Forms and Publications

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Welcome to the forms and publications database

The tables below contain materials the Department publishes for various reasons. You can use the links above to jump to a specific section. In this database, you will find:

Forms used for licensing, reporting, and other functions
Reports published annually and from time to time
Brochures for consumers about various insurance-related topics

You can filter the database using the dropdown menus, or search for part of a file name. Please note that you can select more than one option in the filters.

Forms

Document	Category	Licensee type
Individual Resident License Application	Licensing, Application	Producer
Individual Non-Resident License Application	Licensing, Application	Producer
Individual License Renewal Application	Licensing, Application, Renewal	Producer
Individual License Reinstatement Application	Licensing, Application, Reinstatement	Producer
Individual/Agency Change Request Form	Licensing, Form	Agency, Producer
Clearance Letter Request Form	Licensing, Form	Producer
Business Entity Resident License Application	Licensing, Application	Agency, Company
Business Entity Non-Resident License Application	Licensing, Application	Agency, Company
Business Entity License Renewal Application	Licensing, Application, Renewal	Agency, Company
Business Entity License Reinstatement Application	Licensing, Application, Reinstatement	Agency, Company
Notice of Addition/Termination of Designee to Agency License	Licensing, Form	Agency, Producer
Instructions & Filing Form for Title Organization License	Licensing, Application	Agency, Title
Third-Party Administrator (TPA) Bond Form	Licensing, Form	TPA
Form A: Statement Regarding the Acquisition of Control of or Merger with a Domestic Insurer [Rule R590-70]	Licensing, Rule Attachment, Form	Insurer
Form B: Insurance Holding Company System Annual Registration Statement [Rule R590-70]	Licensing, Rule Attachment, Form	Insurer
Form C: Summary of Changes to Registration Statement [Rule R590-70]	Licensing, Rule Attachment, Form	Insurer
Form D: Prior Notice of a Transaction [Rule R590-70]	Licensing, Rule Attachment, Form	Insurer
Form E: Pre-Acquisition Notification Form Regarding the Potential Competitive Impact of a Proposed Merger or Acquisition by a Non-Domiciliary Insurer Doing Business in This State or by a Domestic Insurer [Rule R590-70]	Licensing, Rule Attachment, Form	Insurer
Form F: Enterprise Risk Report [Rule R590-70]	Licensing, Rule Attachment, Form	Insurer
Medicare Supplement Refund Calculation Form [Rule R590-146]	Reporting, Rule Attachment, Form	Insurer, Health
Reporting Form for the Calculation of Benchmark Ratio Since Inception for Group Policies [Rule R590-146]	Reporting, Rule Attachment, Form	Insurer, Health
Reporting Form for the Calculation of Benchmark Ratio Since Inception for Individual Policies [Rule R590-146]	Reporting, Rule Attachment, Form	Insurer, Health
Form for Reporting Medicare Supplement Policies [Rule R590-146]	Reporting, Rule Attachment, Form	Insurer, Health
Supplemental Form for Renewal of Utah Bail Bond Agency License	Licensing, Rule Attachment, Form, Renewal	Agency, Bail Bond
