PURPOSE: This rule outlines the procedure for filing life or accident and health insurance policies, 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) Applicability—This regulation applies to all policies, contracts and related forms, rates and advertisements which must be filed with the director.

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

      1. 1. Individual policies and group poli-

cies, certificates and insert pages;

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; and

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

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

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

   1. (A) All policies, contracts and related forms must be submitted in duplicate to the life and health section for approval prior to use in this state.
   2. (B) Each filing of forms must be accompanied by a letter of transmittal, in duplicate, which references the forms and which briefly describes the benefits or other purpose of the forms and the intended market in which it will be utilized.
   3. (C) The letter of transmittal 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 letter must give the reason for the replacement and provide the form number and approval date for the form being replaced.
   4. (D) Life insurance forms must be submitted separately from health insurance forms. However, this restriction does not apply where the combination of coverage is inherent to the plan design of group coverage.
   5. (E) Group forms must be submitted separately from individual forms.
   6. (F) Life insurance and annuity submissions must be accompanied by actuarial demonstra- 20 CSR 400-8

tions of compliance with section 376.670, 376.671 or 376.697, RSMo, where appropriate.

1. (G) Each policy, contract or related form must contain a form number in the lower left corner of the face page. In the case of riders, amendments or applications, the form number must appear in the lower left corner of the first page.

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

   1. (A) The type of group to which the filing is intended to be issued clearly shall be identified in the letter of transmittal. The group type shall be described pursuant to classifications enumerated in section 376.421, 376.691, 376.693 and 376.951.2(4)(d), RSMo.
   2. (B) If the policy is intended to be issued to a group as defined in section 376.421.2, 376.693 or 376.951.2(4)(d), RSMo, actuarial justification that the proposed group meets the criteria set forth in these sections must accompany the filing. Subsequent changes to the policy affecting the original actuarial assumptions must be accompanied by additional actuarial justifications.

   3. (C) If a group policy as described in section 376.421.2, 376.693 or 376.951.2(4)(d), 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) Filing Requirements for pro forma HMO Provider Contracts and Risk-Sharing Arrangements.

   1. (A) Pro forma provider contracts must contain an identifying form number in the lower left corner of the first page.
   2. (B) Each pro forma provider contract, including any amendments or endorsements, and any risk-sharing arrangements or terms, must be filed with a transmittal document as specified in section (6).
   3. (C) The filing fee for pro forma provider contracts and for all risk-sharing arrangements or terms shall be calculated in the same manner as for policies, contracts and related forms as set forth in section (7) of this regulation.

2. (6) Transmittal Document Required.

   1. (A) All filings must include a completed transmittal document (form TD-1) in the form illustrated in Exhibit I to this regulation.
   2. (B) The TD-1 must be submitted in triplicate and list each form by form number and title in the appropriate area.

3. (7) Computation of Filing Fees for Policies, Contracts and Related Forms.

   1. (A) The fee for each separately filed group or individual policy, including any certificates, riders, applications, etc. to be used with that policy is fifty dollars ($50).
   2. (B) The fee for each separately filed group certificate, including any riders, applications, endorsements, etc. to be used with that certificate is fifty dollars ($50).
   3. (C) The fee for any applications, riders, amendments, etc. filed independent of a policy or certificate is fifty dollars ($50) per form.
   4. (D) The fee for group policy or certificate insert pages is fifty dollars ($50) for each group policy with which they will be used.
   5. (E) The fee for group insert pages which are filed on a general use basis is fifty dollars ($50) per insert page.
   6. (F) The fee for filing each pro forma provider contract and each risk-sharing arrangement or term is fifty dollars ($50) per contract, arrangement or term.

4. (8) Filing of Rates.

   1. (A) All rates, rate increases and rate decreases must be filed no later than sixty

5. (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; and

1. 2. The coverage to which the rate

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

1. (B) Any rate which must be filed pursuant to this subsection must be accompanied by—

   1. 1. A transmittal document (TD-1) which

lists each policy form to which the rate change applies; and

1. 2. A fifty dollar ($50) filing fee for each

rate schedule filed.

1. (9) Advertisement—Any statutorily required filing of advertisements must be accompanied by a fifty dollar ($50) filing fee, a transmittal letter and TD-1 form.

AUTHORITY: sections 354.485, 376.405, 376.670, 376.675 and 376.777, RSMo 1994, and 354.624 and 374.045, RSMo Supp. 1997.* 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. *Original authority: 354.485, RSMo 1983, 354.624, RSMo 1997, 374.045, RSMo 1967, amended 1993, 1995, 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.