Product Filing Checklists & Guidance Documents

Guidance Documents

• SERFF Instructions
• Annuity Forms used with Pension Risk Transfer Agreements
• Family Leave Coverage Guidance Document
• Loss Ratio Filing and Monitoring Requirements for Excepted Benefits Policies
  • Excepted Benefits Loss Ratio Template  
• Medicare Supplement Guidance
• Variability Guidance Document
• Wellness Benefits in Excepted Benefit Policies Guidance

Product Checklists by Category

Accident and Sickness

• Accident and Sickness Applications
• Embedded Dental
• Essential Health Benefits
• Explanation of Benefits
  • EOB Notice Minimum Requirements
  • Sample EOB Notice
• Group Accident Only Insurance
• Group Accident and Sickness While Traveling
• Group Association Short-Term Limited-Duration Major Medical, PPO, Hospital-Medical-Surgical
  • Short-Term Limited-Duration Insurance Guidance Document
• Group Disability Income
  • Disability Arising Out of Childbirth
• Group Family Leave Insurance
• Group Hospital and Other Fixed Indemnity Insurance
• Group Long-Term Care Insurance
• Group Long-Term Care Rider
• Group Medicare Supplement Insurance
• Group Medicare Supplement Applications
• Group Specified Disease and Cancer Only
• Group Stand-Alone Dental
• Group and Individual Stand-Alone Vision and/or Hearing Policy
• Individual Accident Only Insurance
• Individual Accident and Sickness While Traveling
• Individual Disability Income
  • Disability Arising Out of Childbirth
• Individual Hospital Confinement Indemnity
• Individual Income Replacement
• Individual Long-Term Care Insurance
• Individual Long-Term Care Insurance Rider
• Individual Major Medical, PPO, Hospital-Medical Surgical
• Individual Medicare Select Insurance
• Individual Medicare Supplement Applications
• Individual Medicare Supplement Insurance
• Individual Short-Term Limited-Duration Major Medical, PPO, Hospital-Medical-Surgical
  • Short-Term Limited-Duration Insurance Guidance Document
• Individual Specified Disease Insurance
• Individual Stand-Alone Dental
• Large Group Major Medical, PPO, Hospital-Medical Surgical
• Long-Term Care Applications
• Long-Term Care New Rate Filing Checklist
• Long-Term Care Rate Revision Checklist
  • Policyholder Notification of Proposed Premium Rate Increase Guidance Document
• Long-Term Care Policyholder Communications Checklist
• Mental Health and Substance Use Disorder Benefits Parity
• Health Rate Review Checklist
  • Virginia ACA Rate Filing Template
  • Virginia ACA Rate Filing Template Instructions
  • Template for data supporting rate revisions Form 130A (Not used for ACA plans)
  • Trend analysis detail Form 130B (Not used for ACA plans)
  • Health Insurance Rate Request Summary Part 1
  • Unified Rate Review Template
  • Part III Actuarial Memorandum
  • Reinsurance Care Management Protocol Assessment
  • Virginia Medigap Premium Finder - Premium Table Submission Instructions
  • Virginia Medicare Supplement Premium Data Table 1
  • Virginia Medicare Supplement Premium Data Table 2
  • Individual - Virginia Dental Rate Template
  • Small Group - Virginia Dental Rate Template
• Small Group Major Medical, PPO, Hospital-Medical-Surgical
• Stop Loss/Excess Loss
• Student Health Small Group Major Medical, PPO, Hospital-Medical-Surgical
• Virginia Plan Schedule Comparison (Exchange-certified stand-alone dental only)
   

Annuity

• Equity Index Products
• Fraternals
• Group Annuity
• Group Variable Annuity
• Individual Annuity
• Individual Variable Annuity
• Life/Annuity Applications
• Market Value Adjustment Products
• Preneed Funeral Products
   

Assumption Certificates

• Assumption Certificates
   

Credit Insurance

• Credit Accident and Sickness Insurance
• Credit Life Insurance
• Credit Life/Accident and Sickness Application/Disclosures
   

Dental or Optometric Services Plans

• Individual and Group Dental Services Plan
• Rate Review Checklist
  • Individual - Virginia Dental Rate Template
  • Small Group - Virginia Dental Rate Template
  • Template for data supporting rate revisions Form 130A
• Virginia Plan Schedule Comparison (Exchange-certificate stand-alone dental only)
   

Dental Plan Organizations

• Individual Stand-Alone Dental Plan Organizations
• Group Stand-Alone Dental Plan Organizations
• Rate Review Checklist
  • Individual - Virginia Dental Rate Template
  • Small Group - Virginia Dental Rate Template
  • Template for data supporting rate revisions Form 130A
• Virginia Plan Schedule Comparison (Exchange-certificate stand-alone dental only)
   

Foreign Language Forms

• Foreign Language Forms
   

Health Maintenance Organizations (HMOs)

• Embedded Dental
• Group Association Short-Term Limited-Duration HMO
• HMO Large Group
• Individual and Group HMO Stand-Alone Dental Plan
• Individual and Small Group HMO
  • Essential Health Benefits
• Individual Short-Term Limited-Duration HMO
• Long-Term Care New Filing Checklist
• Long-Term Care Rate Revision Checklist
• Mental Health and Substance Use Disorder Benefits Parity
• Rate Review Checklist
  • Virginia ACA Rate Filing Template
  • Virginia ACA Rate Filing Template Instructions
  • Template for data supporting rate revisions Form 130A (Not used for ACA plans)
  • Trend analysis detail Form 130B (Not used for ACA plans)
  • Health Insurance Rate Request Summary Part 1
  • Unified Rate Review Template
  • Part III Actuarial Memorandum
  • Reinsurance Care Management Protocol Assessment
  • Individual - Virginia Dental Rate Template
  • Small Group - Virginia Dental Rate Template
• Student Health HMO
• Virginia Plan Schedule Comparison (Exchange-certified stand-alone dental only)
   

Health Services Plans

• Embedded Dental
• Group Association Short-Term Limited-Duration Health Services Plans
• Individual and Group Health Services Plans Stand-Alone Dental
• Individual and Small Group Health Services Plans
  • Essential Health Benefits
• Individual Short-Term Limited-Duration Health Services Plans
• Large Group Health Services Plans
• Long-Term Care New Filing Checklist
• Long-Term Care Rate Revision Checklist
• Mental Health and Substance Use Disorder Benefits Parity
• Rate Review Checklist
  • Virginia ACA Rate Filing Template
  • Virginia ACA Rate Filing Template Instructions
  • Template for data supporting rate revisions Form 130A (Not used for ACA plans)
  • Trend analysis detail Form 130B (Not used for ACA plans)
  • Health Insurance Rate Request Summary Part 1
  • Unified Rate Review Template
  • Part III Actuarial Memorandum
  • Reinsurance Care Management Protocol Assessment
  • Individual - Virginia Dental Rate Template
  • Small Group - Virginia Dental Rate Template
• Student Health Health Group Plans
• Virginia Plan Schedule Comparison (Exchange-certified stand-alone dental only)
   

Legal Services Plans

• Legal Services Plans
   

Life Insurance

• Accelerated Death Benefits
• Equity Index Products
• Fraternals
• Group Flexible Premium Adjustable Life
• Group Life
• Group Variable Life
• Individual Flexible Premium Adjustable Life
• Individual Life
• Individual Variable Life
• Market Value Adjustment Products
• Preneed Funeral Products
• Variable Life Application
   

Viatical Settlements

• Viatical Settlements