FINANCIAL REPORTING - DOMESTIC: Captive Insurer

Captive News

3/22/2017:  The Captive Annual Filing Portal now accepts captive renewal fee payments by credit card (Visa, MasterCard or Discover) or by ACH electronic check!  Please use the portal to pay your fee.  

2/29/2016:  Captive insurers must use Arizona's new secure, encrypted Captive Insurer Annual Filing Portal ("Portal"), available at https://azinsurance.online/upload/captiveannual, to upload all documents pertaining to the annual filing. 

NOTE: Domestic risk retention groups submit most filings directly to the NAIC but will use the Portal to file the signed Jurat page for the annual and quarterly blanks, the actuarial opinion summary, and the Certificate of Disclosure (Form E-178). 

Using the Portal is free, easy, secure, and eliminates the hassle of having to send information by mail on CDs/DVDs.

Contact the Captive Insurance Division at (602) 364-4490 if you have any questions about the Portal or filing requirements.

Warning - Phishing Scam

We are aware of a phishing scam targeting insurance professionals claiming that the National Association of Insurance Commissioners received a complaint that the professional submitted a falsified claim. This fraudulent email displays the NAIC and CIPR logos, can originate from what appears to be an naic.org or gmail.com email account, and instructs the recipient to click on a link to download the complaint notification.

Certain antivirus products will detect this as a malicious email.  If you receive a similar email and have any concerns, contact the NAIC Service Desk at (816) 783-8500 or [email protected].

ANNUAL FILINGS

For Captives Other Than RRGs: Captive Insurer Annual Report and Renewal Fee Transmittal

This form provides a checklist of captive insurer annual filing requirements.  Pay the annual renewal fee via the online portal or mail a check to the Department of Insurance either with this form or a printout of the "Success!" page you receive after uploading Annual Report documents to the Captive Insurer Annual Report Portal. 

NOTE: Domestic captive RRGs have a different checklist.  See Below.

For Risk Retention Groups: Captive Insurer Annual Report and Renewal Fee Transmittal

This form provides a checklist of captive RRG insurer annual filing requirements.  Pay the annual renewal fee via the online portal or mail a check to the Department of Insurance either with this form or a printout of the "Success!" page you receive after uploading Annual Report documents to the Captive Insurer Annual Report Portal.

NOTE: Domestic RRGs will use the Portal to file the annual and quarterly signed Jurat pages, the annual Form E-178, and the actuarial opinion summary, and will continue to file most other documents through the NAIC.

Captive Insurer Annual Report

Complete this form as part of the required annual filing for insurers licensed as (non-RRG) captives, unless instructed by the Department to use a different format. RRGs file using the NAIC Blank.

Captive Insurer Annual Filing Portal Instructions

Captive insurers other than domestic risk retention groups must use Arizona's new Captive Insurer Annual Filing Portal ("Portal"), available at https://azinsurance.online/upload/captiveannual, to upload all documents pertaining to the annual filing. RRGs also use the portal on a limited basis.  This document contains instructions for using the Portal.

Form E-178: Certificate of Disclosure
ADOI Fee Schedule

Fees are nonrefundable upon payment.  ARS § 20-167(A)

CREDIT PROPERTY EXPERIENCE REPORT, ANNUAL STATEMENT SUPPLEMENT
CREDIT LIFE, DISABILITY AND UNEMPLOYMENT EXPERIENCE REPORT