PURPOSE: This rule outlines the procedure for filing life or accident and health insurance policies, health maintenance organization benefit plans, health maintenance organization provider contracts, annuities and other contracts, and related forms which must be approved by the director prior to their use in Missouri. This rule also establishes the procedure for the filing of certain rates and sets forth the manner in which filing fees are calculated.

1. (1) Applicability—This regulation applies to all policies, contracts and related forms, rates, and advertisements which must be filed with the department.

2. (2) Definitions.

   1. (A) “Insurer” means all companies authorized to transact the business of life or health insurance in this state, fraternal benefit societies, health service corporations, health maintenance organizations (HMOs), or any other prepaid plan providing health care, dental, vision, or similar types of services or benefits to citizens of this state.
   2. (B) “The department” means the Department of Insurance, Financial Institutions and Professional Registration.

   3. (C) “Policies, contracts, and related forms,” or “forms,” means group or individual policies or contracts issued by an insurer, including any:

      1. 1. Individual policies, group policies,

and certificates;

1. 2. Endorsements, riders, amendments,

or addendums to the policy or contract;

1. 3. Group certificates of coverage as set

forth in subsection (4)(C) of this regulation;

1. 4. Applications and enrollment forms or

any forms supplemental to them;

1. 5. Any schedule pages filed separately

from the policy or contract when they are used to set forth the provisions and conditions of coverage provided under contracts issued by insurers;

1. 6. Any form used by an HMO or other

prepaid plan to contract with persons providing care, services, or supplies to enrollees; and

1. 7. Any HMO provider risk-sharing

arrangement in accordance with section 354.624, RSMo.

1. (3) Filing Requirements for All Policies, Contracts, and Related Forms.

   1. (A) All policies, contracts, and related forms must be submitted via the System for Electronic Rate and Form Filing (SERFF).
   2. (B) Each filing of a form(s) must be accompanied by a general description, which briefly describes the benefits or other purpose of the form(s) and the intended market in which the form(s) will be utilized.
   3. (C) The general description must disclose if a form is new or a replacement to a previously-approved form. If a form is replacing a previously-approved form, the general description must give the reason for the 20 CSR 400-8

replacement and provide the SERFF tracking number for the form being replaced. If there is no SERFF tracking number applicable to the form being replaced, the insurer must provide other indentifying information as determined by the department.

1. (D) Each form, if not a complete policy, must specify if it is an amendment, rider, endorsement, addendum, or other type of attachment to a policy form.

   1. 1. Each amendment, rider, endorse-

ment, addendum, or other type of attachment to a policy form must be submitted with the SERFF tracking number of the policy(ies) to which it will be attached; or

1. 2. If the original policy was not submit-

ted via SERFF, a copy of the policy(ies) to which it will be attached and a copy of the stamped approved transmittal document (TD- 1) that was provided to the company by the department at the time the policy was approved.

1. (E) Life insurance forms must be submitted separately from health insurance forms.
2. (F) Group forms must be submitted separately from individual forms.
3. (G) HMO contracts and evidences of coverage must be submitted separately from HMO provider contracts.
4. (H) Life insurance and annuity submissions must be accompanied by actuarial demonstrations of compliance with section 376.670, 376.671, or 376.697, RSMo, where appropriate.
5. (I) Each policy, contract, or related form must contain a unique form number in the lower left corner of the face page. In the case of riders, amendments, or applications, the unique form number must appear in the lower left corner of the first page.
6. (J) Each separately-licensed insurer must file its forms separately from any other separately-licensed insurer, including separatelylicensed-but-affiliated insurers. A filing submitted by one (1) affiliate may not serve to meet any filing obligation of a separatelylicensed affiliate.

1. (4) Filing Requirements for Group Policies and Contracts.

   1. (A) The type of group to which the filing is intended to be issued shall be clearly identified in the general description. The group type shall be described pursuant to classifications enumerated in sections 376.421, 376.691, 376.693, and 376.1100.2(4), RSMo.
   2. (B) If the policy is intended to be issued to a group as defined in section 376.421.2, 376.693, or 376.1100.2(4), RSMo, actuarial justification that the proposed group meets the criteria set forth in these sections must FINANCIAL INSTITUTIONS AND PROFESSIONAL REGISTRATION

accompany the filing. Subsequent changes to the policy affecting the original actuarial assumptions must be accompanied by additional actuarial justifications.

1. (C) If a group policy as described in section 376.421.2, 376.693, or 376.1100.2(4), RSMo, is issued in another state but coverage is offered to residents of Missouri, the certificate of coverage must be filed for approval prior to use in Missouri.

   1. 1. Each filing also must be accompanied

by the actuarial justifications required of Missouri sitused groups under subsection (4)(B).

1. 2. The filing for approval required in

subsection (4)(C) need not be provided if the insurer demonstrates that the group policy was delivered and approved in a state which adopted the 1983 version or a more recent version of the National Association of Insurance Commissioners (NAIC) Model Group Law, which includes provisions substantially similar to those contained in the statutes referenced in subsection (4)(C).

1. (5) Each filing submitted in SERFF will be subject to a fifty-dollar ($50) filing fee.

2. (6) Filing of Rates.

   1. (A) Any rate which must be filed must be submitted via SERFF.
   2. (B) All rates, rate increases, and rate decreases must be filed no later than sixty

3. (60) days prior to the date the rate is to become effective when—

   1. 1. The coverage to which the rate

applies is Medicare Supplement coverage as defined in section 376.854, RSMo; or

1. 2. The coverage to which the rate

applies is credit life or disability coverage subject to Chapter 385, RSMo.

1. (7) Advertisement—Any statutorily-required filing of advertisements must be submitted via SERFF.

AUTHORITY: sections 354.624, 376.405, 376.670, 376.675, and 376.777, RSMo 2000 and sections 354.485, 374.045, and 374.056, RSMo Supp. 2010.* This rule was previously filed as 4 CSR 190-13.010. Original rule filed Dec. 5, 1969, effective Dec. 15, 1969. Amended: Filed Aug. 5, 1974, effective Aug. 15, 1974. Rescinded and readopted: Filed Jan. 13, 1984, effective May 11, 1984. Amended: Filed March 3, 1986, effective Aug. 25, 1986. Rescinded and readopted: Filed Oct. 24, 1991, effective April 4, 1992. Amended: Filed Nov. 3, 1997, effective May 30, 1998. Amended: Filed Feb. 14, 2011, effective Aug. 30, 2011. *Original authority: 354.485, RSMo 1983, amended 2007; 354.624, RSMo 1997, 374.045, RSMo 1967, amended 1993, 1995, 2008; 374.056, RSMo 2008; 376.405, RSMo 1959, amended 1984, 376.670, RSMo 1943, amended 1959, 1961, 1965, 1975, 1979, 1982; 376.675, RSMo 1963, amended 1984; and 376.777, RSMo 1959, amended 1984. Op. Atty. Gen. No. 112, Edmiston (6-21-76). Insurance companies are required to pay a filing fee pursuant to section 374.230(6), RSMo for documents filed with the director of the Division of Insurance pursuant to sections 376.405, 376.675, 376.777, RSMo Supp. 1975. The filing fee imposed by section 374.230(6) is for each document and not each page of each document. The filing fee paid pursuant to section 374.230(6) is not pursuant to section 148.400, RSMo, deductible from the premium tax payable by such companies. Survivors Ben. Ins. Co. v. Farmer, 514 SW2d 565 (Mo. 1974). Superintendent of insurance has the duty to approve or disapprove life insurance contracts and forms and no contract or form may be used in Missouri without the approval of the superintendent.