Section 916.10  Authority

 

This Part is promulgated by the Director of Insurance pursuant to authority contained in Section 401 of the Illinois Insurance Code [215 ILCS 5/401] which empowers the Director to make reasonable rules and regulations as may be necessary for making effective insurance laws of the State of Illinois.  This Part implements Section 143 of the Illinois Insurance Code [215 ILCS 5/143] and Section 10 of the Voluntary Health Services Plans Act [215 ILCS 165/10] and Section 109 of the Dental Care Patient Protection Act [215 ILCS 109] and Section 25 of the Dental Service Plan Act [215 ILCS 110/25] and Section 4003 of the Limited Health Service Organization Act [215 ILCS 130/4003] and Section 5-3 of the Health Maintenance Organization Act [215 ILCS 125/5-3] and the Electronic Commerce Security Act [5 ILCS 175].

 

(Source:  Amended at 29 Ill. Reg. 4922, effective March 22, 2005)

 

Section 916.20  Purpose and Scope

 

The purpose of this Part is to establish a uniform, expeditious and required method and procedure under which all companies, defined under Section 916.30, shall file with and secure approval of the Director of Insurance of all life insurance, annuity and accident and health insurance policy forms, defined under Section 916.30, before issuance or delivery.

 

(Source:  Amended at 17 Ill. Reg. 15853, effective September 14, 1993)

 

Section 916.30  Definitions

 

"Certificate of Compliance" means a document as described in Section 916.50, an example of which is included in Exhibit A, which certifies that the filing complies with Illinois applicable provisions.  The Certification must include a readable, authentic and visible signature of an officer of the company.

 

"Combination Form" means a policy form that will be used for both life and accident and health. Combination forms must be submitted under TOI/Sub-TOI's for life and for accident and health.

 

"Company" means any entity that is defined, identified or functions as a "company" in Section 2 of the Illinois Insurance Code [215 ILCS 5/2], in Section 2 of the Voluntary Health Services Plans Act [215 ILCS 165/2], in Section 3 of the Dental Service Plan Act [215 ILCS 110/3], in Section 1002 of the Limited Health Service Organization Act [215 ILCS 130/1002], or in Section 1-2 of the Health Maintenance Organization Act [215 ILCS 125/1-2], and that issues or delivers in the State of Illinois policies, group contracts or certificates of life, annuity and accident and health insurance, which fall within the definition of Classes 1(a), 1(b) and 2(a) of Section 4 of the Illinois Insurance Code, unless the context clearly indicates that the entity shall not constitute a company for purposes of this Part.

 

"Department" means the Illinois Department of Insurance.

 

"Director" means the Director of the Illinois Department of Insurance.

 

"Illinois Insurance Code" or "Code" means 215 ILCS 5.

 

"Informational filing" means a filing of a policy form, rate or other informational material that does not require approval by the Director, but is filed for informational purposes only.  These filings would include, but are not limited to, an informational policy, other State approvals, calculations, required informational material, outlines of coverage and variable material.

 

"PDF" means an Adobe Portable Document Format.

 

"Policy Form" means any form to be issued or delivered in the State of Illinois, pursuant to Section 143(l) of the Illinois Insurance Code, constituting in form and content a policy, group contract or certificate of insurance or evidence of coverage, endorsement, rider, schedule of benefits page, by-law or other matter incorporated by reference, or application blank or discretionary group forms requiring the Director's approval pursuant to Section 230.2 and 367.3 of the Illinois Insurance Code.

 

"SERFF" means the System for Electronic Rate and Form Filing used for electronic filings of participating company policy forms and rating information.

 

"State Tracking/Company Tracking Numbers" means the number assigned by the company that is used to distinguish one filing from any other filing submitted by that same company. All policy forms submitted in a filing shall be for the same line of business and the same category.

 

"Subtype of Insurance" or "Sub-TOI" means the characteristic and detailed description of the policy form as set forth on the SERFF website (www.serff.com).

 

"Type of Insurance" or "TOI" means the general classification of the policy form to be issued or delivered as set forth on the SERFF website.

 

(Source:  Amended at 39 Ill. Reg. 2590, effective February 6, 2015)

 

Section 916.40  Filing Procedures

 

a)          Certificate of Compliance.  Each company doing business in the State of Illinois shall submit with each filing a Certificate of Compliance, as described in Section 916.50 and Exhibit A.

