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Completing the 2008 ICHIA Supplement Form is essential for ensuring compliance with Indiana regulations regarding health insurance assessments. This guide will provide clear, step-by-step instructions to assist you in accurately filling out the form online.

Follow the steps to successfully fill out the ICHIA Supplement Form online.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor for completion.
2. Begin by filling in the company information section, including your NAIC number, company name, address, phone number, contact name, and billing address if it differs.
3. For the Indiana premium deductions section, report the premium amounts from the provided categories. Ensure you have the appropriate figures from your company’s annual statement as required.
4. Complete each deduction line (A through J) by entering the correct dollar amounts. If a specific deduction type does not apply, leave that line blank or insert a zero as necessary.
5. Calculate the total deductions by summing the amounts entered in each deduction field (A through J) and enter this total in the designated field.
6. At the bottom of the form, the officer must sign and date the document, and print their name and title in the spaces provided to affirm the accuracy of the reported figures.
7. Finally, ensure you have attached the required page from your company’s annual statement and prepare the supplement for mailing. It must be sent through traceable mail methods such as UPS, FedEx, or Certified Mail to the address specified.

Complete the 2008 ICHIA Supplement Form online today to ensure your compliance with Indiana health insurance regulations.