Guidance for Filing Accident and Health Insurance Policy Forms

Submit a filing for only one licensee per submission.  Parallel filings for an affiliated company must be submitted separately.  (Refer to “Companies and Contact Tab” information listed below.)

• Applications and enrollment forms are policy forms and must be submitted to the Department for approval under Insurance Law §§ 3201 and 4308.
• The fraud warning statement must be included in applications and enrollment forms pursuant to Insurance Law § 403(d).
• An Electronic Application Supplemental Worksheet must be submitted if the company intends to use applications or enrollment forms in electronic format.  Further guidance on filing electronic applications can be found on the Department’s website.

• Filings submitted through SERFF must use the correct filing types.  Filings with incorrect filing types will be closed with a request to resubmit with the correct filing type.
• The Department encourages the company’s use of the speed-to-market Filing Types (certifications and deemer).  They are particularly useful for “quick fixes” to forms (e.g., minor changes in previous language, address changes).  Note that a certification form, completed by an officer of the company, must be included in the filing.  Filings submitted using the “Certification by Previously Approved Form” filing type cannot be combined with new forms.  (Example of a recent problem filing:  Submitted 10 forms via Certification by Previously Approved Form but only one form was previously approved and all the others were new.)
• Further guidance on Filing Types, including expedited review filing types, can be found on the Department’s website.

Products with new coverage innovations and methods of reducing health care costs must provide health care benefits of real economic value.  To ensure prompt and efficient review of new and innovative products, companies should communicate with the Department prior to making a SERFF policy form and rate submission so that the Department will be made aware of the filing and have the opportunity to offer feedback that may impact the filing.

Pursuant to Insurance Law §§ 3217-i(d) and 4306-h(d), the Superintendent of Financial Services may require the use of model language describing the coverage requirements for any accident and health insurance policy form that is subject to the Superintendent’s approval. 

• Model language should be used for all individual and group comprehensive health insurance.  
• Model language should be used for stand-alone dental insurance coverage; however,  companies have flexibility to insert their own language in the benefit description section.
• Model language should be used for vision insurance.

• Clearly identify the filing as a combination filing that is also being submitted to the Life Bureau and include the Life Bureau filing number and reviewer assigned. Submit accident and health policy forms and rates to the Health Bureau and life insurance policy forms to the Life Bureau for review.  Applications and enrollment forms must be submitted to both Bureaus and the same version of the forms must be approved by both Bureaus.  Consult with the Life Bureau for the submission requirements for life insurance components.  Further information on combination Accident & Health and Life Products (e.g., disability/life) can be found on the Department’s website.

• Clearly identify the filing as a combination filing that is also being submitted to the Property Bureau and include the Property Bureau filing number and reviewer assigned.  Submit accident and health insurance policy forms and rates to the Health Bureau and property and casualty policy forms to the Property Bureau for review.  Applications and enrollment forms must be submitted to both Bureaus and the same version of the forms must be approved by both Bureaus.  Consult with the Property Bureau for submission requirements for the property and casualty components.  Further information on combination Accident & Health and Property/Casualty Products (e.g., sickness/travel accident) can be found on the Department’s website.
• Note that the forms cannot be used until all necessary approvals are obtained.

• A name change endorsement form must be submitted for use with existing business.  The form may also be used with new business but only for a period not to exceed six months.  Within the six-month period, all previously approved forms intended for use with new business under the new company name must be submitted for approval on the new company paper.  If the company does not need to make any changes to the previously approved forms to bring them into compliance with statutory or regulatory changes, then the company should submit the forms under the “Certification by Previously Approved Form” filing type and the filing should be accompanied by a certification that there are no changes in the form other than the name and that the form has been reviewed for ongoing compliance.  If the company needs to make any changes to the previously approved forms to bring them into compliance with statutory or regulatory changes, the company should submit the forms under the “Normal Pre-Approval” filing type and should provide a copy of the form with changes tracked, indicating the specific changes made, under the “Supporting Documentation” tab in SERFF.  Name change guidance can be found on the Department’s website, including specific guidance on name changes applicable as part of a company merger.
• An address change endorsement form must be submitted for use with existing business.  For new business, an informational filing must be submitted.  Address change guidance can be found on the Department’s website.

