(1) provide complete and accurate information
about the filing;
(2) include, at a
minimum, the following information:
(A) the
name and address of the submitting company;
(B) the contact person information as
required in §
3.4(b) of this
title (relating to General Submission Requirements);
(C) the unique identifying form number of
each form submitted;
(D) an
explanation of the purpose and use of each form as defined in §
3.2 of this title (relating to
Definitions);
(E) an indication of
the product and type;
(F) an
indication of whether the filing is prompted by a business change such as an
assumption, a name change, or a demutualization/conversion;
(G) the applicable authority from the
Insurance Code or the Administrative Code under which the form is being
submitted as described in §
3.5 of this title (relating to
Filing Authorities and Categories);
(H) an indication of whether the filing is a
matrix filing;
(I) rate filing
information, if applicable;
(J) a
statement that the submission will be used:
(i) on a general use basis, only with the
policy being filed, or with previously approved or exempted forms;
and
(ii) if the submission will be
used with previously approved or exempted forms, a listing of the following:
(I) the form numbers of the previously
approved or exempted forms;
(II)
the approval or exemption dates of the previously approved or exempted forms;
and
(III) a brief description of
when or how each submitted form will be used with the previously approved or
exempted forms;
(K) if the filing is a group filing, it must
contain:
(i) A statement specifying the
specific group type as set forth in §
3.6(c)(1) of
this title (relating to Certifications, Attachments, and Additional Information
Requirements).
(ii) A separate
policy and certificate for each type of group. A submission of a single policy
and certificate for use with more than one type of group is
prohibited.
(iii) The following as
applicable:
(I) a statement specifying the
size of the group if issued under Chapter 26 of this title (relating to Small
Employer Health Insurance Regulations);
(II) a copy of the trust agreement if issued
to a trust;
(III) a copy of the
constitution, bylaws, and articles of incorporation if issued to an
association; or
(IV) certification
and evidence that the master policy for the group was lawfully issued and
delivered in a state in which the company was authorized to do insurance
business;
(L)
any certifications and attachments, including summary of differences, if
applicable, or any additional information required by §
3.6 of this title, or variable
information in accordance with §
3.4(e) of this
title.
(3) be completed,
signed, and certified by an attorney licensed to practice law in this state, an
actuary familiar with the requirements of the Insurance and Administrative
Codes, the chief executive officer of the filing company, or a person with
authority to bind the company.
