South Carolina Department of Insurance Life, Accident and ...

South Carolina Department of Insurance Life, Accident and Health Matrix

Type of Insurance Sub-Type of Insurance

Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate

SC Line Code DOI Series

How Filing Handled

A01 Annuities - Assumption Agreement

A01.000 Annuities - Assumption Agreement

Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms applicable

None 75-00 100 Prior Approval

A02G Group Annuities - Deferred Non-Variable

A02G.001 Fixed Premium None None None 75-22 200 No form filings required for group annuities

A02G.002 Flexible Premium

None None None 75-22 200 No form filings required for group annuities

A02G.003 Single Premium None None None 75-22 200 No form filings required for group annuities

A02G.004 Modified Single Premium


A02G.005 Limited Flexible Premium


A02I Individual Annuities- Deferred Non-Variable

A02I.001 Fixed Premium Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable, Contract Summary, Actuarial Memorandum

None 75-12 100/300 Exempt

A02I.002 Flexible Premium

Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable, Contract Summary, Actuarial memorandum


A02I.003 Single Premium Form Cover letter, Certificate of Readability,


of 103


Type of Insurance

Filing Types Accepted (Please include Combos, Advertisements,

SC Endorsements, Applications, Sub-Type of

Insurance Informational, if applicable) Form Rate

Line How Filing DOI Series Code Handled

Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable, Actuarial certification

A02I.004 Modified Single Premium

Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable, Actuarial certification


A02I.005 Limited Flexible Premium

Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable, Contract Summary, Actuarial memorandum


A02.1G Group Annuities - Deferred Non-Variable

A02.1G.001 Fixed Premium


A02.1G.002 Flexible Premium


A02.1G.003 Single Premium


A02.1G.004 Modified Single Premium


A02.1G.005 Limited Flexible Premium


A02.1G Group Annuities - Deferred Variable

A02.1G.001 Fixed Premium


of 103


Type of Insurance





A02.1G.002 Flexible Premium


A02.1G.003 Single Premium


A02.1G.004 Modified Single Premium


A02.1G.005 Limited Flexible Premium


A02.1I Individual Annuities- Deferred Non-Variable

A02.1I.001 Fixed Premium Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable


A02.1I.002 Flexible Premium

Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable


A02.1I.003 Single Premium



A02.1I.004 Modified Single Premium



of 103


Type of Insurance





A02.1I.005 Limited Flexible Premium



A02.1I Individual Annuities- Deferred Variable

A02.1I.001 Fixed Premium Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

None 75-30 100/300/400 Exempt

A02.1I.002 Flexible Premium


None 75-30 100/300/400 Exempt

A02.1I.003 Single Premium


None 75-30 100/300/400 Exempt

A02.1I.004 Modified Single Premium


None 75-30 100/300/400 Exempt

A02.1I.005 Limited Flexible Premium


None 75-30 100/300/400 Exempt

of 103


Type of Insurance





A03G Group Annuities-Deferred Variable

A03G.001 Fixed Premium None None None 75-40 200 No form filings required for group annuities

A03G.002 Flexible Premium


A03G.003 Single Premium None None None 75-40 200 No form filings required for group annuities

A03G.004 Modified Single Premium


A03G.005 Limited Flexible Premium


A03I Individual Annuities - Deferred Variable

None None

A03I.001 Fixed Premium Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

None 75-30 100/300/400 Exempt

A03I.002 Flexible Premium


None 75-30 100/300/400 Exempt

A03I.003 Single Premium Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

None 75-30 100/300/400 Exempt

of 103


Type of Insurance





A03I.004 Modified Single Premium


None 75-30 100/300/400 Exempt

A03I.005 Limited Flexible Premium


None 75-30 100/300/400 Exempt

A05G Group Annuities - Immediate Non-Variable

A05.000 Annuities - Immediate Non-variable

No form filings required for group annuities

75-21 200 No form filings required for group annuities

A05I Individual Annuities- Immediate Non-Variable

A05I.000 Annuities - Immediate Non-variable

None None None 75-11 100/300 Exempt

A06G Group Annuities - Immediate Variable

A06G.000 Annuities - Immediate Variable


A06I Individual Annuities - Immediate Variable

A06I.000 Annuities – Immediate Variable

Form 75-30 100/300/400 Exempt

A06.1G Group Annuities - Immediate Non-Variable

A06.1G.000 Annuities - Immediate Non-Variable


A06.1G Group Annuities - Immediate Variable

A06.1G.000 Annuities - Immediate Variable


A06.1I Individual Annuities- Immediate Non-Variable

A06.1I.000 Annuities - Immediate Non-Variable



of 103


Type of Insurance





A06.1I Individual Annuities- Immediate Variable

A06.1I.000 Annuities - Immediate Variable


None 75-30 100/300/400 Exempt

A07G Group Annuities - Special

A07G.001 Equity Indexed None None None 75-20 200 No form filings required for group annuities