 

b)         Forms Review. Each company shall file with the Director for approval each new policy form in a searchable text PDF before it is issued or delivered in this State. Each filing shall be submitted directly through SERFF and shall include each of the following:

 

1)         A detailed description of:

 

A)        the purpose for the policy form and the manner in which it will be marketed; and

 

B)        a cross-reference SERFF tracking number for identical submissions made by affiliated companies.

 

2)         The policy forms:

 

A)        The text of each policy form shall be made out in "John Doe" fashion, bracketing any appropriate variable material.  The form number shall appear in the lower left-hand corner of the policy form to be approved. 

 

B)        A combination form shall be submitted in two separate filings.  Each filing must be identified with a unique company tracking number and must have an accurate TOI and Sub-TOI selected.

 

3)         Informational filings must contain a detailed description of:

 

A)        The purpose of submitting the informational filing; and

 

B)        The form number, date of approval, state/company filing number and/or SERFF tracking number for the form to which the informational filing relates.

 

c)         Riders and Endorsements.  Riders or endorsements that unilaterally reduce benefits, and are attached to a policy subsequent to the date the policy is issued, shall be reviewed and approved by the Director prior to their issuance or delivery.

 

d)         Replacement Filings.  A new policy form that replaces or is substantially similar to a previously approved policy form must have a redlined version submitted detailing the revisions made to the previously approved policy form. A new policy form replacing a form previously approved, when the new policy form bears the same form number as the previously approved form, shall be accompanied by:

 

1)         a statement that the filing is a replacement;

 

2)         the State tracking/company tracking number and/or SERFF tracking number of the previously approved form and the date of the previous approval; and

 

3)         a statement that the previously approved policy form was never issued. 

 

e)         Rates

 

1)         Individual and group Medicare supplement policy form filings and individual and group long-term care policy form filings shall be accompanied by rates providing a description of the classification of risks and the premium rates. Data demonstrating the calculation of the rates shall accompany each individual accident and health policy form.  The rate data must be submitted in a separate SERFF filing.

 

2)         Any insurance company, health maintenance organization or health service plan authorized to offer health insurance coverage, as that term is defined in the Illinois Health Insurance Portability and Accountability Act [215 ILCS 97] (HIPAA), must file all proposed rate increases with the Department prior to use.  All rate filings must be submitted electronically through the Health Rate Review Web Portal.

 

f)         Credit Policies.  Individual and group credit policy form filings shall be accompanied by the rate filing that provides a description of the classification of risks and the premium rates.  Data demonstrating the calculation of the rates shall accompany each credit policy form.

 

g)         Filing Fee. Fees are paid through Electronic Funds Transfer through SERFF upon submission of the SERFF Filing.

 

h)         Policy Form Withdrawal 

 

1)         Filings submitted for the withdrawal of policy forms shall include a letter of explanation providing the form numbers to be withdrawn, along with the SERFF Tracking Number or Company Tracking/State Tracking Number under which the form was originally approved.

 

2)         Health insurance contracts subject to HIPAA shall include requirements set forth in 50 Ill. Adm. Code 2025.

 

i)          Multiple Company Filings.  The form language and form numbers in multiple company filings must be identical, and filing fees must be submitted through Electronic Funds Transfer for each form filed for approval by each company.

 

(Source:  Amended at 39 Ill. Reg. 16152, effective December 3, 2015)

 

Section 916.50  Certificate of Compliance

 

a)         Each filing shall contain a Certificate of Compliance that the filing complies with all applicable Illinois statutes.  The Certificate of Compliance must carry a readable, authentic and visible signature of an officer of the company.

 

b)         The Certificate of Compliance shall be signed by an officer of the company, identified by title, who has the authority to obligate the company by his or her signature.  In this manner, the company shall agree and consent to the discontinuance of future use of any approved policy form. Discontinuance is effective 30 days from the date of mailing an order of withdrawal issued by the Director pursuant to Section 143(1) of the Illinois Insurance Code.  The order shall set forth the reasons why the previously approved policy form is violative of or contrary to the Illinois Insurance Code or all provisions of 50 Ill. Adm. Code applicable to policy forms.  Each company shall have the right to request a hearing within that 30 day period.  The request shall be made in writing to the Director.  The order of withdrawal shall be stayed and the company shall be given a hearing under Sections 143(1), 401(c), 401.1, 402(2), 426 and 429 of the Illinois Insurance Code and 50 Ill. Adm. Code 2402, as may be applicable, to determine:

 

1)         whether the policy form shall be disapproved; and

 

2)         whether further orders of the Director may be appropriate.

