Whats Wrong With My Form Filing

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Whats Wrong With My Form Filing?
Presenters Cindy Carpenter Jackie Murphy
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Life, Annuities and Accident Health
Common Objections

• Toll-Free Notice
• Guaranty Fund Disclosure Summary Document
• Guaranty Fund Nonparticipation Disclosure for
  Variable
• Products
• Bracketed Items Statement of Variability
• Letters of Commitment and Actuarial
  Certifications
• Form and Actuarial Memorandum Conflicts
• Scannable Documents Pages and Shrunken data
• A submission of a single policy and certificate
  for use with more than one type of group.
• Statutory Product Types

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Frequent Objections Accident Health

• Small Employer Market
• Large Employer Market
• Dependent Definition
• Mandated Benefits
• Required Signature

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Frequently Omitted Certifications
Small Employer Market
1212 CERT SECHC STATUS or Figure 40 1212
Risk-Assuming or Reinsured Carrier or Figure 42
1212 CERT SEHC GEOG or Figure 44
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Frequently Omitted Certifications
Large Employer Market
1212 CERT LEHC STATUS or Figure 50 1212 CERT
LEHC GEOG or Figure 51
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Dependent Definition
If a policy includes or is required to include
dependent coverage, then coverage must be
extended to

• Newborn Children
• Adopted Children
• Step Children
• Grandchildren
• Court Mandated Children
• Handicap Children

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Mandated Benefits
Hospital Stay Following Mastectomy
A health benefit plan that provides coverage for
the treatment of breast cancer must provide for
inpatient care for a minimum of 48 hours
following a mastectomy and 24 hours following
a lymph node dissection for the treatment of
breast cancer.
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Mandated Benefits, continued
Contraceptive Drugs and Devices
A health benefit plan that provides benefits for
prescription drugs or devices may not exclude or
limit benefits for a prescription
contraceptive drug or device approved by the
United States Food and Drug Administration or
an outpatient contraceptive service.
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Mandated Benefits, continued
Acquired Brain Injury

• A health benefit plan may not exclude coverage
  for any of the therapies or services related to
  acquired brain injury that are listed in
  1352.003 of the Texas Insurance Code.
• Each of the therapies must be defined in the
  insurance policy/certificate as specified in 28
  TAC 21.3102.

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Mandated Benefits, continued
Telehealth Telemedicine Chapter 1455
A health benefit plan may not exclude a
telemedicine medical service or a telehealth
service from coverage under the plan, solely
because the service is not provided through a
face-to-face consultation. Telehealth service and
telemedicine medical service have the meanings
assigned by Section 57.042, Utilities Code as
follows Telehealth service means a health
service, other than a telemedicine medical
service, delivered by a licensed or certified
health professional acting within the scope of
the health professionals license or
certification who does not perform a telemedicine
medical service that requires the sue of advanced
telecommunications technology, other than by
telephone or facsimile, including
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Mandated Benefits, continued
Telehealth Telemedicine, continued
(A) compressed digital interactive video,
audio, or data transmission (B) clinical
data transmission using computer imaging by way
of still-image capture and store and forward
and (C) other technology that facilitates
access to health care services or medical
specialty expertise. Telemedicine medical
service means a health care service initiated by
a physician or provider by a health professional
acting under a physician delegation and
supervision, for purposes of patient assessment
by a health professional, diagnosis or
consultation by a
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Mandated Benefits, continued
Telehealth Telemedicine, continued
physician, treatment, or the transfer of medical
data, that requires the use of advanced
telecom-munications technology, other than by
telephone or facsimile, including (A)
compressed digital interactive video, audio, or
data transmission (B) clinical data
transmission using computer imaging by way of
still-image capture and store and forward
and (C) other technology that facilitates
access to health care services or medical
specialty expertise.
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Required Signature
Riders or Endorsements to Individual Policies, 28
TAC 3.3040(b)
All riders or endorsements added after date of
issue, except those requested by the policyholder
and those required by law, require signed
acceptance by the policyholder.
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Frequent Objections Life, Annuity Credit

• Universal Life
• Annuities
• Credit Life and Credit AH

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Frequent Objections Life, Annuity Credit
Universal Life

• Surrender Charges as a percentage
• Surrender and Expense Charges for increases in
  specified
• amounts
• Substandard Issues Designation
• Juvenile Issues Smoker/Non-Smoker
• Juvenile Reclassification Statement
• Unisex Justification
• Not Universal Life Interest Sensitive/Current
  Assumption
• Whole Life

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Frequent Objections Life, Annuity Credit
Annuities

• Nonforfeiture Interest Rate methodology
• Guaranteed Minimum Interest Rate methodology
• Reserve basis
• List of previously filed Qualified Plan
  endorsements

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Frequently Objections Life, Annuity Credit
Credit Life and Credit A H Forms

• Form Number - 3.50 and 3.53 (recodified 1131
  and 1153 or 1153)
• Rate information
• Refund method
• Notification of Insured for Early Termination
  Refund
• Consumer Bill of Rights
• Maximum Term exceeds 120 months
• Exclusions for Pre-existing conditions for
  Credit Life
• Certificate and Debtor Application under same
  form
• number
• Contestability beyond 2 years for credit life