A & H Bona Fide Employer Association Group Authorization [Rule R590-220]	Filing, Rule Attachment, Form	Insurer, Health
A & H Discretionary Group Authorization [Rule R590-220]	Filing, Rule Attachment, Form	Insurer, Health
A & H Filing Certification [Rule R590-220]	Filing, Rule Attachment, Form	Insurer, Health
A & H Group Questionnaire [Rule R590-220]	Filing, Rule Attachment, Form	Insurer, Health
Appendix A: Utah Life Settlements Initial Application Checklist [Rule R590-222]	Licensing, Rule Attachment, Checklist	Life Settlement Provider
Appendix B: Utah Life Settlement Provider Annual Report [Rule R590-222]	Reporting, Rule Attachment, Form	Life Settlement Provider
Appendix E: Utah Life Settlement Provider Renewal Application [Rule R590-222]	Licensing, Rule Attachment, Application	Life Settlement Provider
Workers Compensation Loss Cost Multiplier Filing Form [Rule R590-225]	Filing, Rule Attachment, Form	Workers Compensation
Utah Insurer Loss Cost Multiplier Filing Form [Rule R590-225]	Filing, Rule Attachment, Form	Insurer, Property & Casualty
Filing Certification [Rule R590-226, R590-227]	Filing, Rule Attachment, Form	Insurer, Life, Annuity
Group Questionnaire [Rule R590-226, R590-227]	Filing, Rule Attachment, Form	Insurer, Life, Annuity
Discretionary Group Authorization [Rule R590-226, R590-227]	Filing, Rule Attachment, Form	Insurer, Life, Annuity
Credit Life and Credit Accident & Health Filing Certification [Rule R590-228]	Filing, Rule Attachment, Form	Insurer, Credit Life, Credit Health
Credit Life and Credit Accident & Health Report Check-Off List [Rule R590-228]	Reporting, Rule Attachment, Checklist	Insurer, Credit Life, Credit Health
Utah Individual Health Insurance Application [Rule R590-247]	Rule Attachment, Application	Insurer, Health
Utah Small Employer Health Insurance Application [Rule R590-247]	Rule Attachment, Application	Insurer, Health
Producer Agreement and Compensation Disclosure [Rule R590-247]	Rule Attachment, Form	Insurer, Producer, Health
Independent Review Request Form [Rule R590-261]	Rule Attachment, Form	Consumer, Health
Independent Review Organization (IRO) Application [Rule R590-261]	Licensing, Rule Attachment, Application	IRO
All Payer Claims Database Opt-In Form [Rule R590-262]	Rule Attachment, Form	Insurer, Producer, Consumer, Health
Utah Stop-Loss Experience Report [Rule R590-268]	Reporting, Rule Attachment, Template	Insurer
Large Customer Compensation Disclosure Form [Rule R590-272]	Reporting, Rule Attachment, Form	Producer
Pharmacy Benefit Manager (PBM) Application [Rule R590-282]	Licensing, Rule Attachment, Application	PBM
Mandate Defrayal Data Template [Rule R590-283]	Reporting, Rule Attachment, Template	Insurer, Health
Dual Licensee Request Form [Rule R592-5]	Licensing, Rule Attachment, Form	Producer, Title
Dual Licensee Expedited Request Form [Rule R592-5]	Licensing, Rule Attachment, Form	Producer, Title
Title Office/Manager Change – Office Report Form [Rule R592-10]	Reporting, Rule Attachment, Form	Agency, Title
Title Insurance Producer Annual Report Form [Rule R592-11]	Reporting, Rule Attachment, Form	Agency, Producer, Title
Motor Club Renewal Form	Licensing, Form	Motor Club

