|
R590. Insurance,
Administration. (Effective 7-12-07)
R590-220. Submission of Accident and Health Insurance Filings.
R590-220-1. Authority.
This rule is promulgated by the insurance commissioner pursuant to
Section 31A-2-201.1 and Subsections 31A-2-201(3), 31A-2-202(2),
31A-22-605(4), 31A-22-620(3)(f), and 31A-30-106(1)(i) and (k).
R590-220-2. Purpose and
Scope.
(1) The purpose of this rule is to set forth procedures for submitting:
(a) accident and health filings required by Section 31A-21-201;
(b) individual accident and health filings in accordance with Section
31A-22-605 and Rule R590-85;
(c) [individual and group ]Medicare supplement filings in
accordance with Sections 31A-22-605 and 31A-22-620, and Rules R590-85 and
R590-146;
(d) long term care filings required by Section 31A-22-1404 and Rule
R590-148;
(e) basic health care plan filings required by Section 31A-22-613.5 and
Rule R590-175; and
(f) health benefit plan filings required by Chapter 31A-30 and
Rule R590-167.
(2) This rule applies to:
(a) all types of accident and health insurance products; and
(b) group accident and health contracts issued to nonresident
policyholders, including trusts, when Utah residents are provided coverage
by certificates of insurance.
R590-220-3. Documents
Incorporated by Reference.
(1) The department requires that the documents described in this rule
shall be used for all filings. Actual copies may be used or you may adapt
them to your word processing system. If adapted, the content, size, font,
and format must be similar.
(2) The following filing documents are hereby incorporated by reference
and are available on the department's web site,
www.insurance.utah.gov:
(a) "NAIC Life, Accident and Health, Annuity, Credit Transmittal
Document," dated March 1, 2007[effective January 1, 2006];
(b) "NAIC [Instruction Sheet for ]Life, Accident and Health,
Annuity, Credit Transmittal Document (Instructions)," dated March
1, 2007[effective January 1, 2006;
(c) "NAIC Instruction Sheet for Life, Accident and Health, Annuity,
Credit Transmittal Document Form Filing Attachment and Rate Filing
Attachment," effective January 1, 2006
(c)[(d)] "NAIC Uniform Life, Accident and Health, Annuity
and Credit Coding Matrix," dated March 1, 2007[effective January
1, 2006];
(d)[(e)] "Utah Accident and Health Insurance Filing
Certification," dated July 1, 2007[version September 1, 2006];
(e)[(f)] "Utah Accident and Health Insurance Group
Questionnaire," dated July 1, 2007[version September 1, 2006];
and
(f)[(g)] "Utah Accident and Health Insurance Request for
Discretionary Group Authorization," dated July 1, 2007[version
September 1, 2006].
R590-220-4. Definitions.
In addition to the definitions in Sections 31A-1-301 and
31A-30-103, the following definitions shall apply for the purposes of
this rule.
(1) "Certification" means a statement that the filing being submitted is
in compliance with Utah laws and rules.
(2) "Discretionary group" means a group that has been specifically
authorized by the commissioner under Subsection 31A-22-701(1)(b).
(3) “Electronic filing”
means a:
(a) filing submitted via the Internet by using the System for Electronic
Rate and Form Filings, SERFF, system; or
(b) filing submitted via the Internet by using the Sircon system.
(4) "Eligible group" means a group that meets the
definition in Subsection 31A-22-701(1)(a).
(5)[(4)] "File And Use" means a filing can be used, sold,
or offered for sale after it has been filed with the department.
(6)[(5)] "File Before Use" means a filing can be used,
sold, or offered for sale after it has been filed with the department and a
stated period of time has elapsed from the date filed.
(7)[(6)] "File For Acceptance" means a filing can be used,
sold, or offered for sale after it has been filed and the filer has received
written confirmation that the filing was accepted.
(8)[(7)] "File for Approval" means a filing can be used,
sold, or offered for sale after it has been filed and the filer has received
written confirmation that the filing was approved.
(9)[(8)] "Filer" means a person or entity who submits a
filing.
