Required Checklists for Life/Health & HMO Form Filings

Presenters: Nathan Robertson, Jr., Insurance Specialist Kay Zimmermann, Insurance Specialist Daniel Trevino, Insurance Specialist Division: Life, Health & HMO Filings Intake MC 106-1E Street: 333 Guadalupe, Austin, TX Mailing Address: P. O. Box , Austin, TX Phone: (512) Fax: (512)

Electronic Filing Opportunities for All Filings SERFF – System for Electronic Rate & Form Filing To find out more on how SERFF can help make your company’s filing processes more efficient and to schedule a free online demonstration contact SERFF Marketing Team at For additional information go to MSR – Multi State Review Program (Fast Track Filing) Website available through Florida’s I-File System at: Point of Contact: Jim Walker, or

Transmittal Checklist for Life/Health Form Filings Changes in 2010: Form LHL020 Rev. 01/10

Transmittal Form for Certain Miscellaneous Documents for Life/Health Changes in 2010: Form LHL243 Rev. 03/10

Rule Change January 13, 2009 Impacts The Following Long Term Care Forms: Claims Denial Reporting LHL564(LTC) Long Term Care Policies Sold LHL565(LTC) Replacement & Lapse Report LHL562(LTC) Rescission Reporting LHL563(LTC) Suitability Reporting LHL566(LTC) The forms are no longer accepted via SERFF or U.S. Mail The forms are located in the Forms Section of the TDI website to be completed and submitted through the website

Websites for Transmittal checklist for Life/Health Transmittal Checklist for HMO Filings

Transmittal Checklist for HMO Filings

HMO FILINGS TO BE SUBMITTED TO FINANCIAL ANALYST (303-1A): Management/Administrative Service/Marketing/Data Processing/Claims Agreement Change to Bond on Officers/Directors Agreements with Affiliates Stop Loss or Reinsurance Change in Affiliate Chart Change in Ownership Miscellaneous

HMO FILINGS TO BE SUBMITTED TO COMPANY LICENSING (MC 305-2C): Name, Assumed Name, Service Mark or Trademark Amendments to Basic Organizational Documents Domiciliary States’ COA and Power of Attorney Biographical changes or updates Change in Administrative offices Service Area Expansions Amendments to Bylaws

HMO FILINGS TO BE SUBMITTED TO FILING/INTAKE UNIT FOR APPROVAL: Evidence of Coverage Service Area Description and Map Riders Schedule of Benefits

HMO FILINGS TO BE SUBMITTED TO FILING/INTAKE UNIT FOR INFORMATION: Provider Directories Notice to Providers Rates Provider Contracts Member Handbook

REMINDERS 1.NO BOUND BOOKLETS 2.TYPED FORM NUMBERS 3.FORM NUMBERS WITH 40 CHARACTERS OR LESS 4.MATCHING FORM NUMBERS 5.SAME FORM NUMBER ON EACH PAGE OF FILING

Thank you for attending the conference and have a safe trip home.