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Life, Accident & Health Insurers

The forms listed below are financial filing statements for: Life, Accident and Health Insurers/Fraternal Benefit Societies/United States Branches of Non-US Insurers.

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 0063

Valuation of Section 411 Trusteed Assets Under Section 901 - Life and A&H

FIS 0079

Fraternal Benefit Society Qualifying Assets Under Section 901

FIS 0081

Life, Accident and Health Insurers Qualifying Assets Under Section 901

FIS 0082

Non-Insurance Entity Qualifying Assets Under Section 901(1)

FIS 0318

Complaint and Grievance Summary for Health Carriers FIS 319 was merged into FIS 0318.

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.