(10)[(9)] "Filing," when used as a noun, means an item
required to be filed with the department including:
(a) a policy;
(b) a rate, rate manual, or rate methodologies;
(c) a form;
(d) a document;
(e) a plan;
(f) a manual;
(g) an application;
(h) a report;
(i) a certificate;
(j) an endorsement;
(k) an actuarial memorandum, demonstration, and certification;
(l) a licensee annual statement;
(m) a licensee renewal application; or
(n) an advertisement.
(11)[(10)] “Filing Objection Letter” means a letter
issued by the commissioner when a review has determined the filing fails to
comply with Utah law and rules. The filing objection letter, in addition to
requiring correction of non-compliant items, may request clarification or
additional information pertaining to the filing.
(12) "Filing status information" means a list of the states to
which the filing was submitted, the date submitted, and the states' actions,
including their responses.
(13)[(11)] "Letter of authorization" means a letter signed
by an officer of the insurer on whose behalf the filing is submitted that
designates filing authority to the filer.
(14)[(12)] "Market type" means the type of policy that
indicates the targeted market such as individual or group.
(15)[(13)] "Order to Prohibit Use" means an order issued by
the commissioner that [forbids] prohibits the use of a filing.
(16)[(14)] "Rating methodology change" for the purpose of a
ealth benefit plan means a:
(a) [a ]change in the number of case characteristics used by a
covered carrier to determine premium rates for health benefit plans in a
class of business;
(b) [a ]change in the manner or procedures by which insureds are
assigned into categories for the purpose of applying a case characteristic
to determine premium rates for health benefit plans in a class of business;
(c) [a ]change in the method of allocating expenses among health
benefit plans in a class of business; or
(d) [a ]change in a rating factor, with respect to any case
characteristic, if the change would produce a change in premium for any
individual or small employer that exceeds 10%. A change in a rating factor
shall mean the cumulative change with respect to such factor considered over
a 12-month period. If a covered carrier changes rating factors with respect
to more than one case characteristic in a 12-month period, the carrier shall
consider the cumulative effect of all such changes in applying the 10% test.
(17)[(15)] "Rejected" means a filing is:
(a) not submitted in accordance with Utah laws and rules;
(b) returned to the filer by the department with the reasons for
rejection; and
(c) not considered filed with the department.
(18)[(16)] "Type of insurance" means a specific accident
and health product including dental, health benefit plan, long-term care,
Medicare supplement, income replacement, specified disease, or vision.
(19) “Utah Filed Date” means the date provided to a filer by the Utah
Insurance Department, that indicates a filing has been accepted pursuant to
Subsections 4, 5, 6 or 7.
R590-220-5. General
Filing Information.
(1) Each filing submitted must be accurate, consistent, complete and
contain all required documents in order for the filing to be processed in a
timely and efficient manner. The commissioner may request any additional
information deemed necessary.
(2) An insurer and filer are responsible for assuring that a filing is
in compliance with Utah laws and rules. A filing not in compliance with
Utah laws and rules is subject to regulatory action under Section 31A-2-308.
(3) A filing that does not comply with this rule will be rejected and
returned to the filer. A rejected filing:
(a) is not considered filed with the department[.];
(b) must be submitted as a new filing; and
(c) will not be reopened for purposes of resubmission.
(4) A prior filing[Prior filings] will not be
researched to determine the purpose of the current filing.
(5) The department does not review or proofread every filing.
(a) A filing may be reviewed:
(i) when submitted;
(ii) as a result of a complaint;
(iii) during a regulatory examination or investigation; or
(iv) at any other time the department deems necessary.
(b) If a filing is reviewed and is not in compliance with Utah laws and
rules, a Filing Objection Letter or an Order To Prohibit Use will be
issued to the filer. The commissioner may require the filer
insurer to disclose deficiencies in forms or rating practices to
affected insureds.
(6) Filing correction.
(a) [No transmittal is required when making a correction to misspelled
words and punctuation in a filing. This]Filing corrections are[filing
will be] considered informational.
(b) [No transmittal is required when a clerical correction is made to
a previous filing if]Filing corrections must be submitted within
15 days of the date ["Filed" with]the original filing was
submitted to the department. The filer must reference the original
filing[ or include a copy of the original transmittal].
