Tom Portier

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Office of Health InsuranceFiling in the Fast
Lane

• Tom Portier
• Crystal M. Campbell
• Ricky Shields

Louisiana Department of Insurance Commissioner
James J. Donelon Form Filing Seminar ? July 24
25, 2008
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Regulation 78

• Policy Form Filing Requirements
• for
• Major Medical, Medicare Supplement and
  Supplemental/Limited Benefit
• Health Insurance Products

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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.

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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.

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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.

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(No Transcript)
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Is A Filing Required ? YES!

• LSA R.S. 22620.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.

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Does LSA R.S. 22620.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.

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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

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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

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Form Filing Road Rules, contd

• 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 companys set of the policy forms
  filed, if applicable.

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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.

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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.

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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.
  22215.A(1)(a)(iv), or 22250.1(5)(b), or
  221734(4).

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Associations and Trusts,continued

• Filings of products to be issued to an
  association must include the associations
• Constitution
• By-laws
• Membership application
• Membership agreement and
• Brochure of membership benefits other than the
  insurance products offered.

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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.

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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.

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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 Select Policy
• A Group Medicare Select Policy

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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.

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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.

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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.

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Med Supp Road Rules continued
Filings of all Med Supp products must include

• 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

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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

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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 companys set of
  the policy forms filed, if applicable.

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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.

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Med Supp Road Rulescontinued

• Sowhats 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.

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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.

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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.

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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.

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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.

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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.

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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 doesnt
  match statement of compliance
• Failure to enter description and form numbers on
  pages 5 and 6.

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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

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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

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Its 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.
• Louisianas 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".

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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
• Its the FASTEST way to submit filing!

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Were Here For YOU!

• Need some guidance?
• Call us! 1-800-259-5301
• Or E-mail Us
• tportier_at_ldi.state.la.us
• ccampbell_at_ldi.state.la.us
• sshields_at_ldi.state.la.us

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Any Questions or Suggestions?