Description: This filing type may only be used when an appropriate product checklist is available on the DFS website. The insurer must diligently complete the product checklist and follow all applicable regulations and statutes in its preparation of the filing.

Availability: Form and rate filings or form only filings.

Description: This process may be used for a filing where the major portion of the policy form was previously approved but the new filing contains changes to that policy form. The previously approved form must have been approved within three (3) years of the date of the new submission. Under this method, the majority of the policy form will be acceptable and the review will be primarily based on the proposed changes.

Availability: Form and rate filings or form only filings.

Description: A template consists of language commonly included by an insurer in its various form filings without variation.  The template must have been approved within three (3) years of the date of the filing. Under this method, the majority of the policy form will be acceptable and the review will be primarily based on the proposed changes.

Availability: Form and rate filings or form only filings.

Description: This filing type is used for advance filings by insurers, Article 43 Corporations, and Health Maintenance Organizations (HMOs) that plan to submit a rate adjustment filing pursuant to Insurance Law §§ 3231(e)(1) or 4308(c).  This prefiling must contain a draft of the initial notice of proposed premium rate adjustments and a draft of the narrative summary explaining the reasons for the proposed rate.  This prefiling is required to be submitted at least 10 calendar days before submitting a premium rate adjustment application. Refer to Insurance Circular Letter No. 12 (2011) for more information.

Availability: Rate only filings.

Description: This filing type may be used for insurers to file rate adjustments for Medicare Supplement insurance.  This filing type is not used for rate adjustments for long term care insurance or individual and small group comprehensive medical insurance (On or Off Exchange).      

Availability: Rate only filings for rate adjustments by commercial insurers only.

Description: This filing type may be used for corporations or HMOs to file rate adjustments for Medicare Supplement insurance or large group HMOs.  This filing type is not used for rate adjustments for long term care insurance or individual and small group comprehensive medical insurance (On and Off Exchange). 

Availability: Rate only filings for rate adjustments by an Article 43 corporation or an HMO.

Description: Section 3201(b)(6) provides specific timeframes for action on the filing or it may be deemed approved or denied.  Within 90 days of receipt, DFS must approve, deny, or detail additional information to make a determination.  However, if the filing is incomplete or noncompliant, the DFS may close the file within 60 days of receipt. 

Availability: Form and rate filings or form only filings.

Description: This filing type should be used to file only Medicare Supplement insurance advertising.  Advertising is not filed for any other products such as long term care insurance; however, insurers are required to keep advertising for all products in compliance with Regulation 34 (11 NYCRR Part 215).

Availability: Form only filings.

Description: This filing type should be used to submit previously approved forms that the insurer is requesting to use a different manner (e.g., use a previously approved form with a permissible group that was not listed in the original filing).  This filing type should also be used for approval of an electronic application that is identical to the previously approved paper application (e.g., a fillable PDF version of the paper application).

Availability: Form only filings.

Description: This filing type is available for submissions that contain documents that are not policy forms as defined by Insurance Law § 3201(a).  Initial rate filing or a rate adjustment filing should not use this filing type. 

Availability: Form and rate filings (e.g., explanation of variability), form only filings (e.g., outline of coverage or disclosure material), or rate only filings (e.g., rates for use outside New York).

Description:  Insurers writing group coverage (other than statutory Disability Benefits Law coverage) may provide coverage for a specific policyholder prior to the filing and approval of policy forms.  The filing type is used to submit the required notice of the effective date of coverage and the benefits.  This procedure may only be used:

• on a single case basis;
• when it is not reasonably possible for the insurer to obtain approval prior to the effective date of coverage; and
• when the insurer has a reasonable expectation of approval of the appropriate forms by the Department.

The insurer must seek formal approval of the policy forms and rates.  Insurers are strongly encouraged to submit policy forms and rates within 60 days of the date the insurer agreed to provide coverage using the appropriate filing type.  To minimize the need to use the prefiling process, insurers should use variable material for inclusion in the group policy forms, especially with respect to cost-sharing provisions in the policy form or schedule of benefits.

The prefiling process should not be used for any innovative or unique products, features, or benefits.  In general, an innovative or unique product, feature, or benefit would include one that has not been previously approved and would be new to the New York accident and health insurance marketplace.  It may not be used with individual or blanket coverage.

