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Tom Portier Crystal M. Campbell Ricky Shields. Office of Health Insurance “Filing in the Fast Lane”. Louisiana Department of Insurance Commissioner James J. Donelon Form Filing Seminar ● July 24 – 25, 2008. Regulation 78. Policy Form Filing Requirements for

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tom portier crystal m campbell ricky shields
Tom Portier

Crystal M. Campbell

Ricky Shields

Office of Health Insurance“Filing in the Fast Lane”

Louisiana Department of Insurance

Commissioner James J. Donelon

Form Filing Seminar ● July 24 – 25, 2008

regulation 78

Regulation 78

Policy Form Filing Requirements

for

Major Medical, Medicare Supplement and Supplemental/Limited Benefit

Health Insurance Products

how does reg 78 keep insurers on the right track
How does Reg 78 keep insurerson the right track?
  • Provides for uniform and practicable administration of the form filing, review and approval requirements of the LA Insurance Code.
  • Assists insurers in complying with form filing, review and approval requirements of the Code.
product filing matrix
Product Filing Matrix
  • As a tool to help implement Regulation 78, the Department of Insurance created a Product Filing Matrix (PFM) to provide insurers the ability to search for the filing and legal requirements applicable to specific product types.
product filing matrix5
Product Filing Matrix
  • The PFM generates the Statements of Compliance required by Regulation 78 to be submitted with most filings.
  • The Statement of Compliance acts as a “road map” so that carriers can be certain they are submitting a policy form that complies with the applicable law.
is a filing required yes
LSA R.S. 22:620.A. - No basic insurance policy or application form, where written application is required and is to be attached to the policy or be a part of the contract, or printed rider or endorsement form, may be issued or delivered in this state unless and until it has been filed with and approved by the commissioner of insurance.Is A Filing Required ? YES!
does lsa r s 22 620 a apply to my product
This requirement applies to any individual policy written and delivered in Louisiana, as well as any group health or accident insurance policy covering residents of Louisiana, regardless of where issued or delivered. Does LSA R.S. 22:620.A.apply to my product?
complete form filings will get a green light every time
COMPLETE Form Filingswill get a green light every time…
  • Only complete filings will be accepted, whether by mail or electronically through SERFF or CRAFT.
  • All Major Medical and Supplemental/Limited Benefit Filings must include, very specific items…
road rules for a complete form filing
Road Rules for aComplete Form Filing:
  • Completed DOI Health and Accident Transmittal Document, (paper only);
  • Statement of Compliance for said products;
  • Policy forms filed for approval, application form, rider or endorsement forms, copies of any sample identification card intended for issue to covered persons;
form filing road rules cont d
Form Filing Road Rules, cont’d…
  • Initial premium rates and classification of risks;
  • Required filing fee, per insurance product, per insurance company;
  • Stamped, self addressed envelope for use in returning the company’s set of the policy forms filed, if applicable.
where do i find the required forms
Where Do I Findthe Required Forms?

The transmittal document, statement of compliance, certification of compliance and compliance affidavit, as well as other helpful resources and documents, can be found at www.ldi.state.la.us/ldipolicymatrix.

group insurance products

Filings of all group insurance products must include:

Group master contract;

Individual certificates or subscriber agreements or other statements of coverage;

Group application;

Individual enrollment forms; and

Any conversion insurance policy and application for conversion, if offered under the group master contract.

Group Insurance Products
associations and trusts
Associations and Trusts

Association:

Filings of group health and accident products intended for issuance to an association are limited to associations as defined in LSA R.S. 22:215.A(1)(a)(iv), or 22:250.1(5)(b), or 22:1734(4).

associations and trusts continued
Associations and Trusts,continued…

Filings of products to be issued to an association must include the association’s:

  • Constitution;
  • By-laws;
  • Membership application;
  • Membership agreement; and
  • Brochure of membership benefits other than the insurance products offered.
associations and trusts continued16
Associations and Trusts,continued…

Trusts:

Filings of group health and accident products intended for issuance to a trust are limited to trusts established by an employer, an association, or to a multiple employer trust established by an insurer on behalf of participating employers.

associations and trusts continued17
Associations and Trusts,continued…

Filings of products to be issued to a trust must include:

  • The trust agreement;
  • Articles of incorporation or other instrument creating the trust; and
  • Member adoption agreement.
medicare supplement form filings
Medicare SupplementForm Filings

There are four (4) “types” of Medicare Supplement Insurance Products:

  • An Individual Medicare Supplement Policy
  • A Group Medicare Supplement Policy
  • An Individual Medicare SelectPolicy
  • A Group Medicare Select Policy
medicare supplement form filings19
Medicare SupplementForm Filings

All filings of policy forms for one or more standardized Medicare Supplement Insurance plans, or one or more standardized Medicare Select insurance plans, shall be considered a filing of one insurance product per insurer.

road rules for a med supp filing
Road Rules for aMed Supp Filing
  • An issuer should file all benefit plans of the same type under one form filing.
  • Whether an issuer files 1 benefit plan or all 14 plans under the same form filing of one type, the filing fee would be $100.