Use variable material (often referred to as a memorandum of variable material, statement of variability, or explanation of variability) to the extent possible for group products, which allows for flexibility without having to make multiple form submissions.  When using variable material: 

• Review 11 NYCRR 52.31(l) to ensure compliance with the requirements.
• Bracket the variable language or benefit options that may be provided in the policy form.
• Submit a memorandum of variable material that specifically describes the range of optional language or benefit options that may be used and the circumstances under which they will be used for each instance of variable material.  The range of benefit options must match what is included in the rate filing, which should include the means for calculating the premium for each variable option.  Any type of placeholders in brackets will not be accepted (e.g., blank spaces or Xs).
• Companies submitting a memorandum of variable material may footnote or otherwise flag the variable language so the Department can easily identify the language to which each item in the memorandum of variable material relates.
• The range of variables used should be tied to the options for plan designs the company sells or intends to sell to limit the extent of variability.
• A variable item in the model language does not mean it should also be variable in the submitted form.  Internal plan functions (e.g., certain time frames, medical necessity standards, etc.) should not be variable in a submission; they should align with how the coverage is administered.
• Explanations such as the variable “will conform to law” or “as requested by policyholder” are not acceptable.  Explanations must be specific.
• Remember that variable material is generally not permitted for individual forms.  Under certain circumstances, variable material with individual coverage is permitted when used on a very limited basis (e.g., variable amounts of benefits on the schedule page depending on the benefit package chosen).
• Ensure compliance with cost-sharing restrictions in the Insurance Law for comprehensive health insurance policies, even where cost-sharing is bracketed in the schedule of benefits. 
  • Refer to checklists and model schedule of benefits on the Departments website for specific cost-sharing restrictions in the Insurance Law.
  • Additional resources on the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) cost-sharing provisions can also be found on the Department's website.

If the form is in a foreign language, submit the following:

• A certification uploaded to the “Supporting Documentation” tab in SERFF that the form is an exact translation of a previously approved English language form pursuant to Insurance Law § 3102; and
• A listing of the state tracking number and form number of the previously filed and/or approved English version of the foreign language document submitted for filing and/or approval.

If a filing is closed because it contains at least three instances of non-compliance, remember that a complete review of the filing has not occurred.  Resubmitting the filing and only addressing the items listed in the closure letter may not produce a compliant filing.  Therefore, the Department requests that in addition to responding to the objections listed, the company review the entire filing more closely for compliance with applicable law and regulation before resubmitting the filing.  To help with this review, product checklists are available for all comprehensive health insurance policies and contracts, dental policies and contracts, and accident policies on the Department’s website.  See also the “Model Language” and “Product Checklists” subsections of this guidance.

• When resubmitting a previously closed non-compliant filing, the company must reference the previously closed filing (including filing and form numbers) in the “General Information” tab of the new SERFF submission.
• Examples of incomplete and/or non-compliant submissions that the Department regularly receives from companies are listed below.  Note that this list is not exhaustive and is meant to assist in alleviating any unnecessary delay in the form approval process.
• Submissions that are poorly organized and/or difficult to understand:  The practice of using separate forms for each provision of the policy or certificate.  This practice leads to excessive fragmenting and makes it difficult to ascertain the content of a policy or certificate as it may be constructed when issued.
• Incomplete Responses:  Not addressing all questions and issues set forth in a comment.

Check the following before submitting a filing:

• Is the company name on the first page of the form?  Remember to identify the company name, phone number, and address on the application/enrollment forms.
• If the company is filing a rider, amendments, endorsement, application, or enrollment form, does the filing state the policy form number, approval date, and tracking/file number of the policy with which it will be used?
• Did the company include a unique form number in bottom left corner?
• Are there spelling errors?
• Do all brackets for variable language include a beginning and ending bracket?
• Are all drafting notes and track changes removed from the form?  Forms must be submitted in clean, final format.

Please contact the Department in the following situations.    

• The company should call, email, or meet with the Department well in advance of making a submission of any innovative products or benefits.
• The Department encourages companies to contact appropriate Department personnel prior to making their submissions with any questions concerning submission rules and filing requirements or for any guidance regarding the rules, regulations, or statutes that apply to any insurance product.  Please also contact the Department at [email protected] to further discuss the guidance contained on this page.
  • For questions or comments specific to a current filing, the Department requests that companies or company representatives first contact the Department’s personnel listed on the filing through the SERFF filing.  Email correspondence should not be a company’s first line of contact on a current filing.

Information required by 11 NYCRR 52.33 should be entered in the Filing Description field on the “General Information” tab in SERFF.  The more details the company provides, the better the Department will understand the nature of the submission, which in turn reduces additional objections and questions.  (For example, if numerous policies are being filed and they are essentially the same with only slight differences, indicate the differences.)

• Indicate if the filing contains forms that will replace or be issued with any other previously approved forms.  Identify previously approved forms by date, form number, and filing numbers.
• Indicate if the filing is a resubmission of a previously closed filing.

The form number entered on the “Form Schedule” tab in SERFF must match the actual form number on the lower left-hand corner of the form.  The form number is used to search filings and to satisfy FOIL requests.