(c) A new filing is required if a [clerical]filing
correction is made more than 15 days after the date ["Filed" with]the
original filing was submitted to the department. The filer must
reference the original filing[ or include a copy of the original
transmittal].
(7) If responding to a Filing Objection Letter or an Order to Prohibit
Use refer to R590-220-15 for instructions.
(8) Filing
withdrawal. A filer must notify the department when withdrawing a previously
filed form, rate, or supplementary information.
R590-220-6. Filing
Submission Requirements.
(1) All filings must be submitted as an electronic filing.
(2) A
filing must be submitted by market type and type of nsurance.
(3) A
filing may not include more than one type of insurance, or request filing
for more than one insurer.[ A complete filing consists of the following
documents submitted in the following order:]
(4) SERFF Filings.
(a) Filing Description. Do not submit a cover letter. On the general
information tab, complete the Filing Description section with the following
information, presented in the order shown below.
(i) Provide a description of the filing.
(ii) Indicate if the filing:
(A) is new;
(B) is replacing or modifying a previous submission; if so, describe the
changes made, if previously rejected the reasons for rejection, and the
previous filing’s Utah Filed Date;
(C) includes forms for informational purposes; if so, provide the Utah
Filed Date; or
(D) does not include the base policy; if so, provide the Utah Filed Date
of the base policy and describe the effect on the ase
policy.
(iii) Identify if any of the provisions are unusual, controversial, or
have been previously objected to, or prohibited,
and explain why the provision is included in the filing.
(iv) Explain any change in benefits or premiums that may occur
while the contract is in force.
(v) List the issue ages, which means the range of minimum and maximum
ages for which a policy will be issued.
(b) Certification. The filer must certify that a filing has been properly completed AND is
in compliance with Utah laws and rules. The Utah Accident and Health
Insurance Filing Certification must be properly completed, signed, and
attached to the supporting documentation tab. A false certification may
subject the insurer or filer to administrative action.
(c) Domiciliary Approval and Filing Status Information. All filings for
a foreign insurer must include on the supporting documentation tab:
(i) copy of domicile approval for the exact same filing;
(ii) filing status information which includes:
(A) a list of the states to which the filing was submitted;
(B) the date submitted; and
(C) summary of the states' actions and their responses; or
(iii) if the filing is specific to Utah and only filed in Utah, then
state, "UTAH SPECIFIC - NOT SUBMITTED TO ANY OTHER STATE."
(d) Group Questionnaire or Discretionary Group Authorization Letter. A
group filing must attach to the supporting documentation tab either a:
(i) signed and fully completed Utah Accident and Health Insurance Group
Questionnaire; or
(ii) copy of the Utah Accident and Health Insurance iscretionary Group
Authorization letter.
(e) Letter of Authorization.
(i) When the filer is not the insurer, a letter of authorization from the
insurer must be attached to the supplementary documentation tab.
(ii) The insurer remains responsible for the filing being in compliance
with Utah laws and rules.
(f) Items being submitted for filing.
(i) Any forms must be attached to the form schedule tab.
(ii) Any rating documentation, including actuarial memorandums and rate
schedules, must be attached to the rate/rule schedule.
(5) Sircon Filings.
(a)[(1)] Transmittal. The NAIC Life, Accident and
Health, Annuity, Credit Transmittal Document, as provided in R590-220-3[(2)],
must be [on the top of the filing. The transmittal form must be
]properly completed.
(i)[(a)] Complete the transmittal by using the following:
(A)[(i)] NAIC [Instruction Sheet for ]Life, Accident
and Health, Annuity, Credit Transmittal Document (Instructions);
and
(B)[(ii) NAIC Instruction Sheet for Life, Accident and
Health, Annuity, Credit Transmittal Document Form Filing Attachment and Rate
Filing Attachment; and
(iii)
(ii)[(b)]
Do not submit the document described in sections (a)(i)(A) and (B)[,
(ii), and (iii)] with the filing.
