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Health Maintenance Organizations

Health Maintenance Organizations

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 517-284-8762 or toll free at 877-999-6442.

Forms for Filing Financial Statements

FIS 0081

Life, Accident and Health Insurers Qualifying Assets Under Section 901

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.