A07G.002 Modified Guaranteed


A07I Individual Annuities - Special

A07I.001 Equity Indexed Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

N/A 75-10 100/300/400 Exempt

A07I.002 Modified Guaranteed


N/A 75-10 100/300/400 Exempt

A08G Group Annuities - Unallocated

A08G.001 Funding Agreement


A08G.002 GIC None None None 75-20 200 No form filings required for group annuities

A08G.003 Deposit Administration


of 103


Type of Insurance





A10 Annuities - Other A10.000 Annuities - Other Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

N/A 75-00 100/300/400 Exempt

CR01 Credit - Assumption Agreement

CR01.000 Credit - Assumption Agreement



CR01 Credit - Assumption Agreement

CR01.000 Credit - Assumption Agreement



CR02G Group Credit - Credit Disability

CR02G.001 Monthly Premium - Open-End

Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

Actuarial memorandum and rates

55-30 100/200/400/600 Prior Approval

CR02G.002 Monthly Premium - Closed-End



55-30 100/200/400/600 Prior Approval

CR02G.003 Single Premium

Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms


55-30 100/200/400/600 Prior Approval

of 103


Type of Insurance





Applicable

CR02G.004 Full Term Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable


55-30 100/200/400/600 Prior Approval

CR02G.005 Critical Period Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable


55-30 100/200/400/600 Prior Approval

CR02G.006 Truncated Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable


55-30 100/200/400/600 Prior Approval

CR02G.007 Other Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable


55-30 100/200/400/600 Prior Approval

CR02I Individual Credit - Credit Disability

CR02I.001 Monthly Premium – Open-End



55-30 100/200/300/600 Prior Approval

of 103


Type of Insurance





CR02I.002 Monthly Premium - Closed-End



55-30 100/200/300/600 Prior Approval

CR02I.003 Single Premium



55-30 100/200/300/600 Prior Approval

CR02I.004 Full Term Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable


55-30 100/200/300/600 Prior Approval

CR02I.005 Critical Period Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable


55-30 100/200/300/600 Prior Approval

CR02I.006 Truncated Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable


55-30 100/200/300/600 Prior Approval

CR02I.007 Other Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable


55-30 100/200/300/600 Prior Approval

of 103


Type of Insurance





CR03G Group Credit - FMLA


CR03G.001 Monthly Premium - Open-End



55-30 100/200/400/600 Prior Approval




55-30 100/200/400/600 Prior Approval




55-30 100/200/400/600 Prior Approval

CR03I Individual Credit -FMLA

CR03I.001 Monthly Premium - Open-End



55-30 100/200/300/600 Prior Approval

of 103


Type of Insurance








55-30 100/200/300/600 Prior Approval




55-30 100/200/300/600 Prior Approval

CR04G Group Credit - Life CR04G.001 Monthly

Premium - Open-End Form/Rate Cover letter, Certificate

of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable


01-50 100/200/300 Prior Approval









CR04G.004 Gross Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



of 103


Type of Insurance





CR04G.005 Net Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



CR04G.006 Truncated Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



CR04I Individual Credit - Life

CR04I.001 Monthly Premium - Open-End












CR04I.004 Gross Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



of 103


Type of Insurance





CR04I.005 Net Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



CR04I.006 Truncated Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



CR07 Credit - Other CR07.000 Credit - Other Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable


01-00 100/200/300/400 Prior Approval

CR07 Credit - Other CR07.000 Credit - Other Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable


