New York State

Department of Financial Services

NYS State Seal - DFS

LIFE BUREAU

FILING GUIDANCE NOTE

Benjamin M. Lawsky, Superintendent of Financial Services

One State Street, New York, NY 10004

GUIDANCE DATE: 01/13/2012FOR IMMEDIATE RELEASE

Filing Guidance for Changes to MIB, Inc. Authorization Forms

 The MIB, Inc. is requesting that its member companies amend their authorization forms to add the following language:

“I authorize XYZ Insurance Company or its reinsurers to make a brief report of my personal health information [or “protected health information” for member companies that are HIPAA covered entities] to MIB, Inc.”[or “MIB” or “Medical Information Bureau” for insurers that have not updated their forms to reflect MIB, Inc.]

The MIB, Inc. authorization generally appears in a policy form as defined in Section 3201(a) of the Insurance Law. Any policy form revised solely to comply with the exact language in the MIB, Inc. request, as set forth above, is not required to be submitted to the Department for review and approval provided that the member companies making the requested change to a policy form send a letter to the Department identifying, by form number, the policy forms that will be revised to make the change, confirmation that this is the only change being made to the policy form and confirmation that upon the next revision of the policy form submitted for approval the authorization language will be incorporated into the policy form.

Letters should be addressed to the Life Bureau or the Health Bureau in Albany, as applicable, in accordance with policy form submission requirements.

Submissions to the Life Bureau and/or Health Bureau may be made either by paper or SERFF. Paper submissions should be addressed to:

Life Bureau

Ms.Kathleen Nelligan
Chief Insurance Attorney
New York State Department of Financial Services
One Commerce Plaza
Albany, New York 12257

Health Bureau

Mr. Austin Rinella
Supervising Attorney
New York State Department of Financial Services
One Commerce Plaza
Albany, New York 12257

SERFF submissions should use the following:

  Life Bureau Health Bureau
SERFF Type of Insurance (TOI) L08 Life – Other H21 Health - Other
SERFF Filing Type Form Filed for Reference
SERFF Requested Filing Mode Informational Informational

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