(b)[(2)] Filing Description. [A cover letter]Do
not submit a cover letter[ should not be submitted]. [Instead,
the ]In Section 15 of the transmittal, complete the Filing
Description with the following information [must be included in the
Filing Description on the transmittal and ]presented in the order shown
below.
(i) Provide a description of the filing.
(ii)[(i)] Indicate if the filing:
(A)
is new[,];
(B) is
replacing or modifying a previous[ filing, or contains forms]
submission; if so, describe the changes made, if previously rejected the
reasons for rejection, and the previous filing’s Utah Filed Date;
(C) includes forms
[that have been previously filed and are included]for informational
purposes[.]; if so, provide the Utah Filed Date; or
(D) does not include the base policy; if so, provide the Utah Filed Date
of the base policy and describe the effect on the base policy.
[(ii) Provide a brief description of each component's purpose,
benefits and provisions.]
(iii) Identify if any of the provisions are[any new,]
unusual, [or ]controversial,[ provision.]
[ (iv) Identify] or have been [any unresolved
]previously objected to, or prohibited,
and explain why the provision is included in the filing.[
provision and explain why the provision is included in the filing.]
(iv)[(v)]
Explain any change in benefits or premiums that may occur while the contract
is in force.
[ (vi) If the filing is replacing or modifying a previous submission,
provide information that identifies the filing being replaced or modified,
the Utah filed date, and a detailed description of the changes made.
(vii) If the filing includes forms for informational purposes, provide
the dates the forms were filed.
(viii) If filing a certificate, outline of coverage, application, or
endorsements, and the filing does not contain a policy, identify the
affected policy form number, the Utah filed date, and describe the effect of
the submitted forms on the base policy.
(b) Marketing Facts.
(v)[(i)] List the issue ages, which means the range of
minimum and maximum ages for which a policy will be issued.[;]
[ (ii) Identify the intended market, such as senior citizens, nonprofit
organizations, association members, etc; and
(iii) Describe marketing and advertising in detail, i.e., through a
marketing association, mass solicitation, electronic media, financial
institutions, internet, telemarketing, or individually through licensed
producers.
(c) [Underwriting Methods. Provide a general explanation of the
underwriting applicable to the filing.
(3)] Certification. The
filer must certify that a filing has been properly completed AND is in
compliance with Utah laws and rules. The Utah Accident and
Health Insurance Filing Certification must be properly completed and signed.
[A filing will be rejected if the certification is missing or incomplete.]
A false certification[ that is inaccurate] may subject the
insurer or filer to administrative action.
(d)[(4)] Domiciliary Approval and Filing Status
Information. All filings for a foreign insurer must include:
(i)[(a) a stamped copy of the approval letter from the
domicile state for the exact same filing;]copy of domicile approval
for the exact same filing;
(ii)[(b)]filing status information which includes:
(A)[(i)] a list of the states to which the filing was
submitted;
(B)[(ii)] the date submitted; and
(C)[(iii)] summary of the states' actions and their
responses; or
(iii)[(c)] if the filing is specific to Utah and only filed
in Utah, then section 14 of the transmittal must be completed stating, "UTAH
SPECIFIC - NOT SUBMITTED TO ANY OTHER STATE."
(e)[(5)] Group Questionnaire or Discretionary Group
Authorization Letter. A group filing must attach either a: [identify
the type of group, and include either a]
(i) signed
and fully completed ["]Utah Accident and Health Insurance Group
Questionnaire;[,"] or[ a]
(ii) copy
of the "Utah Accident and Health Insurance Discretionary Group
Authorization["] letter.
(f)[(6)] Letter of Authorization.
(i) When
the filer is not the insurer, a letter of authorization from the insurer
must be included.
(ii) The
insurer remains responsible for the filing being in compliance with Utah
laws and rules.
(g)[(7)] Items being submitted for filing. Any form or
rate items submitted for filing must be attached to the product forms
tab.
[ (8) Return Notification Materials.
(a) Return notification materials are limited to:
(i) a copy of the transmittal; and
(ii) a self addressed, stamped envelope.
(b) Any additional documents submitted for return will be discarded.
(c) Notice of filing will not be provided unless return notification
materials are submitted.
