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HEADLINES:
Note: Life and Health Statutory Data Reporting Forms have been moved to another page on this site.
(No due date, use as needed)
Form #
(pdf)
Title
Alternative Version
OIR-B2-312
Notice to Applicant Regarding Replacement of Life Insurance
Word
OIR-B2-313
Exhibit B Comparative Information Form for Proposed Insurance
OIR-B2-1311
Individual Carriers Application to Become a Risk Assuming Carrier or a Reinsuring Carrier- Information
OIR-B2-1304
Individual Carriers Application to Modify Previous Election to Become a Risk Assuming Carrier or a Reinsuring Carrier - Information
OIR-B2-1093
Small Employer Carrier's Application To Become A Risk Assuming Carrier or A Reinsuring Carrier - Information
OIR-B2-1095
Small Employer Carrier's Application To Modify Previous Election To Become A Risk Assuming Carrier or A Reinsuring Carrier - Information
OIR-B2-1261
Election and Premium Notice Form
OIR-B2-1361
Certificate of Individual Health Coverage - Information
OIR-B2-1362
Certificate of Group Health Coverage - Information
OIR-B2-MSC
Outline of Medicare Supplement Coverage
SELF-FUNDED HEALTH BENEFIT PLANS
If you have any general questions about the additional forms listed immediately above, please contact:
Life and Health Product Review (850) 413-3152