Reports

Document	Category	Subcategory	Year
DTR Report March 2024	Pharmacy	Drug Transparency Report	2024
DTR Report February 2024	Pharmacy	Drug Transparency Report	2024
DTR Report January 2024	Pharmacy	Drug Transparency Report	2024
2023 Statutory Deposit Report	Insurer	Statutory Deposits	2023
2022 Statutory Deposit Report	Insurer	Statutory Deposits	2022
PPI Report 2023	Pharmacy	Pharmacy Premium Impact Report	2023
PPI Report 2022	Pharmacy	Pharmacy Premium Impact Report	2022
PPI Report 2021	Pharmacy	Pharmacy Premium Impact Report	2021
2023 Annual Comparison Tables	Auto, Home	Comparison Report	2023
2022 Annual Comparison Tables	Auto, Home	Comparison Report	2022
2021 Annual Comparison Tables	Auto, Home	Comparison Report	2021
2020 Annual Comparison Tables	Auto, Home	Comparison Report	2020
2019 Annual Comparison Tables	Auto, Home	Comparison Report	2019
2023 Pharmacy Premium Impact Report	Pharmacy	Premium Impact Report	2023
2022 Pharmacy Premium Impact Report	Pharmacy	Premium Impact Report	2022
2021 Pharmacy Premium Impact Report	Pharmacy	Premium Impact Report	2021
DTR Report January 2023	Pharmacy	Drug Transparency Report	2023
DTR Report February 2023	Pharmacy	Drug Transparency Report	2023
DTR Report March 2023	Pharmacy	Drug Transparency Report	2023
DTR Report April 2023	Pharmacy	Drug Transparency Report	2023
DTR Report May 2023	Pharmacy	Drug Transparency Report	2023
DTR Report June 2023	Pharmacy	Drug Transparency Report	2023
DTR Report July 2023	Pharmacy	Drug Transparency Report	2023
DTR Report August 2023	Pharmacy	Drug Transparency Report	2023
DTR Report September 2023	Pharmacy	Drug Transparency Report	2023
DTR Report October 2023	Pharmacy	Drug Transparency Report	2023
DTR Report November 2023	Pharmacy	Drug Transparency Report	2023
DTR Report December 2023	Pharmacy	Drug Transparency Report	2023
DTR Report January 2022	Pharmacy	Drug Transparency Report	2022
DTR Report February 2022	Pharmacy	Drug Transparency Report	2022
DTR Report March 2022	Pharmacy	Drug Transparency Report	2022
DTR Report April 2022	Pharmacy	Drug Transparency Report	2022
DTR Report May 2022	Pharmacy	Drug Transparency Report	2022
DTR Report June 2022	Pharmacy	Drug Transparency Report	2022
DTR Report July 2022	Pharmacy	Drug Transparency Report	2022
DTR Report August 2022	Pharmacy	Drug Transparency Report	2022
DTR Report September 2022	Pharmacy	Drug Transparency Report	2022
DTR Report October 2022	Pharmacy	Drug Transparency Report	2022
DTR Report November 2022	Pharmacy	Drug Transparency Report	2022
DTR Report December 2022	Pharmacy	Drug Transparency Report	2022
2022 Annual Report	Department	Annual Report	2022
2021 Annual Report	Department	Annual Report	2021
2020 Annual Report	Department	Annual Report	2020
2019 Annual Report	Department	Annual Report	2019
2018 Annual Report	Department	Annual Report	2018
2017 Annual Report	Department	Annual Report	2017
2016 Annual Report	Department	Annual Report	2016
2015 Annual Report	Department	Annual Report	2015
2014 Annual Report	Department	Annual Report	2014
2013 Annual Report	Department	Annual Report	2013
2023 Health Insurance Market Report	Health	Health Market Report	2023
2022 Health Insurance Market Report	Health	Health Market Report	2022
2021 Health Insurance Market Report	Health	Health Market Report	2021
2020 Health Insurance Market Report	Health	Health Market Report	2020
2019 Health Insurance Market Report	Health	Health Market Report	2019
2018 Health Insurance Market Report	Health	Health Market Report	2018
2017 Health Insurance Market Report	Health	Health Market Report	2017
2016 Health Insurance Market Report	Health	Health Market Report	2016
2015 Health Insurance Market Report	Health	Health Market Report	2015
2014 Health Insurance Market Report	Health	Health Market Report	2014
Affordable Insulin Study (2020)	Health	Other	2020
Utah In Vitro Fertilization and Genetic Testing Report (2022)	Health	Other	2022
2022 Market Share Report	Department	Market Share Report	2022
2021 Market Share Report	Department	Market Share Report	2021
2020 Market Share Report	Department	Market Share Report	2020
2019 Market Share Report	Department	Market Share Report	2019
2018 Market Share Report	Department	Market Share Report	2018
2017 Market Share Report	Department	Market Share Report	2017
2016 Market Share Report	Department	Market Share Report	2016
2015 Market Share Report	Department	Market Share Report	2015
2014 Market Share Report	Department	Market Share Report	2014
2013 Market Share Report	Department	Market Share Report	2013
FY2023 Division Annual Report	Fraud	Annual Report	2023
Who Me?: Who Commits Insurance Fraud and Why	Fraud	Coalition Against Insurance Fraud Report	2023
The Impact of Insurance Fraud on the US Economy	Fraud	Coalition Against Insurance Fraud Report	2022
Globalization of Insurance Fraud	Fraud	Coalition Against Insurance Fraud Report	2021
Workers Compensation Insurance Fraud in America	Fraud	Coalition Against Insurance Fraud Report	2022
Four Faces of Fraud	Fraud	Coalition Against Insurance Fraud Report	2017

Note regarding online retention periods: The Reports database provides a rolling archive of reports for the following durations:

Annual Reports: 10 years, plus the current year
Comparison Tables: 5 years
Market Share Reports: 10 years, plus the current year
Statutory Deposits: 2 years

Records outside these periods may be available by GRAMA request.

