Delaware Department of
Insurance

Forms & Applications

This page provides links to many of the forms used by the Delaware Department of Insurance.

Medicare Supplement Annual Filing Forms:

DE Motorists Protection Act – Form A “Coverage Election,” Reg. 603
Motor vehicle forms such as FR1 – Delaware Uninsured Vehicle Report, FR4 – Notice of Cancellation or Termination of Policy, and FR19 – State of Delaware Insurance Certification can be found on the Uninsured Motorist section of the Delaware Division of Motor Vehicles website at https://dmv.de.gov/VehicleServices/uninsuredmotorist/ .
Network Disclosure and Transparency (For medical providers who have patients with policies issued in Delaware)
- APPENDIX 1 – FORM OF FACILITY-BASED PROVIDER DISCLOSURE
- APPENDIX 2 – FORM OF HEALTH CARE PROVIDER DISCLOSURE
State of Delaware Employment Application