• Forms for Filing Financial Statements

    The forms listed below are financial filing statements for: Health Maintenance Organizations/Alternative Financing and Delivery Systems/Nonprofit Health Care Corporations/Dental Service Corporations

    For questions about the annual statements, quarterly statements, and Michigan supplemental forms, contact DIFS at 517-284-8749 or toll free at 877-999-6442.

Forms for Filing Financial Statements

  • FIS 0081 PDF icon

    Life, Accident and Health Insurers Qualifying Assets Under Section 901

  • FIS 0084 PDF icon

    Summary of Subsidiary Corporations

  • FIS 0279 PDF icon

    ANNUAL Notice of Medicaid Claims Defects (was quarterly)

  • FIS 0317 PDF icon

    Revenue and Expense Report for HMOs

  • FIS 0318 PDF icon

    Complaint and Grievance Summary for Health Carriers FIS 0319 was merged into FIS 0318.

  • FIS 0320 PDF icon

    HMO Inpatient Discharges and Benefit Payouts Report

  • FIS 0321 PDF icon

    Working Capital Calculation for HMOs and AFDS

  • FIS 0322 PDF icon

    Michigan Health Insurance Enrollment, Premiums and Losses
    NOTE:  DIFS no longer accepts paper copies of FIS 0322.  Companies must submit via DIFS Online Services portal.