(6) Refer to each applicable section of this rule for additional
procedures on how to submit forms, rates, and reports.
R590-220-7. Procedures
for Form Filings.
(1) Forms in General.
(a) Forms are ["]File and Use["] filings.
(b) Each form must be identified by a unique form number. The form
number may not be variable.
(c) A form must be in final printed form or printer's proof format. A
draft may not be submitted.
(d) Specific sections may be filed with variable data by placing brackets
around affected information. Variable data must be identified within the
specific section, or on a separate sheet included with the submission.
(e) Blank spaces within the forms must be completed in John Doe fashion
to accurately represent the intended market, purpose, and use.
(2) Application Filing.
(a) Each
application or enrollment form may be submitted as a separate filing or may
be filed with its related policy or certificate filing.
(b) If an
application has been previously filed or is filed separately, an
informational copy of the application must be included with the policy or
certificate filing.
(3) Policy Filing.
(a) Each
type of insurance must be filed separately.
(b) A
policy filing consists of one policy form, including its related forms, such
as outline of coverage, certificate, or endorsement, and an actuarial
memorandum.
(c)[(a)] Only one policy filing for a single type of
insurance may be filed, except as stated in subsection [(b)](d).
(d)[(b)] A Medicare supplement filing may include more than
one policy filing but each filing is limited to only one of each of the
Medicare supplement plans A through [J]L.
(4) Endorsement Only Filing.
(a) Up to three related endorsements may be filed together.
(b) A single endorsement that affects multiple forms may be filed if the
Filing Description references all affected forms.
(c) The filing must include:
(i) A listing of all base policy form numbers, title and [dates
filed with the department] Utah Filed Dates; and
(ii) a description of how each filed endorsement affects the base policy.
(d) Unrelated endorsements may not be filed together.
(5) Outline of Coverage. If an outline of coverage is required to be
issued with a policy or an endorsement, the outline of coverage must
be filed when the policy or endorsement is filed.
R590-220-8. Additional
Procedures for Individual Accident and Health Market Filings.
(1) This section does not apply to filings for individual health benefit
plans that are subject to 31A-30 and Rule R590-167. Individual health
[Health ]benefit plan filings are discussed in R590-220-10.
(2) Rate and rate documentation filings.
(a) Rates
and rate documentation submitted with a new form filing are a ["]File
and Use["] filing.
(b) A rate
revision filing is a ["]File for Acceptance["] filing.
(3) A filer submitting an individual accident and health filing is
advised to review Chapter 31A-22[,] Part 6[VI],
and Rules R590-85, R590-126, and R590-131.
(4) Every individual accident and health policy, or endorsement affecting
benefits shall be accompanied by a rate filing with an actuarial memorandum
signed by a qualified actuary.
(a) A rate
filing need not be submitted if the filing does not require a change in
premiums, however the reason why there is not a change in premium must be
explained in the Filing Description.
(b) Rates
must be filed in accordance with the requirements of Section 31A-22-602,
Rule R590-85, and this rule.
(5) A filer submitting a long term care filing, including an endorsement
attached to a life insurance policy, is advised to review Chapter
31A-22 Part 1401-1414, [XIV and ]Rule R590-148, and Rule
R590-220-12 and 13.
(6) A filer submitting a Medicare supplement filing is advised to review
Section 31A-22-620, [and ]Rule R590-146, and
R590-220-11.
R590-220-9. Additional
Procedures for Group Market Form Filings.
A filer submitting a group accident and health filing is advised to
review 31A-8, 31A-22 Parts VI and VII, 31A-30, Rules R590-76, R590-126,
R590-131, R590-146, [and ]R590-148, and R590-233.
A filer submitting a group health benefit plan filing should also review
R590-220-10 in addition to this section.
(1) Determine whether the group is an eligible group or a discretionary
group.
(2) Eligible Group. A filing for an eligible group must include a
completed ["]Utah Accident and Health Insurance Group Questionnaire.["]
(a) A questionnaire must be completed for each eligible group under
Sections 31A-22-503 through 507.
(b) When a filing applies to multiple employee-employer groups under
Section 31A-22-502, only one questionnaire is required to be completed.
