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.
- FIS 0081
Life, Accident and Health Insurers Qualifying Assets Under Section 901
- FIS 0084
Summary of Subsidiary Corporations
- FIS 0279
ANNUAL Notice of Medicaid Claims Defects (was quarterly)
- FIS 0317
Revenue and Expense Report for HMOs
- FIS 0318
Complaint and Grievance Summary for Health Carriers FIS 0319 was merged into FIS 0318.
- FIS 0320
HMO Inpatient Discharges and Benefit Payouts Report
- FIS 0321
Working Capital Calculation for HMOs and AFDS
- FIS 0322
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.