Medicare Supplement Reporting Forms

Last Updated: January 16, 2018

Procedure to Submit Required Annual Market Regulatory Reports to OCI

​The following reporting forms are required to be filed with the Office of the Commissioner of Insurance (OCI) annually by the indicated Due Date for all insurers that had Medicare supplement business in force in Wisconsin during the previous calendar year:

Form NumberDescriptionReferenceDue Date
26-300Medicare Supplement Experience Exhibits. Ins 3.39 (16) (a), Wis. Adm. CodeApril 1
26-302Medicare Supplement Benefit Appealss. Ins 3.55 (3) (a), Wis. Adm. CodeMarch 31
26-303Medicare Supplement Multiple Policiess. Ins 3.39 (26), Wis. Adm. CodeMarch 1

OCI has an online interface for insurance companies to interact with the Wisconsin Market Regulatory Reports and Forms application.

The insurer's Wisconsin Market Regulatory Reports and Forms Security Administrator/Forms Administrator will assign the required Medicare supplement reporting forms to staff for completion. The forms are completed utilizing the online Wisconsin Market Regulatory Reports and Forms application.

For information regarding the Wisconsin Market Regulatory Reports and Forms application, please reference the procedures document.

For any questions, please e-mail ocimrreports@wisconsin.gov. The e-mail should include the company's legal name and NAIC company number.