Guidance Documents

SERFF Instructions
Annuity Forms used with Pension Risk Transfer Agreements
Family Leave Coverage Guidance Document
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
• 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

• 2023 Plan Year Implementation Calendar
• Product Information
  • NAIC Product Review Standard State Filing Checklists for Life and Health​
• Health Carriers
  • MCHIP Complaint System Filing/Appeal Procedures Checklist
• Life & Health Data Calls
• Long Term Care Annual Rate Reports (Instructions and Reporting Forms)
• Long Term Care Forms (14 VAC 5-200)
• Common Problems Identified by the L&H Market Conduct Section
• Medicare Supplement Forms (14 VAC 5-170)
• Credit Insurance Experience Exhibit and Questionnaire
  • Company Filing Portal
  • Questionnaire
  • Filing Instructions
• Shared Savings Program Demonstration (§38.2-3462) Carriers submit updates for review prior to offering any Program that varies from the previously filed and reviewed Program. See Administrative Letter 2020-01 for submission requirements and information.  
• Shared Savings Annual Report (§ 38.2-3462) (Due April 1)
• Virginia Group Health Insurance Medical History Form (currently unavailable)
• Interstate Insurance Compact
  • The Interstate Insurance Compact is an important modernization initiative that benefits state insurance regulators, consumers and the insurance industry. The Compact established a multi-state public entity, the Interstate Insurance Product Regulation Commission (IIPRC) which serves the Member States. The IIPRC serves as a central point of electronic filing for certain insurance products, including life insurance, annuities, disability income and long-term care insurance to develop uniform product standards, affording a high level of protection to purchasers of asset protection insurance products. We encourage insurance companies to submit filings through the Interstate Compact. Learn more about the Compact. ​