fail.
- A penny difference between Exhibit 5 and Page 3: the cross-check edit blocks finalization.
- Leaving a General Interrogatory blank: a completeness edit fails and regulators suspect concealment.
- Taking reserve credit for an uncollateralized unauthorized reinsurer: a Schedule S penalty provision is forced.
- A Schedule T total that misses total direct premium: state allocation edits fire and premium-tax review stalls.
- Filing the Actuarial Opinion late or not at all: the domiciliary state issues a deficiency notice.
- Mixing stockholder and policyholder dividends: the surplus roll-forward is misstated.
- Wrong NAIC Company or Group Code: the filing routes to the wrong company record and looks unfiled.
Do’s and Don’ts
Do’s
- Do confirm you are on the 2025 blank before keying numbers, because the form changes every year.
- Do reconcile every exhibit to the financial pages, since the system blocks any filing that does not tie.
- Do gather your prior-year statement first, because every page compares against it.
- Do line up your appointed actuary early, because the Actuarial Opinion gates the whole filing.
- Do run the validation edits before you submit, so you catch failures on your schedule, not the regulator’s.
- Do save the confirmation report and state receipts, because they are your only proof of timely filing.
Don’ts
- Don’t leave any line blank; enter “None” or “0” so completeness edits pass.
- Don’t paraphrase official line titles, because regulators match exact NAIC labels.
- Don’t admit assets statutory rules disallow, since it overstates surplus and invites restatement.
- Don’t wait until late February, because edit corrections take days you may not have.
- Don’t file without the notarized Jurat, because an unsworn statement does not count.
- Don’t ignore the April 1 supplements, because they carry their own penalties.
Pros and Cons of Filing on Your Own vs. With Help
| Filing In-House | Using a Vendor or Consultant |
|---|---|
| Pro: lower direct cost, because you avoid consultant fees | Pro: vendor software handles edits and cross-checks for you |
| Pro: your staff knows your data best | Pro: experts catch statutory nuances before the regulator does |
| Pro: full control of the timeline | Pro: faster turnaround during the February crunch |
| Pro: builds internal expertise year over year | Pro: reduces risk of a rejected or amended filing |
| Pro: no dependence on outside availability | Pro: support line when edits fail at the deadline |
| Con: high risk of edit failures without experience | Con: ongoing license and service fees |
| Con: heavy time burden on a small team | Con: less hands-on knowledge stays in-house |
| Con: easy to miss annual blank changes | Con: you still own the data accuracy and signatures |
| Con: no backup if your preparer leaves | Con: scheduling competes with other clients at peak |
| Con: steeper learning curve for new staff | Con: cost grows with company complexity |
NAIC Annual Statement vs. Health Annual Statement Blank
| Life, Accident & Health/Fraternal Blank | Health Blank |
|---|---|
| Filed by life insurers and fraternal societies | Filed by health-focused entities and HMOs |
| Uses Exhibit 5 life reserves and AVR/IMR | Uses health-specific claim and reserve exhibits |
| Governed by the Life/Fraternal Instructions | Governed by the Health Instructions |
| Emphasizes long-duration reserves | Emphasizes short-duration medical claims |
| Due March 1 with life supplements | Due March 1 with health supplements |
FAQs
Do I have to file if my company wrote zero premium last year?
Yes. If you held a certificate of authority for any part of the year, you file a complete statement, including all required pages and the signed Jurat, even with no premium written.
Is the Annual Statement the same as a tax return?
No. It is a statutory solvency report filed with insurance regulators and the NAIC, not the IRS, and it uses statutory accounting rather than tax or GAAP rules.
Do I write my legal name or trade name on the Jurat Page?
No. You enter your exact legal company name as licensed by your state, not a marketing or trade name, because regulators match it to your certificate of authority.
Does Total Admitted Assets have to equal Liabilities plus Surplus?
Yes. Page 2 Total Admitted Assets must equal Page 3 Total Liabilities plus Capital and Surplus to the penny, or the balance-check edit blocks the filing.
Do I report premium gross or net of reinsurance on the Summary of Operations?
No, not gross. You report premium net of reinsurance ceded, and the ceded amounts must reconcile to Schedule S, or a cross-check edit will fail.
Do I enter agents’ balances over 90 days as an admitted asset?
No. Premiums and agents’ balances over 90 days due are nonadmitted and belong in Column 2 of the Assets page, not in admitted assets.
Is the Actuarial Opinion part of the blank or a separate filing?
No, not part of the blank. It is a separate signed PDF due March 1, and Exhibit 5 interrogatories reference the related opinions you must file.
Do I need two officer signatures on the Jurat Page?
Yes. Most states require at least two officers to sign, often before a notary, and a single or unnotarized signature can void the oath.
Does a fraternal benefit society use this same blank?
Yes. Fraternals file the Life, Accident & Health/Fraternal blank and answer fraternal-specific interrogatories, such as confirming operation through a lodge system.
Do I file the Variable Annuities Supplement on March 1?
No. That supplement, like Long-Term Care Experience forms and the MD&A, is due April 1, while the core statement and Actuarial Opinion are due March 1.
Can I use last year’s blank if the format looks the same?
No. You must use the current 2025 blank, because annual maintenance changes lines and edits, and an old blank fails on upload.
Does filing electronically to the NAIC cover all my states?
No, not always. Most states accept the NAIC electronic copy, but some require a state portal submission or hard copy, so check each state’s annual filing checklist.
Do I leave a General Interrogatory blank if it does not apply?
No. Enter “None,” “N/A,” or “0,” because a blank fails the completeness edit and signals to regulators that you skipped a required disclosure.
Is risk-based capital reported inside the Annual Statement?
No. The Risk-Based Capital Report is a separate filing due March 1, though it draws its figures directly from the numbers in your Annual Statement.
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