Form to petition for health insurance arbitration

Form to respond to petition for health insurance arbitration

"Proof service" form required for health insurance arbitration

 

Form to request auto insurance arbitration

Form to respond to auto insurance arbitration request

"Proof of service" form for auto insurance arbitration

 

Form to request homeowner insurance arbitration

Form to respond to homeowner insurance arbitration request

"Proof of service" form for home insurance arbitration

 

Form to petition for health care reimbursement arbitration

Form to respond to petition for health care reimbursement arbitration

"Proof of Service" of Papers Required for Health Care Reimbursement Arbitration

 

For a more comprehensive list of BERG forms, go to the Company Regulations web page.

General Procedures and Information for Company Changes

Report of Delaware Medical Negligence Claims (18 Del. C. § 6820)

UCAA - Certificate of Authority Applications/Information

UCAA - Corporate Amendments Application

Online complaint form

Complaint form (PDF format)

Authorization to release information (HIPAA privacy consent form)

CE-1 Form - Delaware Continuing Education Provider Approval Application

CE-2 Form - Course Approval Request

CE-3 Form - Notice of Approved Course to be Repeated

CE-4 Form - Continuing Education Course Report Form

CE-5 Form - Continuing Education Course Evaluation

These forms are for inusrance company use only.

Uniform Suspected Insurance Fraud Reporting Form

Instructions for the Fraud Reporting Form

Note: The form is in Microsoft Word format. You may enter your information, print a hard copy, and mail it to Fraud Prevention Bureau, 841 Silver Lake Blvd., Dover, DE 19904. Or, complete the form, save it on your computer and then e-mail it to fraud@deins.state.de.us.

Effective November 1, 2007, all filings must be submitted through SERFF. Hardcopy filings will no longer be accepted.

General Instructions

Small Employer Carrier Annual Information Filing Form
Click here to read the Memorandum from the Director

State Specific Requirements

Form for Reporting Medicare Supplement Policies

Medicare Supplement Refund Calculation Form

Reporting Form for the Calculation of Benchmark Ratio Since Inception for Individual Policies

Reporting Form for the Calculation of Benchmark Ratio Since Inception for Group Policies

Reporting Form for Annual Medigap Rates

State of Delaware Employment Application

Attachments/Forms For Compliance With Regulation 606

Delaware Insurance Certification Form

Notice Of Cancellation Or Termination Of Policy

Effective November 1, 2007, all filings must be submitted through SERFF. Hardcopy filings will no longer be accepted.

General Instructions

State Specific Requirements

Certification of Readability

Form A (from Regulation 603)