55-00 100/200/300/4 00 Prior Approval

H01 Health - Assumption Agreement

H01.000 Health - Assumption Agreement



H02G Group Health - Accident Only

H02G.000 Health - Accident Only


N/A 55-21 100/200/400 Exempt

of 103


Type of Insurance







Form/Rate -if mass marketed

Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable





Rate None N/A 55-21 100/200/400 No rate filing required for group health

H02I Individual Health - Accident Only

H02I.000 Health - Accident Only


N/A 55-11 100/200/300 Exempt

H02I Individual Health - Accident Only

H02I.000 Health - Accident Only

Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



H03G Group Health - Accidental Death & Dismemberment

H03G.000 Health - Accidental Death & Dismemberment


N/A 55-21 100/200/400 Exempt



Form/Rate - if mass marketed







of 103


Type of Insurance





H03I Individual Health - Accidental Death & Dismemberment

H03I.000 Health - Accidental Death & Dismemberment


N/A 55-11 100/200/300 Exempt

H03I Individual Health - Accidental Death & Dismemberment

H03I.000 Health - Accidental Death & Dismemberment




H04 Health - Blanket Accident/Sickness

H04.000 Health - Blanket Accident/Sickness


N/A 55-12 100/200/300 Exempt

H04 Health - Blanket Accident/Sickness

H04.000 Health - Blanket Accident/Sickness




H04.001 Student Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

N/A 55-12 100/200/300 Exempt

H04.001 Student Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



of 103


Type of Insurance





H05 Health - Champus/Tricare Supplement

H05.000 Health - Champus/Tricare Supplement




H06 Health - Conversion H06.000 Health - Conversion




H07G Group Health - Specified Disease - Limited Benefit

H07G.001 Critical Illness Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

N/A 55-29 100/200/400 Exempt

H07G.001 Critical Illness Form/Rate - if mass marketed




H07G.001 Critical Illness Rate None N/A 55-29 100/200/400 No rate filing required for group health

H07G.002 Dread Disease Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

N/A 55-29 100/200/400 Exempt

of 103


Type of Insurance





H07G.002 Dread Disease Form/Rate - if mass marketed




H07G.002 Dread Disease Rate None N/A 55-29 100/200/400 No rate filing required for group health

H07G.002A Dread Disease - Cancer Only


N/A 55-29 100/200/400 Exempt








H07G.003 HIV Indemnity Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

N/A 55-29 100/200/400 Exempt

H07G.003 HIV Indemnity Form/Rate - if mass marketed




of 103


Type of Insurance





H07G.003 HIV Indemnity Rate None N/A 55-29 100/200/400 No rate filing required for group health

H07I Individual Health - Specified Disease - Limited Benefit

H07I.001 Critical Illness Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

N/A 55-19 100/200/300 Exempt

H07I.001 Critical Illness Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



H07I.002 Dread Disease Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

55-19 100/200/300 Exempt

H07I.002 Dread Disease Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



H07I.002A Dread Disease - Cancer Only


N/A 55-19 100/200/300 Exempt

of 103


Type of Insurance





H07I.002A Dread Disease - Cancer Only




H07I.003 HIV Indemnity Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

N/A 55-19 100/200/300 Exempt

H07I.003 HIV Indemnity Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



H08G Group Health - Intensive Care -Limited Benefit

H08G.000 Health - Intensive Care - Limited Benefit


N/A 55-20 100/200/400 Exempt










H08I Individual Health - Intensive Care -Limited Benefit

H08I.000 Health - Intensive Care - Limited Benefit

Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms

N/A 55-10 100/200/300 Exempt

of 103


Type of Insurance





Applicable

H08I Individual Health - Intensive Care -Limited Benefit

H08I.000 Health - Intensive Care - Limited Benefit




H09G Group Health - Organ & Tissue Transplant - Limited Benefit

H09G.000 Health - Organ & Tissue Transplant -Limited Benefit


N/A 55-20 100/200/400 Exempt










H09I Individual Health - Organ & Tissue Transplant - Limited Benefit

H09I.000 Health - Organ & Tissue Transplant -Limited Benefit


N/A 55-16 100/200/300 Exempt

of 103


Type of Insurance





H09I Individual Health - Organ & Tissue Transplant - Limited Benefit

H09I.000 Health - Organ & Tissue Transplant -Limited Benefit




H10G Group Health - Dental H10G.000 Health - Dental Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

N/A 55-23 100/200/400 Exempt

H10G Group Health - Dental H10G.000 Health - Dental Form/Rate - if mass marketed




H10G Group Health - Dental H10G.000 Health - Dental Rate None N/A 55-23 100/200/400 No rate filing required for group health