(3) Discretionary Group. If the group is not an eligible group, then
specific discretionary group authorization must be obtained prior to filing.
(a) To obtain discretionary group authorization a Utah Accident and
Health Insurance Request for Discretionary Group Authorization must be
submitted and include all required information.
(b) Evidence or proof of the following items are some factors considered
in determining acceptability of a discretionary group:
(i) the existence of a verifiable group;
(ii) that granting permission is not contrary to public policy;
(iii) the proposed group would be actuarially sound;
(iv) the group would result in economies of acquisition and
administration which justify a group rate; and
(v) the group would not present hazards of adverse selection.
(c) A discretionary group filing that does not provide authorization
documentation will be rejected.
(d) A change to an authorized discretionary group, such as change of
name, trustee or domicile state, must be submitted to the department within
30 days of the change.
(e) Adding additional types of insurance products to be offered, requires
that the discretionary group be reauthorized. The discretionary group
authorization will specify the types of products that a discretionary group
may offer.
(f) The commissioner may periodically re-evaluate the group's
authorization.
(4) A filer may not submit a rate or form
filing prior to receiving discretionary group authorization. If a rate or
form filing is submitted without discretionary group authorization, the
filing will be rejected.
(5) A filer submitting a long-term care filing, including a long-term
care endorsement attached to a life insurance policy, is advised to review
Chapter 31A-22 Part 1401-1414[XIV], Rule R590-148, and
[section]Sections 12 and 13 of this rule.
(6) A filer submitting a Medicare supplement filing is advised to review
Section 31A-22-620, Rule R590-146, and [section]R590-220-11[
of this rule].
R590-220-10. Additional
Procedures for Individual, Small Employer, and Group Health Benefit Plan
Filings.
This section contains instructions for filings subject to 31A-30. A
filer submitting health benefit plan filings that are subject to 31A-30 is
advised to review 31A-8, Chapter 31A-22 Parts 6[VI] and
7[VII], Chapter 31A-30, Rules R590-76, R590-131,
R590-167, R590-175, [and ]R590-176, and R590-233.
(1) General requirements.
(a) Letter of Intent. A filing must include a copy of the letter filed
with the commissioner declaring the carrier's intention as required by
R590-167-10.
(b) Class of Business. The Filing Description must describe the class of
business, as provided in Section 31A-30-105.
(c) Rate Manual. A health benefit plan form filing must include a rate
manual. If the rate manual was previously filed, provide [a copy of the
transmittal and ]documentation indicating the department's receipt.
(2) Rate Manual Filing.
(a) A rate manual that does not request a change in rating methodology is
a ["]File Before Use["] filing.
(b) A change in rating methodology filing is a ["]File for
Approval["] filing.
(c) A new and revised rate manual must:[.]
(i) [A filing must ]include an actuarial certification signed by a
qualified actuary[.];
(ii) [A rate manual and subsequent change must ]be filed 30
days prior to use[.];
(iii) [A rate manual must ]list the case characteristics and
rate factors to be used[.];
(iv) [A
rating manual must ]be applied in the same manner for all health benefit
plans in a class;[.]
(v) contain specific
The
area factor and industry factors must contain the
specific schedules ]applicable in Utah;[.]
[Any case characteristic not listed in Subsection 31A-30-106(1)(h)
requires prior approval of the commissioner.
(iv)]vi [The rating manual shall describe ]the
method of calculating the risk load, including the method used to determine
any experience factors[.]; and
(vii) [The
rating manual must clearly describe ]how the overall rate is reviewed
for compliance with the rate restrictions.
(d) Any case characteristic not listed in Subsection 31A-30-106(1)(h)
requires prior approval of the commissioner.
(3) Health Benefit Plan Reports.
(a) [Reports due April 1 each year:
(i) ""]
(i) All individual and small employer carriers must file an
[An ]actuarial
certification as described in Section 31A-30-106 and Rule R590-167-11(1)(a)[.A].
(ii) The report is due April 1 each year.