Availability:  Form only filings for group coverage other than statutory Disability Benefits Law coverage.

Description: This filing type is used for submission of provider networks for medical, stand-alone dental, and/or vision products.  Submission instructions, standards, and guidance are available at Network Adequacy and Out-of-Network Guidance.

Availability: Form only filings.

Description: This filing type is the standard filing type for forms and/or rates that do not qualify for one of the expedited filing types. 

Availability: Form and rate filings, form only filings, or rate only filings, including commission schedules and experience rating formula filings.

Description: Domestic insurers must file all accident and health policy forms intended for use outside New York with DFS before their issuance under Insurance Law § 3201(b)(2).  This filing type may not be used for submissions pursuant to Regulation 123 (11 NYCRR 59) where coverage is issued out-of-state to cover New York residents.

Availability: Form only filings.

Description: 11 NYCRR 52.40 requires that an insurer’s underwriting rules be submitted to DFS.  DFS requires insurers to separately file their underwriting guidelines for reference for comprehensive hospital, medical, and surgical coverage issued in the individual, small group, and large group markets.

Availability:  Form only filings.

Description: This filing type is used to collect enrollment information for all comprehensive health insurance policies. 

Availability:  Rate only filings.

Description:  This filing type may be used for the annual filing of the following:

• Experience data as required under 11 NYCRR 52.44(a) and (b) for individual policies;
• Experience monitoring/reporting as required under 11 NYCRR 59.7(b); or
• Experience data for individual and group Medicare Supplement policies as required under 11 NYCRR 52.40(k).

Availability:  Rate only filings only if the experience data is submitted separately from a rate adjustment request.

Description: This filing type is used to submit quarterly and annual reports of health care claims.

Availability: Rate only filings.

Description:  This filing type is used to submit reports for reimbursement from the Healthy New York Funds. 

Availability: Rate only filings.

Description:  Insurance Law §§ 3231(e)(1) and 4308(c) require an annual loss ratio report to be submitted to the Department by June 30 of the following year for policies subject to these sections, except Medicare Supplement insurance policies.  For products subject to these sections and which are subject to the Department of Health and Human Services (HHS) medical loss ratio (MLR) annual reporting form and rebate testing, submitting a copy of the HHS MLR annual reporting form by June 30 will satisfy the reporting requirement of these sections.  Insurers should follow the HHS methodology and instructions using the reporting forms prescribed by HHS.  See also Circular Letter No. 15 (2011) and the loss ratio reporting guidance posted on the DFS website.  For Medicare Supplement products refer to filing types Experience Monitoring/Reporting and Med Supp Refund Calculation Report.

In addition, this submission would then be amended by August 1st to indicate whether, in accordance with HHS requirements, the insurer has paid any rebates to policyholders.  If rebates have been or will be paid, the amount of such rebates by each market segment (i.e., aggregation pool) is to be reported to DFS using this amendment process.

Availability:  Rate only filings.

Description:  This filing type is used for insurers to submit a required report for long term care insurance to DFS.  The Claims Denial report is due June 30 each year.

Availability: Form only filings.

Description:  This filing type is used for insurers to submit a required report for long term care insurance to DFS.  The Lapse and Replacement report is due June 30 each year. 

Availability: Form only filings.

Description:  This filing type is used for insurers to submit a required report for long term care insurance to DFS.  The Rescission report is due March 1 each year. 

Availability: Form only filings.

Description:  This filing type is used to submit reports for all Medicare Supplement insurance subject to open enrollment and community rating.

Availability: Rate only filings.

Description:  This filing type is used to submit the report required for all individual and group Medicare Supplement policies per 11 NYCRR 52.44(c), entitled Premium Refund or Credit Calculation for Individual and Group Medicare Supplement Policies.  The report is due by May 1 of each year.  The reporting and refund calculation form is found in 11 NYCRR 52.28 for each type in a standard Medicare Supplement benefit plan.  See also the loss ratio reporting guidance posted on the Department’s website.

Availability: Rate only filings.

Description: On or before March 1st of each calendar year, each issuer is required to report the information specified in 11 NYCRR 58.1(h) for every NYS resident for which the issuer has in force more than one Medicare supplement insurance policy or certificate.  The information shall be reported using the form included in the regulation.

Availability: Form only filings.