Note regarding Market Share Report zip files: These reports include the top 20 companies with the highest percentage of insurance sold in Utah in each specific line. Older reports may not contain the same market share information that later reports include. Generally, reports will contain most of the following lines:

Aggregate Write-Ins
Aircraft
Allied Lines
Annuities
Boiler & Machinery
Burglary & Theft
Collectively Renewable Accident & Health
Commercial Auto
Commercial Multiple Peril
Credit
Credit A&H
Credit Life
Crop
Earthquake
Farmowners
Federal Employee Health Benefit
Fidelity
Financial Guaranty
Fire
Flood
Fraternal Life
Group Accident & Health
Group Life
Homeowners
Individual Accident & Health
Industrial Life
Inland Marine
Medical Malpractice
Mortgage Guaranty
Ocean Marine
Ordinary Life
Other Liability
Private Crop
Private Passenger Auto
Products Liability
Property Totals
Surety
Warranty
Workers’ Compensation
Workers’ Compensation – Excess

Brochures

Document	Category	Language	Source
What is Insurance Fraud?	Fraud	English	Utah Insurance Department
Insurance Agent Fraud	Fraud, Licensees	English	Utah Insurance Department
Health Insurance Fraud	Fraud, Health	English	Utah Insurance Department
Homeowners Insurance Fraud	Fraud, Home	English	Utah Insurance Department
Contractor and Homeowners Insurance Fraud	Fraud, Home	English	Utah Insurance Department
Automotive Insurance Fraud	Fraud, Auto	English	Utah Insurance Department
Auto Accident Victim Recruitment	Fraud, Auto	English	Utah Insurance Department
¿Que es el Fraude de Seguros?	Fraude	Español	Departamento de Seguros de Utah
Fraude de un Agente de Seguros	Fraude, Agente	Español	Departamento de Seguros de Utah
El Fraude de Seguros de Salud	Fraude, Salud	Español	Departamento de Seguros de Utah
Propietarios Fraude de Seguros	Fraude, Casa	Español	Departamento de Seguros de Utah
Contratista y Dueño de Casa Fraude de Seguro	Fraude, Casa	Español	Departamento de Seguros de Utah
El Captar y Atraer Víctimas de Accidentes Automovilísticos	Fraude, Auto	Español	Departamento de Seguros de Utah
“Fight Fake Insurance” Message Points	Fraud	English	NAIC
Protect Yourself: Buying Insurance on the Internet	Fraud	English	NAIC
Consumer Alert: Long Term Care Insurance Fact Sheet	Long-Term Care	English	NAIC
Consumer Alert: Protecting Small Businesses from Fraudulent Health Plans	Fraud, Health	English	NAIC
Consumer Alert: Be Careful When Purchasing a Discount Health Card	Health	English	NAIC
Consumer Alert: Tips for Saving Money on Auto Insurance	Auto	English	NAIC
A Shopper's Guide to Long-Term Care Insurance	Long-Term Care	English	NAIC
Deferred Annuity Buyers Guide	Life, Annuity	English	NAIC
Deferred Annuity Fixed Buyers Guide	Life, Annuity	English	NAIC
Deferred Annuity Variable Buyers Guide	Life, Annuity	English	NAIC
A Consumer's Guide to Auto Insurance	Auto	English	NAIC
Consumer Alert: Tips for Saving Money on Auto Insurance	Auto	English	Utah Insurance Department
Putting Down Roots in Earthquake Country	Disaster Preparedness	English	Utah Seismic Safety Commission
Echando Raíces en Tierra de Terremotos	Preparación para desastres	Español	Comisión de Seguridad Sísmica de Utah
A Consumer's Guide to Earthquake Insurance	Disaster Preparedness	English	NAIC