(b)[(ii)
"]Small Employer Index Rates Report.["]
All small employer carriers must file their index rates as of January
[March ]1 of the current year and preceding year, as required by
Subsection 31A-29-117(2).[ ,]
(i) The
report must include:
(A) the
actual index rates[,]; and
(B)
calculate the percentage change in these rates between the two years.
(ii) The report is due February 1 each year.
(c)[(b) A] Each report must be filed separately and
be properly identified.
R590-220-11. Additional
Procedures for Medicare Supplement Filings.
A filer submitting Medicare supplement filings is advised to review
Section 31A-22-620 and Rule R590-146. A Medicare supplement form filing
that affects rates must be filed with all required rating documentation.
(1) An insurer must file its Medicare Supplement Buyers Guide.
(2) Rates.
(a) Rates and rate documentation submitted with a new form filing are a
["]File and Use["] filing.
(b) A rate
revision filing is a ["]File for Acceptance["] filing.
(c)[(b)] Medicare supplement rates must comply with Section
31A-22-602, Rules R590-146 and R590-85.
(d)[(c)] An insurer shall not use or change premium rates
for a Medicare supplement policy or certificate unless the rates, rating
schedule and supporting documentation have been filed.
(e)[(d)] A rate revision request may not be used to
satisfy the annual filing requirements of Rule R590-146-14.C.
(3) Annual Medicare Supplement Reports.
(a) Medicare supplement reports are ["]File and Use["]
filings.
(b) Reports are due May 31 [March 1 ]each year.[,]
(c) ["]Report
of Multiple Policies.["]
(i) As
required by R590-146-22, an issuer of Medicare supplement policies shall
annually submit a report of multiple policies the insurer has issued to a
single insured.
(ii) The
report is required each year listing each insured with multiple policies or
stating that no multiple policies were issued.
[ (c) Reports due May 31 each year.
(i)"]Annual Filing of Rates and Supporting Documentation.["]
(i) An
issuer of Medicare supplement policies and certificates shall file annually
its rates, rating schedule and supporting documentation, including ratios of
incurred losses to earned premiums by policy duration, in accordance with
R590-146-14.C.
(ii) The
NAIC Medicare Supplement Insurance Model Regulations Manual details what
should be included in the annual rate filing.
(iii)
Annual reports submitted with a request or any type of reference to a rate
revision will be rejected.
(e)[(ii)] ["]Refund Calculation and Benchmark
Ratio.["] An issuer shall file the ["]Medicare Supplement
Refund Calculation Form["] and ["]Reporting Form for the
Calculation of Benchmark Ratio Since Inception for Group Policies["]
reports according to R590-146-14.B.
(f) [(d) A ]Each report must be filed separately
and be properly identified.
R590-220-12. Additional
Procedures for Combination Policies or Endorsements Providing Life and
Accident and Health Benefits.
A filer submitting health and life combination policies, or health
endorsements to life policies, is advised to review Rule R590-226.
(1) A combination filing is a policy or endorsement, which creates a
product that provides both life and accident and health insurance benefits.
(a) The two
types of acceptable combination filings are an endorsement or an
integrated policy.
(b)
Combination filings take considerable time to process, and will be processed
by both the [Life Insurance Division and the ]Health Insurance
Division, and the Life Section of the Life, Property and Casualty
Insurance Division.
(2) [A combination filing submitted via paper must include
transmittals and certifications for both the Life and Property and casualty
Insurance Division and the Health Insurance Division. ]A combination
filing [submitted electronically ]must be submitted separately to
both the Health Insurance Division and the Life Section of the Life,
[and ]Property and Casualty Insurance Division.
(3)(a) For an integrated policy, the filing must be submitted to the
appropriate division based on benefits provided in the base policy.
(b) For an endorsement, the filing must be submitted to the appropriate
division based on benefits provided in the endorsement.
(4) The Filing Description must identify the filing as having a
combination of insurance types, such as:
(a) term life policy with a long-term care benefit rider; or
(b) major medical health policy that includes a life insurance
benefit.
R590-220-13. Additional
Procedures for Long Term Care Products.
A filer submitting long-term care product filings is advised to review
Section 31A-22-1400, Rule R590-148, and section 12 of this rule. A
long-term care form filing that affects rates must be filed with all
required rating documentation.