H10I Individual Health - Dental

H10I.000 Health - Dental Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

N/A 55-13 100/200/300 Exempt

H10I Individual Health - Dental

H10I.000 Health - Dental Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



H11G Group Health - Disability Income

of 103


Type of Insurance





H11G.001 Business Overhead Expense


N/A 55-24 100/200/400 Exempt








H11G.002 Short Term Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

N/A 55-24 100/200/400 Exempt

H11G.002 Short Term Form/Rate - if mass marketed




H11G.002 Short Term Rate None N/A 55-20 100/200/400 No rate filing required for group health

H11G.003 Long Term Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

N/A 55-24 100/200/400 Exempt

of 103


Type of Insurance





H11G.003 Long Term Form/Rate - if mass marketed




H11G.003 Long Term Rate None N/A 55-20 100/200/400 No rate filing required for group health

H11G.004 Other Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

N/A 55-24 100/200/400 Exempt

H11G.004 Other Form/Rate - if mass marketed




H11G.004 Other Rate None N/A 55-20 100/200/400 No rate filing required for group health

H11G.005 Combined Short Term and Long Term


N/A 55-24 100/200/400 Exempt

H11G.005 Combined Short Term and Long Term





H11G.005 Combined Short Term and Long


of 103


Type of Insurance





Term

H11I Individual Health - Disability Income

H11I.001 Business Overhead Expense -Unrelated to marketing with employer or association groups


N/A 55-14 100/200/300 Exempt

H11I.001 Business Overhead Expense -Unrelated to marketing with employer or association groups




H11I.002 Short Term - Unrelated to marketing with employer or association groups


N/A 55-14 100/200/300 Exempt

H11I.002 Short Term - Unrelated to marketing with employer or association groups




H11I.003 Long Term - Unrelated to marketing with employer or association groups


N/A 55-14 100/200/300 Exempt

of 103


Type of Insurance





H11I.003 Long Term - Unrelated to marketing with employer or association groups




H11I.004 Other Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

N/A 55-14 100/200/300 Exempt

H11I.004 Other Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



H11I.005 Business Overhead Expense - Related to marketing with employer or association groups


N/A 55-14 100/200/300 Exempt

H11I.005 Business Overhead Expense - Related to marketing with employer or association groups




H11I.006 Short Term - Related to marketing with employer or association groups


N/A 55-14 100/200/300 Exempt

of 103


Type of Insurance





H11I.006 Short Term - Related to marketing with employer or association groups




H11I.007 Long Term - Related to marketing with employer or association groups


N/A 55-14 100/200/300 Exempt

H11I.007 Long Term - Related to marketing with employer or association groups




H11I.008 Combined Short Term and Long Term Unrelated to marketing with employer or association groups


N/A 55-14 100/200/300 Exempt

H11I.008 Combined Short Term and Long Term Unrelated to marketing with employer or association groups




H11I.009 Combined Short Term and Long Term Related to marketing with employer or association groups


N/A 55-14 100/200/300 Exempt

of 103


Type of Insurance





H11I.009 Combined Short Term and Long Term Related to marketing with employer or association groups




H12 Health - Excess/Stop Loss

H12.001 Accident & Sickness


N/A 55-27 100/200/400 Exempt

H12.002 Managed Care Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

N/A 55-27 100/200/400 Exempt

H12.003 Provider Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

N/A 55-27 100/200/400 Exempt

H12.004 Self-Funded Health Plan


N/A 55-27 100/200/400 Exempt

H13G Group Health - Short Term Care

of 103


Type of Insurance





H13G.001 Home Health Care


55-20 100/200/400 Exempt

H13G.001 Home Health Care





No rate filing required H13G.001 Home Health

Care Rate None N/A 55-20 100/200/400 for group health

H13G.002 Nursing Home Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

N/A 55-20 100/200/400 Exempt

H13G.002 Nursing Home Form/Rate - if mass marketed




H13G.002 Nursing Home Rate None N/A 55-20 100/200/400 No rate filing required for group health

H13G.003 Adult Day Care Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

N/A 55-20 100/200/400 Exempt

of 103


Type of Insurance





H13G.003 Adult Day Care Form/Rate - if mass marketed




H13G.003 Adult Day Care Rate None N/A 55-20 100/200/400 No rate filing required for group health

