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"Prior Aproval With Certification" Procedure Under Circular Letter No. 4 (2003)

NEW OPTIONAL FILING PROCEDURE NOW AVAILABLE

Please see Circular Letter No. 4 (2003) which announces the Department’s new initiative to improve the "speed to market" objective for accident and health insurance products. You now have the choice of one of the following three filing procedures:

WHAT IS THE NEW “PRIOR APPROVAL WITH CERTIFICATIONS” PROCEDURE?

The Health Bureau receives thousands of policy forms each year submitted by commercial insurers, Article 43 corporations, HMOs, Fraternal Benefit Societies and Municipal Cooperatives. Recognizing the significant differences amongst the insurance entities that write accident and health insurance products, the many different types of products that they write, and the differing frequency with which they make product filings, the Health Bureau is making available three different processes under the new “Prior Approval with Certification” procedure so as to meet the differing needs of the health insurance industry. These are:

  1. Certified Policy Form Submission Based Upon a Checklist,
  2. Certified Policy Form Submission Based Upon a Template, and
  3. Certified Policy Form Submission Based Upon a Previously Approved Policy Form.

The new procedure involves the use of:

Submissions made under the new optional certified filing procedure will be given priority over submissions made under the traditional prior approval procedure.

WHAT DO I NEED TO DO TO PARTICIPATE?

  1. Certified Policy Form Submission Based Upon a Checklist
  2. Certified Policy Form Submission Based Upon a Template
  3. Certified Policy Form Submission Based Upon a Previously Approved Policy Form

WHAT DO I NEED TO DO TO PARTICIPATE?

A. Certified Policy Form Submission Based Upon a Checklist

1.

In preparing the checklist, review the most current version of the product outline. Complete the product checklist in an accurate manner. No alterations should be made to the checklist itself as it appears on the website. Any necessary clarification of a response to a checklist item should be made by checking the “*” box and attaching the explanation to the checklist referring to the relevant item number on the checklist.

2.

Each checklist contains separate sections for the forms and the rates. Separate signatures are required with respect to completion of the two sections. The actuarial section must be completed and signed by a member of the Society of Actuaries. 

3.

Complete the new standard transmittal form.

This form must be fully completed and accompany any certified policy form submission. The form has been designed with a series of checkboxes and drop-down boxes that will facilitate the ease of use of this form and its proper completion. 

4.

Complete the appropriate certifications of compliance. The certifications must be completed by an officer of your company who is familiar with the type of product being submitted and who is knowledgeable as to the applicable laws, regulations and circular letters. See Attachment 1 to Circular Letter No. 4 (2003) for the proper format of the requisite certification pertaining to the policy forms. In addition, a certification of compliance pertaining to the premium rates for the submitted policy forms must also be completed. See Attachment 3 to the Circular Letter. No alterations should be made to the wording of the certifications of compliance.

5.

Please note that submissions made under this new process are subject to the Department’s prior Circular Letters No. 14 (1997) and No. 18 (1999) which remain in effect. Please make sure that your submissions comply with the requirements of those circular letters, including your compliance with the 15 calendar day response time on any Department correspondence. 

6.

If you have any questions about the new process, please be sure to contact the Health Bureau prior to making your submission. 

B. Certified Policy Form Submission Based Upon a Template

1.

Submit language to the Health Bureau for approval for use as a template for incorporation in future submissions. It is your decision as to whether such language will include only certain provisions frequently used by your company (such as those provisions mandated by statute) or will be a policy form in its entirety. You may submit language for specific use as a template or may request that the policy forms comprising a typical submission be approved for use as a template in addition to general approval of use of the policy forms for delivery in New York.

2.

Complete the new standard transmittal form. This form must be fully completed and accompany any certified policy form submission. The form has been designed with a series of checkboxes and drop-down boxes that will facilitate the ease of use of this form and its proper completion.

3.

Complete the appropriate certifications of compliance. The certifications must be completed by an officer of your company who is familiar with the type of product being submitted and who is knowledgeable as to the applicable laws, regulations and circular letters. See Attachment 2 to Circular Letter No. 4 (2003) for the proper format of the requisite certification pertaining to the policy forms. In addition, a certification of compliance pertaining to the premium rates for the submitted policy forms must also be completed. See Attachment 3 to the Circular Letter. No alterations should be made to the wording of the certifications of compliance.

4.

