Instructions for filing Medicare supplement annual reports
Medicare Supplement Annual Reports are now being accepted through the email address located at the bottom of this page. Please see the following instructions for the specific Medicare Supplement Reports you wish to file:
Form for Reporting Multiple Medicare Supplement Policies and Certificates (WAC 284-66-320)
Please only file this report if you are issuing to an individual resident of Washington State that has in force more than one Medicare supplement policy or certificate.
Grievance Report (RCW 284-66-073 (11)(f))
Please only file this report if you have Select Medicare supplement policies in force in Washington State.
Refund or Credit Calculation (WAC 284-66-203 (2) and WAC 284-66-220)
Please do not send any refund calculations for policies where there were no policyholders in force during the previous year in Washington State.
Medicare Supplement Loss Ratio Experience (WAC 284-55-205) and Annual Filing of Premium Rates and Experience (WAC 284-66-203(6))
Provide the current rates as part of your Medicare Supplement Loss Ratio Experience and your Annual Filing of Premium Rates and Experience.
Please do not send any experience reports for policies where there were no policyholders in force during the previous year in Washington State.
Submitting your Medicare Supplement Reports
- Your reports should be in PDF format.
- If you no longer have any Medicare Supplement plans, please state this in your email and you will not be required to file any Medicare Supplement reports in the future.
- Do not provide reports for more than one company in an email.
- The subject line of the email must include the company name.
- Each report must be in a separate PDF document and the PDF document must have in its name, the name of the report and name of the company.
If you encounter difficulties with the transmission of your reports through email, it could be due to the size of the attachments. Sending separate smaller transmissions may alleviate this problem.
If you have any questions, please email them to firstname.lastname@example.org .