H13I Individual Health - Short Term Care

H13I.001 Home Health Care


55-16 100/200/300 Exempt

H13I.001 Home Health Care




H13I.002 Nursing Home Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

55-16 100/200/300 Exempt

H13I.002 Nursing Home Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



of 103


Type of Insurance





H13I.003 Adult Day Care Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

55-16 100/200/300 Exempt

H13I.003 Adult Day Care Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



H14G Group Health - Hospital Indemnity

H14G.000 Health - Hospital Indemnity


55-20 100/200/400 Exempt










H14I Individual Health - Hospital Indemnity

H14I.000 Health - Hospital Indemnity


55-15 100/200/300 Exempt

of 103


Type of Insurance





H14I Individual Health - Hospital Indemnity

H14I.000 Health - Hospital Indemnity




H15G Group Health - Hospital/Surgical/Medical Expense

H15G.001 Any Size Group Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

55-20 100/200/400 Exempt

H15G.001 Any Size Group Form/Rate - if mass marketed




H15G.001 Any Size Group Rate None N/A 55-20 100/200/400 No rate filing required for group health

H15G.002 Large Group Only


55-20 100/200/400 Exempt






of 103


Type of Insurance







H15G.003 Small Group Only


55-20 100/200/400 Exempt








H15I Individual Health -Hospital/Surgical/Medical Expense

H15I.001 Health - Hospital/Surgical/Medical Expense




H16G Group Health - Major Medical

H16G.001A Any Size Group - PPO







of 103


Type of Insurance







H16G.001B Any Size Group - POS









H16G.001C Any Size Group - Other









H16G.002A Large Group Only - PPO



of 103


Type of Insurance











H16G.002B Large Group Only - POS









H16G.002C Large Group Only - Other







of 103


Type of Insurance







H16G.003A Small Group Only - PPO









H16G.003B Small Group Only - PPO Basic









of 103


Sub-Type of Insurance Type of Insurance



How Filing Handled

H16G.003C Small Group Only - PPO Standard









H16G.003D Small Group Only - POS









H16G.003E Small Group Only - POS Basic



of 103





How Filing Handled







H16G.003F Small Group Only - POS Standard









H16G.003G Small Group Only - Other







of 103





How Filing Handled



H16G.004 Short Term Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

55-22 100/200/400 Exempt

H16G.004 Short Term Form/Rate - if mass marketed



H16G.004 Short Term Rate None N/A 55-22 100/200/400 No rate filing required for group health

H16I Individual Health - Major Medical

H16I.005A Individual - Preferred Provider (PPO)




H16I.005B Individual - Point-of-Service (POS)




H16I.005C Individual - Other




of 103





How Filing Handled

H16I.004 Short Term Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



H17G Group Health - Prescription Drug

H17G.000 Health - Prescription Drug


55-20 100/200/400 Exempt









H17I Individual Health - Prescription Drug

H17I.000 Health - Prescription Drug



H18G Group Health - Sickness

H18G.000 Health - Sickness


55-20 100/200/400 Exempt

of 103





How Filing Handled









H18I Individual Health - Sickness

H18I.000 Health - Sickness




H19I Individual Health - Travel

H19I.000 Health - Travel Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

55-10 100/200/300 Exempt

H19I Individual Health - Travel

H19I.000 Health - Travel Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



H19G Group Health - Travel H19G.000 Health - Travel Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

55-20 100/200/400 Exempt

of 103





How Filing Handled

H19G Group Health - Travel H19G.000 Health - Travel Form/Rate - if mass marketed




H19G Group Health - Travel H19G.000 Health - Travel Rate None N/A 55-20 100/200/400 No rate filing required for group health

H20G Group Health - Vision H20G.000 Health - Vision Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

55-28 100/200/400 Exempt

H20G Group Health - Vision H20G.000 Health - Vision Form/Rate - if mass marketed




H20G Group Health - Vision H20G.000 Health - Vision Rate None N/A 55-28 100/200/400 No rate filing required for group health

H20I Individual Health - Vision

H20I.000 Health - Vision Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

55-16 100/200/300 Exempt

H20I Individual Health - Vision

H20I.000 Health - Vision Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



of 103





How Filing Handled

HOrg01 Health Organizations -Assumption Agreement

HOrg01.000 Health Organizations - Assumption Agreement


55-00 100 Prior Approval

HOrg02G Group Health Organizations -Health Maintenance (HMO)