(1) Rates.
(a) Rates and rate documentation submitted with a new form filing are a ["]File
and Use["] filing.
(b) A rate
revision filing is a ["]File for Acceptance["] filing.
(c)[(b)] Long-term care rates must comply with Rules
R590-148 and R590-85.
(d)[(c)] An insurer shall not use or change premium rates
for a long-term care policy or certificate unless the rates, rating schedule
and supporting documentation have been filed.
(2) Annual Long-term Care Reports.
(a) All
four long-term care reports required by Rule R590-148-25 must be
submitted together as one filing[ filed separately, with a
transmittal, and be properly identified].
(b) If all four reports are not submitted as one filing, the filing is
considered incomplete and will be rejected.
(c) If there is no information to report, the reporting form must
indicate “NONE.”
(d) Reports are due June 30 each year.
(e) The four reports shown below are required by R590-148-25.
(i) Replacement and Lapse Reporting Form.
(ii) Claims Denial Reporting Form.
(iii) Rescission Reporting Form.
(iv) Suitability Report Form.
R590-220-14.
[Electronic Filings.
A filer submitting an electronic filing must follow the requirements for
both the electronic system and this rule, as applicable.
R590-220-15.
]Correspondence and[,] Status Checks[,
and Responses].
(1) Correspondence. When corresponding with the department, a filer must
provide sufficient information to identify the original filing:
(a) type of insurance;
(b) date of filing;
(c) form numbers;[ and]
(d) submission method, SERFF or Sircon; and[copy of the
original transmittal.]
(e) tracking number.
(2) Status Checks.
(a) A complete filing is usually processed within 45 days of receipt.
[(a)](b) A filer can request the status of its filing
by telephone or email 60 days after the date of submission.
[ (b) A complete filing is usually processed within 45 days of receipt.
If a filing includes all return notification materials, a response should be
received within that time.
(3) Response to an Order. A response to an order must include:
(a) a response cover letter identifying the changes made;
(b) a copy of the Protected Correspondence that was included with the
Order to Prohibit Use;
(c) one copy of the revised documents with all changes highlighted; and
(d) one copy of the revised documents incorporating all changes without
highlights; and
(e) return notification materials, which consist of a copy of the
response cover letter and a self-addressed stamped envelope.
(4) Rejected Filing.
(a) A rejected filing is NOT considered filed. If resubmitted it is
considered a new filing.
(b) If resubmitting a previously rejected filing, the new filing must
include a copy of the rejection notice.
R590-220-15. Responses.
(1) Response to a Filing Objection Letter. A response to a Filing
Objection Letter must include:
(a) a cover letter identifying all changes made;
(b) revised documents with all changes highlighted; and
(c) revised documents incorporating all changes without highlights.
(2) Response to an Order to Prohibit Use.
(a) An Order to Prohibit Use becomes final 15 days after the date of the
Order.
(b) Use of the filing must be discontinued not later than the date
specified in the Order.
(c) To contest an Order to Prohibit Use, the commissioner must receive a
written request for a hearing not later than 15 days after the date of the
Order.
(d) A new filing is required if the company chooses to make the requested
change addressed in the Filing Objection Letter. The new filing must
reference the previously prohibited filing.
R590-220-16. Penalties.
A person found, after a hearing or other regulatory process, to be in
violation of this rule shall be subject to penalties as provided under
Section 31A-2-308.
R590-220-17. Enforcement
Date.
The commissioner will begin enforcing the revised provisions of this rule
30 days from the effective date of this rule.
R590-220-18.
Severability.
If any provision of this rule or the application of it to any person or
circumstance is for any reason held to be invalid, the remainder of the rule
and the application of the provision to other persons or circumstances shall
not be affected by it.
KEY: health insurance
filings
Date of Enactment or Last Substantive Amendment: [January 22, 2007]2007
Authorizing, and Implemented or Interpreted Law: 31A-2-201;
31A-2-201.1; 31A-2-202; 31A-22-605; 31A-22-620; 31A-30-106
[Back to Top]
|