 

(Source:  Amended at 39 Ill. Reg. 16152, effective December 3, 2015)

 

Section 916.60  Effective Date (Repealed)

 

(Source:  Repealed at 9 Ill. Reg. 18139, effective February 13, 1986)

Section 916.EXHIBIT A   Certificate of Compliance

 

Each company shall submit a "Certificate of Compliance" in substantially this format:

 

 

CERTIFICATE OF COMPLIANCE
(Company Name)
By:		Title:

 

certifies that the policy forms submitted or referenced in this filing do comply:

 

a)         with all provisions of the Illinois Insurance Code applicable to the policy forms; and

 

b)         with all provisions of 50 Ill. Adm. Code applicable to policy forms;

 

and does further certify to the best of our knowledge and belief that:

 

1)         the forms do not contain any inconsistent, ambiguous or misleading clauses;

 

2)         the forms do not contain specifications or conditions that unreasonably or deceptively affect the risk purported to be assumed in the general coverage of the policy forms;

 

3)         the only variation from the usual provisions of the policy forms are clearly marked or otherwise indicated;

 

4)         the language of the policy form, as submitted or approved, shall be exactly as it has been or will be offered for issuance or delivery in the State of Illinois as approved by the Director, except for hypothetical data and other appropriate variable material; and

 

5)         the policy forms do not contain any provision or clause currently being disapproved by the Director.

 

In utilizing the procedure for policy form filing and approval set forth in 50 Ill. Adm. Code 916,
(company name)	hereby expressly agrees and consents to a review, by the
Director, to be made at any time, and further hereby expressly agrees and consents to the discontinuance by the company of future use of the approved policy forms, 30 days from the date of mailing an order of withdrawal issued by the Director pursuant to Section 143(1) of the Illinois Insurance Code.  The order shall set forth the reasons why the previously approved policy forms are violative of or contrary to the provisions of the Illinois Insurance Code or all provisions of 50 Ill. Adm. Code applicable to policy forms.  Each company shall have the right to request a hearing within that 30 day period.  The request shall be made in writing to the Director.  The order of withdrawal shall be stayed and the company shall be given a hearing under the provisions of Sections 143(1), 401(c), 401.1, 402(2), 426 and 429 of the Illinois Insurance Code [215 ILCS 5/143(1), 401(c), 401.1, 402(2), 426 and 429] and 50 Ill. Adm. Code 2402, as may be applicable, to determine:

 

a)         whether the policy form shall be disapproved; and

 

b)         whether further orders of the Director may be appropriate.

 

 

(Company Name)
By:
(Signature)
Title:			Date:

 

(Source:  Amended at 39 Ill. Reg. 16152, effective December 3, 2015)

 

Section 916.EXHIBIT B   Coding Guide (Repealed)

 

(Source:  Repealed at 29 Ill. Reg. 4922, effective March 22, 2005)

 

Section 916.EXHIBIT C   Discontinued Acronyms From Exhibit B Coding Guide (Repealed)

 

(Source:  Repealed at 29 Ill. Reg. 4922, effective March 22, 2005)

 

Section 916.EXHIBIT G   General Transmittal Instructions and Transmittal (Repealed)

 

(Source:  Repealed at 29 Ill. Reg. 4922, effective March 22, 2005)

 

Section 916.EXHIBIT H   Replacement/Withdrawal Transmittal Instructions and Transmittal (Repealed)

 

(Source:  Repealed at 29 Ill. Reg. 4922, effective March 22, 2005)

 

Section 916.EXHIBIT I   Certificate of Assumption Transmittal Instructions and Transmittal (Repealed)

 

(Source:  Repealed at 29 Ill. Reg. 4922, effective March 22, 2005)

 

Section 916.EXHIBIT J   Informational Filing Transmittal Instructions and Transmittal (Repealed)

 

(Source:  Repealed at 29 Ill. Reg. 4922, effective March 22, 2005)