Example: If an issuer files plans A, C and F under a Medicare Supplement Individual Product, the fee would be $100. If the issuer files the same plans under a Medicare Select Individual Product, there would be a separate $100 fee, because those plans fall under a different “type” of product.

med supp road rules continued
Med Supp Road Rulescontinued…

ADVERTISEMENTS:

  • In any one submission, a Medicare Supplement issuer can file an unlimited number of advertising forms; and
  • Filings can include advertising materials for one or more benefit plans and can be for any or all four (4) types of Med Supp Products.
med supp road rules continued22
Med Supp Road Rules continued…
  • Completed DOI Health and Accident Transmittal Document (paper only);
  • Statement of Compliance for said product;
  • Policy forms for approval, outline of coverage, application form, replacement notice and rider or endorsement forms;

Filings of all Med Supp products must include:

med supp road rules continued23
Med Supp Road Rulescontinued…
  • Proposed plan of operation, as set forth in Reg 33, Section 525.E for Medicare Select;
  • Premium rates, rating schedule and supporting documentation;
  • Any new, related advertising as defined in Rule 3A, Section 105;
med supp road rules continued24
Med Supp Road Rules continued…
  • Required filing fees per insurance product, per company;
  • Required filing fees for premium rates, rating schedule and supporting docs;
  • Required filing fees for advertisements; and
  • Stamped self-addressed envelope of sufficient size for use in returning the company’s set of the policy forms filed, if applicable.
med supp road rules continued25
Med Supp Road Rulescontinued…

Annual Rate Filings versus Rate Adjustments

  • §545.C.3.b. of Reg 33 states that Annual Med Supp Rate Filings shall NOT include rate adjustments.
  • Carriers issuing Med Supp products must file annual rate filings and any rate adjustment filings separately. Combined filings will no longer be accepted.
slide26

Med Supp Road Rulescontinued…

So…what’s the good news???

  • Although the Med Supp rate adjustment filings are still subject to the $100 filing fee, the Annual Med Supp Rate Filings are now considered an informational filing, therefore, no filing fee will be required.
exceptions to requiring a complete filing
Exceptions to Requiringa Complete Filing

Exceptions to the requirements for a complete filing may be allowed at the discretion of the department for the following policy forms:

Note: These filings do not require a statement of compliance.

exceptions
Exceptions…
  • Application forms or enrollment forms to be used with a particular or with multiple insurance products. Previously approved products would need to be identified. No filing fee is required.
  • Identification cards. No filing fee is required.
exceptions29
Exceptions…
  • Long-Term Care Advertising. No filing fee is required.
  • Amendatory riders or endorsements for products that were approved no more than 3 years prior to the filing of the rider or endorsement. A filing fee IS required.
  • Exclusionary riders and assumption certificates. No filing fee is required.
exceptions30
Exceptions…
  • Medicare Supplement Advertising. Filing fee IS required.
  • Medicare Supplement Rate Filings. Such filings must clearly indicate the percentage of increase in rates for each standardized plan and existing pre-standardized plan. Filing fee is required for standardized plans only.
exceptions31
Exceptions…
  • Following approval of a complete filing of a Med Supp product, subsequent filings by the same issuer of standardized plans of the same type do not require inclusion of associated forms such as the replacement notice or plan of operation, unless changes have been made.
  • No filing fee is required. However, subsequent filings of an outline of coverage will require a filing fee.
common obstacles to a perfect filing
Common Obstaclesto a Perfect Filing
  • Incomplete Filings in General;
  • Incomplete transmittal document:
    • No LDI product code entered;
    • If there is a product code, it often doesn’t match statement of compliance;
    • Failure to enter description and form numbers on pages 5 and 6.
common obstacles to a perfect filing33
Common Obstaclesto a Perfect Filing
  • No rate information submitted – Carriers often assume if the rates have not changed, then they are not required to submit them. Rates must be submitted for a complete filing.
  • No statement of compliance or compliance affidavit attached;
common obstacles to a perfect filing34
Common Obstaclesto a Perfect Filing
  • Confusion between Certification of

Compliance and Compliance Affidavit;

  • Failure to submit an ORIGINAL actuarial memorandum (Medicare Supplement);
  • Incorrect filing fees
it s been a year are you filing with craft
It’s been a year!Are you filing with CRAFT?
  • On July 1, 2007, the LDOI began using its

new Complaint, Rate and Form Tracking

(CRAFT) system.

  • Louisiana’s new electronic filing system allows companies to receive and respond to consumer complaints and to submit rate, rule, and policy form filings.
  • The Department's goals are to become paperless, have one comprehensive system for all filing types, and provide "speed to market".
why should you use craft
WHY should you use CRAFT?
  • No additional charge to use CRAFT;
  • No Transmittal Document required;
  • You are entering data directly into our database;
  • CRAFT is directly linked to the PFM;
  • You immediately receive your filing number; and
  • It’s the FASTEST way to submit filing!
we re here for you
We’re Here For YOU!

Need some guidance?

Call us! 1-800-259-5301

Or E-mail Us:

tportier@ldi.state.la.us

ccampbell@ldi.state.la.us

sshields@ldi.state.la.us