In addition to clean copies, submit a black-lined copy of the proposed policy forms highlighting any new language and/or variations from the approved template language. The portions of the policy forms that are based upon template language should be clearly identified as such.

5.

Please note that submissions made under this new process are subject to the Department’s prior Circular Letters No. 14 (1997) and No. 18 (1999) which remain in effect. Please make sure that your submissions comply with the requirements of those circular letters, including your compliance with the 15 calendar day response time on any Department correspondence.

6.

If you have any questions about the new process, please be sure to contact the Health Bureau prior to making your submission.

Note: You have the obligation to ensure that your approved templates are in ongoing compliance with changes to statute and regulation. You must annually certify to the Health Bureau that you have reviewed your approved templates and find them to be in compliance with all applicable laws and regulations. If changes to the template become necessary due to a change or changes in statute or regulation, you must submit the amended template to the Health Bureau for review and approval. Submission of the amended template should include a full explanation of the reason for each change and the amended template should clearly identify all differences from the previously approved template either by use of highlighting or black-lining.

C. Certified Policy Form Submission Based Upon a Previously Approved Policy Form

1.

Complete the new standard transmittal form. This form must be fully completed and accompany any certified policy form submission. The form has been designed with a series of checkboxes and drop-down boxes that will facilitate the ease of use of this form and its proper completion.

2.

Complete the appropriate certifications of compliance. The certifications must be completed by an officer of your company who is familiar with the type of product being submitted and who is knowledgeable as to the applicable laws, regulations and circular letters. See Attachment 2 to Circular Letter No. 4 (2003) for the proper format of the requisite certification pertaining to the policy forms. In addition, a certification of compliance pertaining to the premium rates for the submitted policy forms must also be completed. See Attachment 3 to the Circular Letter. No alterations should be made to the wording of the certifications of compliance.

3.

In addition to clean copies, submit a black-lined copy of the previously approved form that clearly identifies the differences between the earlier form and the new form submitted for approval.

4.

Please note that submissions made under this new process are subject to the Department’s prior Circular Letters No. 14 (1997) and No. 18 (1999) which remain in effect. Please make sure that your submissions comply with the requirements of those circular letters, including your compliance with the 15 calendar day response time on any Department correspondence.

5.

If you have any questions about the new process, please be sure to contact the Health Bureau prior to making your submission.

Note: When preparing your submission, please remember that there may have been statutory or regulatory changes since the earlier form was approved. Those changes must be incorporated into the new form being submitted.

WHAT ABOUT MY PENDING SUBMISSIONS? CAN I USE THE NEW CERTIFIED FILING PROCEDURE?

1.

If you have a submission currently pending in the Health Bureau and you want to use the new certified filing procedure, it will be necessary to withdraw the pending submission and re-file under the new procedure. Please inform the reviewing attorney and/or actuary that you wish to withdraw the submission. A letter confirming your withdrawal request and closure of our file will be sent to you.

2.

Re-submit the submission in its entirety under the new process. Be certain that the submission is complete and includes all of the requisite components.

3.

Please do not file the same submission under both the new process and the traditional prior approval process or deemer process. This would serve only to increase the current inventory of pending forms and hinder speed to market for all insurers.

CAN I USE THE PRODUCT CHECKLISTS EVEN IF THE NEW CERTIFIED FILING PROCEDURE IS NOT CHOSEN?

Yes, the product checklists are being made available to everyone as a means to assist in streamlining the review process. We strongly recommend that insurers use the applicable product checklist for all filings for which a checklist is available. The use of the product checklists will assist you in preparing policy form and rate filings that comply with New York law and assist us in the review of your submission. This will help to improve the speed to market for all insurers.

CAN I USE THE NEW ACCIDENT AND HEALTH INSURANCE STANDARD TRANSMITTAL FORM EVEN IF THE NEW CERTIFIED FILING PROCEDURE IS NOT CHOSEN?

Yes, the new standard transmittal form is being made available to everyone as a means to furnish insurers with guidance so that the filing will be complete upon its initial submission and, at the same time, provide the Department with the information that it needs to enter the submission into the Health Bureau’s record system, identify the type of product filing and expeditiously route it to the appropriate Unit within the Bureau for assignment, review and disposition. An accurately completed standard transmittal form will provide the information required pursuant to Sections 52.31 and 52.33 of Department Regulation No. 62 (11 NYCRR 52).

We strongly recommend that insurers complete the new standard transmittal form for all Form and Rate submissions or Form Only submissions.

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