Wisconsin.gov

Agency Directory Online Services

Wisconsin Department of Template
Wisconsin Office of the

Commissioner of Insurance

Twitter Linkedin
  • Consumers
  • Agents/Agencies
  • Companies
  • Regulation
  • Funds
  • About OCI
  • Contact Us

Special Reporting Forms

Content_Area1

​​​​​​​Last Updated: January 29, 2019

  • Amendment to Articles of Organization, Town Mutual (OCI 26-003)
  • Biographical Form A (OCI 21-200)
  • Care Management Organizations permitted under ch. 648, Wis. Stat.:
    • Biographical Data (OCI 33-004)
    • CPA Audit Checklist (OCI 33-007)​
  • Designation of Registered Agent for Service of Process (OCI 12-014)  Fillable​
  • Directly Placed Unauthorized Tax Report (OCI 27-016)  Fillable
  • Grievance Reporting Forms
  • HMO Data Collection (OCI 26-903) (Administrative Code repealed. No longer required.)
  • Individual Uniform Application for Individual Major Medical Health Insurance Form (OCI 26-503)
  • Insurance Complaint Form (OCI 51-005)
  • Long-Term Care:
    • Issuer Certification Form (OCI 26-113)
    • Policyholder Long-Term Care Partnership Plan Status Form (OCI 26-114)
    • Long-Term Care Reporting Forms
  • Managed Care Plan Certifications
  • Market Conduct Annual Statement
  • Medicare Supplement Reporting Forms
  • Reservation of Corporate Name (OCI 23-010)  Fillable
  • Risk Retention Group Premium Tax Report (OCI 27-017)  Fillable
  • Small Employer Uniform Employee Application for Group Health Insurance (OCI 26-501)
  • Statutory Hold-Harmless Forms (Opt-Out/In):
    • Election of Exemption (Opt-Out) (OCI 22-510)
    • Election to be Subject to Restrictions (Opt-In) (OCI 22-520)
    • Termination of Election to be Subject to Restrictions (Termination of Opt-In) (OCI 22-540)
    • Termination of Exemption (Termination of Opt-Out) (OCI 22-530)

Street Address

125 South Webster St.
Madison, WI 53703

(608) 266-3585
Contact Us
Mailing Address

PO Box 7873
Madison, WI 53707-7873

OCI Complaints
1-800-236-8517
Policies/Records

Disclaimer
Access to Public Records
Support
Wisconsin.gov