INSURER FORMS AND APPLICATIONS
Find a list of downloadable and online forms for insurance companies.
CYBERSECURITY EXCEPTION CERTIFICATION
Complete this form and email to
cid.mc@ct.gov
.
Annual Financial Filing Requirements
Bail Bonds
Captive Insurance
TAX RETURNS
APPLICATIONS
Connecticut Data Security Forms
CYBERSECURITY NOTIFICATION FORM
Complete this form and email to cid.mc@ct.gov along with all required attachments.
PLEASE NOTE: ALL MATERIAL INFORMATION MUST BE FULLY DOCUMENTED WITHIN EACH FIELD. NOTATIONS SUCH AS ‘SEE ATTACHED LETTER’ OR ANY OTHER COMPARABLE REFERENCE ARE NOT PERMITTED.
DATA SECURITY LAW ANNUAL CERTIFICATION
Complete this form and email to
cid.mc@ct.gov
.
Surveys
CONSUMER REPORT CARD SURVEY PART 1
Five worksheets in this excel workbook
CONSUMER REPORT CARD SURVEY PART 2
Nine worksheets in this excel workbook
CONSUMER REPORT CARD SURVEY ADDENDUM
All networks
FORMULARY SURVEY
Complete this form and email to LHCompliance@ct.gov along with all required attachments.
PHARMACY BENEFIT MANAGEMENT (PBM) SURVEY
Any question, please contact LHCompliance@ct.gov
PRESCRIPTION DRUG REBATE PRACTICES SURVEY
Any question, please contact LHCompliance@ct.gov
OUTPATIENT PRESCRIPTION DRUG COST SURVEY
Use of this portal is ONLY available during the reporting period - from January 1 to September 1 every year.
OUTPATIENT PRESCRIPTION DRUG COST SURVEY USER GUIDE
For the Outpatient Prescription Drug Cost Survey Tool
ANNUAL REPORT ON PRICING & PROFIT
More information coming soon.