HOrg02G.001 Conversion Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

55-25 100/200/400/5 00 Prior Approval

HOrg02G.001 Conversion Rate None N/A 55-25 100/200/400/5 00 No rate filing required for group health

HOrg02G.002A Any Size Group - PPO


55-25 100/200/400/5 00 Prior Approval

HOrg02G.002A Any Size Group - PPO

Rate None N/A 55-25 100/200/400/5 00 No rate filing required for group health

HOrg02G.002B Any Size Group - POS


55-25 100/200/400/5 00 Prior Approval

HOrg02G.002B Any Size Group - POS


of 103





How Filing Handled

HOrg02G.003A Large Group Only - PPO


55-25 100/200/400/5 00 Prior Approval

HOrg02G.003A Large Group Only - PPO


HOrg02G.003B Large Group Only - POS


55-25 100/200/400/5 00 Prior Approval

HOrg02G.003B Large Group Only - POS


HOrg02G.004A Small Group Only - PPO Basic


55-25 100/200/400/5 00 Prior Approval

HOrg02G.004A Small Group Only - PPO Basic


HOrg02G.004B Small Group Only - PPO Standard


55-25 100/200/400/5 00 Prior Approval

HOrg02G.004B Small Group Only - PPO Standard


of 103





How Filing Handled

HOrg02G.004C Small Group Only - POS Basic


55-25 100/200/400/5 00 Prior Approval

HOrg02G.004C Small Group Only - POS Basic


HOrg02G.004D Small Group Only - POS Standard


55-25 100/200/400/5 00 Prior Approval

HOrg02G.004D Small Group Only - POS Standard


HOrg02G.004E Small Group Only - Other


55-25 100/200/400/5 00 Prior Approval

HOrg02G.004E Small Group Only - Other


HOrg02I Individual Health Organizations - Health Maintenance (HMO)

HOrg02I.005A Individual - Preferred Provider (PPO)



55-10 100/200/300/5 00 Prior Approval

of 103





How Filing Handled

HOrg02I.005B Individual - Point-of-Service (POS)



