Department of Insurance's Dover office will be moving to 1351 West North Street, Suite 101, Dover, DE 19904, effective 7/15/19.

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Delaware Department of
Insurance

Forms & Applications

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

Arbitration Forms
Company Regulation Forms
Consumer Complaint Forms
Continuing Education Provider Forms
Fraud Forms
Freedom of Information Act (FOIA) Policy & Request Form (see Title 8, Delaware Administrative Code)
Home Inventory Form
Life and Health Filing Forms
Medicare Supplement Annual Filing Forms (see below)
Miscellaneous (see below)
Proof of Insurance (Regulation 606) Forms (see below)
Property and Casualty Filing Forms
Producer Licensing Forms
Surplus Lines Brokers Tax Filing Forms
Tax and Annual Renewal Forms (all companies including AR, SL, PG, and RRG)

Medicare Supplement Annual Filing Forms:

Form for Reporting Medicare Supplement Policies
Medicare Supplement Refund Calculation Form
Reporting Form for the Calculation of Benchmark Ratio Since Inception for Individual Policies
Reporting Form for the Calculation of Benchmark Ratio Since Inception for Group Policies
Reporting Form for Annual Medigap Rates

Miscellaneous Forms:

State of Delaware Employment Application
Network Disclosure and Transparency (For medical providers who have patients with policies issued in Delaware)
- APPENDIX 1 – FORM OF FACILITY-BASED PROVIDER DISCLOSURE (Word doc)
- APPENDIX 2 – FORM OF HEALTH CARE PROVIDER DISCLOSURE (Word doc)

Forms & Applications

Medicare Supplement Annual Filing Forms:

Miscellaneous Forms:

Proof of Insurance (Regulation 606) Forms:

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