Accident and Health
- A&H Uniform Product Coding Matrix 10/26/2010
- A&H SERFF Filing Types 4/9/2012
- MIB Language Change Filings 4/12/12
The following A&H Group Forms have been deregulated and should not be filed with the Department:
Commercial For-Profit Insurers:
- Group Long or Short-Term Disability Policies;
- Blanket Accident and Health;
Hospital Plan Corporations and Professional Health Services Plan Corporations:
- Blanket Accident and Sickness Policy Forms
Accident and Health Form Submission Checklists:
- Advertising (new 5/19)
- Advertising Compliance Certification (updated 1/2020)
- Individual Accident Only
- Individual Basic Hospital Expense Coverage
- Individual Basic Medical-Surgical Expense Coverage
- Individual Dental or Vision Coverage (3/20)
- Individual Disability Income Protection Coverage
- Individual and Group Comprehensive Major Medical Insurance (3/20)
- Individual and Group Medical Insurance (other than Major Medical) (3/20)
- Individual Preferred Provider Organization (PPO) Coverage
- Individual Specified Disease or Specified Accident Coverage
- Individual Supplemental Insurance Coverage
Small Group Rating:
- Act 134 - Notice eff. 3/21/2012
- Base Medical Checklist
- Base Medical Worksheet
- Base Pharmacy Checklist
- Base Pharmacy Worksheet
Individual Rating:
Medicare Supplement:
- 2010 Medicare Supplement (updated 3/27/19)
Long-Term Care:
Disclosure Requirements:
- Disclosure requirements for health insurance
- Notice regarding replacement disclosure requirement
- Multiple medicare supplement policy-certificate in force reporting
- Plan G Specimen Notice of Change sold on or after January 1, 2020
- Disclosure Requirements for Accident and Sickness Policies or Certificates: Guide to Health Insurance for People with Medicare
- Outline of coverage for Medicare Supplement Insurance Plans sold on or after January 1, 2020
*All actuarial worksheets and exhibits with number and/or formulas must be submitted in Excel.
*Actuarial explanatory materials may be submitted in Adobe.