• Each item on the “Form Schedule” tab in SERFF must contain only one PDF attachment. 
• Only policy forms as defined in Insurance Law §§ 3201(a) and 4308 (e.g., policies, certificates, endorsements, riders, applications) may be submitted on the Form Schedule tab in SERFF.  Documents that explain the content of the forms should be submitted on the “Supporting Documentation” tab in SERFF (e.g., copies with changes tracked or highlighted, memorandum of variable material).

When revising a document in a pending SERFF file, clearly designate the replacement so the previous version of the form is displayed in gray on the Form Schedule in SERFF.  If the changes are extensive, it is very helpful to provide a copy of the form(s) with changes tracked showing the changes.

A submission requirement identifies a document that must be submitted based on the Type of Insurance, sub-Type of Insurance, and Filing Type selected by the company for the filing.  If the company decides to bypass a submission requirement, insert an explanation.  Inserting only an “N/A” does not provide the Department with a meaningful explanation.  The company’s decision to satisfy or bypass a requirement should be based only on whether the filing is a form only, rate only, or form and rate filing.

• When submitting a copy of a form with changes tracked, also submit a clean copy.  The clean copy should be submitted on the Form Schedule in SERFF and the copy with changes tracked should be submitted on the Supporting Documentation Schedule in SERFF.
• The proper certification form must be completed and submitted.  Interactive copies of the appropriate certification forms are available within SERFF and on the Department’s website.
• When using the “Certification by Previously Approved Form” or “Certification by Template” filing types, the previously approved form or template must have been approved within the previous three years for the company submitting the filing.

The checklist is an extremely helpful tool for preparing a compliant filing and for expediting review of the filing.

• A completed product checklist must be submitted with every SERFF filing unless a checklist for that product is not available on the Department’s website. Accident and Health Product Checklists and Outlines are organized by product type.
• Instructions on the cover of the checklist explain the portions of the checklist that should be completed when filings contain only an application, a rider or endorsement, or when the filing is a rate-only filing.  If the submission proposes a language change in just one provision, only the portions of the checklist that are relevant to that provision need to be completed.
• When completing a checklist, insert the page number where the provision can be found, rather than entering a general term such as "policy." 
• If the checklist requires an explanation to be attached, include it with the submission on the Supporting Documentation Tab.

A readability certification must be included with all form submissions pursuant to Insurance Law § 3102(c) and (d).

• A sample certification form is available within SERFF.  A copy of a computer printout from Microsoft Word alone does not qualify as a certification. 
• If the Flesch score is below 45, insert an explanation of how the file complies with the requirements (e.g., model language, statutory language).  This avoids the need for the Department to make an objection.

The Department encourages the company to submit a copy of the form(s) being submitted for approval with changes tracked to show the changes from the previously approved form(s), as it is very helpful to the reviewer and may help speed review.  Copies of forms with changes tracked are not limited to the “Certification by Previously Approved Form” or “Certification by Template” filing types.  The Department also encourages the submission of copies of the form(s) with changes tracked with responses to objection letters to show changes that have been made in the form(s) in response to the Department’s comments.

If the company is submitting a parallel product for another entity of the same parent organization, be sure to complete the “State Specific” field fully with the name of the other entity, the submission date, and the SERFF Tracking Number of the parallel submission.  If the company is unable to submit the filings at the same time, identify the file number of the parallel submission in the later submission.  Also, advise the assigned reviewer that a subsequent parallel submission was made and identify the file number of the later submission.  This will enable Department staff to coordinate review of the submissions.

The company name and NAIC number must match the New York licensee name and NAIC number.  If the company has multiple licensed affiliates, make sure the filing clearly identifies the correct name of the licensee for which the submission is being made.

Once the content of the file receives legal clearance and is awaiting rate clearance, additional forms should not be added to the filing.  (Example of a problem amendment: company submits one form, it clears legal review, and while awaiting actuarial review, company attaches additional forms for review.)

• A response to a comment in an objection letter should not be “please reconsider.”  At a minimum, provide a compelling legal reason or argument stating why the Department should reconsider the comment or request a conference call or meeting to discuss.
• A response should be sufficiently detailed, indicating where in the form(s) changes have been made and how the form(s) has/have been revised in response to the comment(s).  A response to a comment should not be “revised.” 
• A response should not include additional changes to the form, outside of what is requested in the objection letter.  If additional changes are needed after the form is initially filed, an amendment should be made that indicates why the form changes have been requested and where the form changes are located.  
• A response should also be complete and address all issues and questions set forth in a comment.  The filing may be closed for providing incomplete responses.  Refer to the subsection in this guidance on “Incomplete or Non-Compliant Filings.”
• An extension of time to respond to an objection letter may be considered on a case-by-case basis.  Send a Note to Reviewer or call to inquire about an extension in advance of the objection letter due date.