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.
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
Seven 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
