Arizona L&d Policyholder And Certificate Census Form - Arizona Department Of Insurance - 2003

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ARIZONA DEPARTMENT OF INSURANCE
ARIZONA L&D POLICYHOLDER AND CERTIFICATE CENSUS - 2003
Cocode:
Company Name :
Type of Policy
Policies/Certificates
Type of Policy
Policies/Certificates
Group
Group
Consumer Credit Insurance¹
Individual
Policies
Certificates³
Senior Products
Individual
Policies
Certificates³
Credit Life Insurance
Medicare Supplement
Credit Disability Insurance
Long Term & Home Health Care
Credit Unemployment Ins.
Credit Property Insurance
Major Medical Products
Policies
Certificates³
Group
Association Group
4
Individual
Policies
Limited Benefit Products²
Certificates³
Small Group (2-50)
Vision Only
Large Group (>50)
5
Dental Only
Mass Marketed Group
Accident Only
Individual Major Medical
AD&D
Individual Short Term
Disability Income
All Other Major Medical
Hospital Indemnity
Specified Disease
Date Completed
Name of individual completing survey
State
Scheduled Benefit
All Other Ltd Benefit
Address
City
Zip
Group
Variable Products
Individual
Policies
Certificates³
Phone #
Ext
Email
Website Address
Annuities
Life
Group
1
Credit insurance products as defined by A.R.S. §§ 20-1603 and 20-1621.01.
Individual
Policies
2
Non-Variable (Standard) Products
Certificates³
Limited benefit products as defined by A.R.S. § 20-1137.
3
Annuities
Certificates issued to AZ residents under a group policy whether it is issued in AZ or elsewhere.
4
Life
Bona fide Associations as defined by A.R.S. § 20-2324.
5
Mass marketed group health insurance as defined by A.R.S. § 20-1661.
• Survey is for calendar year 2003
Mail To:
For Questions Regarding this Survey or
• Please return survey by 3/1/04
Maria G. Chavira
to Download Survey -
• Survey applies to fully insured AZ business only
Arizona Department of Insurance
Contact Department of Insurance:
• Email survey to MarketConduct@id.state.az.us
Market Oversight Division
• or Mail to
Analysis Section
Phone: 1-602-912-8442
2910 N. 44th Street; Second Floor
Fax: 1-602-912-8469
Phoenix, AZ 85018-7256
Web:
Market Oversight Division - Analysis Section [AZ L&D Policyholder & Certificate Census (Ed - 12/03)]

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