55-10 100/200/300/5 00 Prior Approval

HOrg02I.005C Individual - Other



55-10 100/200/300/500 Prior Approval

L01 Life - Assumption Agreement

L01.000 Life - Assumption Agreement


01-00 100/200/300/400/ 500

Prior Approval

L02G Group Life - Endowment

L02G.000 Life - Endowment


01-20 100/300 Exempt

L02G Group Life - Endowment

L02G.000 Life - Endowment

Rate None N/A 01-20 100/300 No rate filing required for life insurance

L02G.001 Single Life - Fixed/Indeterminate Premium


01-20 100/300 Exempt

L02G.001 Single Life - Fixed/Indeterminate Premium


of 103





How Filing Handled

L02G.002 Single Life - Single Premium


01-20 100/300 Exempt



L02G.101 Joint (First to Die) -Fixed/Indeterminate Premium


01-20 100/300 Exempt

L02G.101 Joint (First to Die) -Fixed/Indeterminate Premium


L02G.102 Joint (First to Die) - Single Premium


01-20 100/300 Exempt



L02G.201 Joint (Last Survivor) -Fixed/Indeterminate Premium


01-20 100/300 Exempt

L02G.201 Joint (Last Survivor) -Fixed/Indeterminate Premium


of 103





How Filing Handled

L02G.202 Joint (Last Survivor) - Single Premium


01-20 100/300 Exempt



L02I Individual Life - Endowment

L02I.000 Life - Endowment


01-10 100/400 Exempt

L02I Individual Life - Endowment

L02I.000 Life - Endowment


L02I.001 Single Life - Fixed/Indeterminate Premium


01-10 100/400 Exempt

L02I.001 Single Life - Fixed/Indeterminate Premium


L02I.002 Single Life - Single Premium


01-10 100/400 Exempt


Rate None 01-10 100/400 No rate filing required for life insurance

of 103





How Filing Handled

L02I.101 Joint (First to Die) -Fixed/Indeterminate Premium


N/A 01-10 100/400 Exempt

L02I.101 Joint (First to Die) -Fixed/Indeterminate Premium


L02I.102 Joint (First to Die) - Single Premium


01-10 100/400 Exempt



L02I.201 Joint (Last Survivor) -Fixed/Indeterminate Premium


01-10 100/400 Exempt

L02I.201 Joint (Last Survivor) -Fixed/Indeterminate Premium


L02I.202 Joint (Last Survivor) - Single Premium


01-10 100/400 Exempt



of 103





How Filing Handled

L03G Group Life - Special L03G.000 Group Life - Special


01-20 100/300 Exempt

L03G Group Life - Special L03G.000 Group Life - Special


L03I Individual Life - Special

L03I.000 Individual Life - Special


01-10 100/400 Exempt

L03I Individual Life - Special

L03I.000 Individual Life - Special


L04G Group Life - Term L04G.003 Single Life -

Single Premium Form Cover letter, Certificate


01-21 100/400 Exempt





01-21 100/400 Exempt



of 103





How Filing Handled



01-21 100/400 Exempt



L04G.103 Renewable - Single Life -Fixed/Indeterminate Premium


01-21 100/400 Exempt

L04G.103 Renewable - Single Life -Fixed/Indeterminate Premium


L04G.104 Renewable - Joint (First to Die) -Fixed/Indeterminate Premium


01-21 100/400 Exempt

L04G.104 Renewable - Joint (First to Die) -Fixed/Indeterminate Premium


L04G.105 Renewable - Joint (Last Survivor) -Fixed/Indeterminate Premium


01-21 100/400 Exempt

L04G.105 Renewable - Joint (Last Survivor) -Fixed/Indeterminate


of 103





How Filing Handled

Premium

L04G.203 Specified Age or Duration - Single Premium - Single Life


01-21 100/400 Exempt

L04G.203 Specified Age or Duration - Single Premium - Single Life


L04G.204 Specified Age or Duration - Single Premium - Joint (First to Die)


01-21 100/400 Exempt

L04G.204 Specified Age or Duration - Single Premium - Joint (First to Die)


L04G.205 Specified Age or Duration - Single Premium - Joint (Last Survivor)


01-21 100/400 Exempt

L04G.205 Specified Age or Duration - Single Premium - Joint (Last Survivor)


L04G.213 Specified Age or Duration -Fixed/Indeterminate Premium - Single Life


01-21 100/400 Exempt

of 103





How Filing Handled

L04G.213 Specified Age or Duration -Fixed/Indeterminate Premium - Single Life


L04G.214 Specified Age or Duration -Fixed/Indeterminate Premium - Joint (First to Die)


01-21 100/400 Exempt

L04G.214 Specified Age or Duration -Fixed/Indeterminate Premium - Joint (First to Die)


L04G.215 Specified Age or Duration -Fixed/Indeterminate Premium - Joint (Last Survivor)


01-21 100/400 Exempt

L04G.215 Specified Age or Duration -Fixed/Indeterminate Premium - Joint (Last Survivor)


L04G.303 Decreasing - Single Life - Single Premium


01-21 100/400 Exempt

L04G.303 Decreasing - Single Life - Single Premium


of 103





How Filing Handled

L04G.304 Decreasing - Joint (First to Die) -Single Premium


01-21 100/400 Exempt

L04G.304 Decreasing - Joint (First to Die) -Single Premium


L04G.305 Decreasing - Joint (Last Survivor) -Single Premium


01-21 100/400 Exempt

L04G.305 Decreasing - Joint (Last Survivor) -Single Premium


L04G.313 Decreasing - Single Life -Fixed/Indeterminate Premium


01-21 100/400 Exempt

L04G.313 Decreasing - Single Life -Fixed/Indeterminate Premium


L04G.314 Decreasing - Joint (First to Die) -Fixed/Indeterminate Premium


01-21 100/400 Exempt

L04G.314 Decreasing - Joint (First to Die) -Fixed/Indeterminate Premium


of 103





How Filing Handled

L04G.315 Decreasing - Joint (Last Survivor) -Fixed/Indeterminate Premium


01-21 100/400 Exempt

L04G.315 Decreasing - Joint (Last Survivor) -Fixed/Indeterminate Premium


L04G.403 Deposit Term - Single Life


01-21 100/400 Exempt

L04G.403 Deposit Term - Single Life


L04G.404 Deposit Term - Joint (First to Die)


01-21 100/400 Exempt

L04G.404 Deposit Term - Joint (First to Die)


L04G.405 Deposit Term - Joint (Last Survivor)


01-21 100/400 Exempt

L04G.405 Deposit Term - Joint (Last Survivor)


of 103





How Filing Handled

L04G.500 Other Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

01-20 100/400 Exempt

L04G.500 Other Form None Rate 100/400 No rate filing required for life insurance

L04I Individual Life - Term L04I.003 Single Life -

Single Premium Form Cover letter, Certificate


01-11 100/400 Exempt





01-11 100/400 Exempt





01-11 100/400 Exempt



of 103





How Filing Handled

L04I.103 Renewable - Single Life -Fixed/Indeterminate Premium


01-11 100/400 Exempt

L04I.103 Renewable - Single Life -Fixed/Indeterminate Premium


L04I.104 Renewable - Joint (First to Die) - Fixed Premium/Indeterminate Premium


01-11 100/400 Exempt

L04I.104 Renewable - Joint (First to Die) - Fixed Premium/Indeterminate Premium


L04I.105 Renewable - Joint (Last Survivor) -Fixed Premium/Indeterminate Premium


01-11 100/400 Exempt

L04I.105 Renewable - Joint (Last Survivor) -Fixed Premium/Indeterminate Premium


L04I.203 Specified Age or Duration - Single Premium - Single Life


01-11 100/400 Exempt

L04I.203 Specified Age or Duration - Single


of 103





How Filing Handled

Premium - Single Life

L04I.204 Specified Age or Duration - Single Premium - Joint (First to Die)


01-11 100/400 Exempt

L04I.204 Specified Age or Duration - Single Premium - Joint (First to Die)


L04I.205 Specified Age or Duration - Single Premium - Joint (Last Survivor)


01-11 100/400 Exempt

L04I.205 Specified Age or Duration - Single Premium - Joint (Last Survivor)


L04I.213 Specified Age or Duration -Fixed/Indeterminate Premium - Single Life


01-11 100/400 Exempt

L04I.213 Specified Age or Duration -Fixed/Indeterminate Premium - Single Life


L04I.214 Specified Age or Duration -Fixed/Indeterminate Premium - Joint (First to Die)


01-11 100/400 Exempt

of 103





How Filing Handled

L04I.214 Specified Age or Duration -Fixed/Indeterminate Premium - Joint (First to Die)


L04I.215 Specified Age or Duration -Fixed/Indeterminate Premium - Joint (Last Survivor)


01-11 100/400 Exempt

L04I.215 Specified Age or Duration -Fixed/Indeterminate Premium - Joint (Last Survivor)


L04I.303 Decreasing -Single Life - Single Premium


01-11 100/400 Exempt

L04I.303 Decreasing -Single Life - Single Premium


L04I.304 Decreasing - Joint (First to Die) -Single Premium


01-11 100/400 Exempt

L04I.304 Decreasing - Joint (First to Die) -Single Premium


L04I.305 Decreasing - Joint (Last Survivor) -Single Premium


01-11 100/400 Exempt

of 103





How Filing Handled

Applicable

L04I.305 Decreasing - Joint (Last Survivor) -Single Premium


L04I.313 Decreasing - Single Life -Fixed/Indeterminate Premium


01-11 100/400 Exempt

L04I.313 Decreasing - Single Life -Fixed/Indeterminate Premium


L04I.314 Decreasing - Joint (First to Die) -Fixed/Indeterminate Premium


01-11 100/400 Exempt

L04I.314 Decreasing - Joint (First to Die) -Fixed/Indeterminate Premium


L04I.315 Decreasing - Joint (Last Survivor) -Fixed/Indeterminate Premium


01-11 100/400 Exempt

L04I.315 Decreasing - Joint (Last Survivor) -Fixed/Indeterminate Premium


of 103





How Filing Handled

L04I.403 Deposit Term - Single Life


01-11 100/400 Exempt

L04I.403 Deposit Term - Single Life


L04I.404 Deposit Term - Joint (First to Die)


01-11 100/400 Exempt

L04I.404 Deposit Term - Joint (First to Die)


L04I.405 Deposit Term - Joint (Last to Survivor)


01-11 100/400 Exempt

L04I.405 Deposit Term - Joint (Last to Survivor)


L04I.500 Other Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

01-10 100/400 Exempt

L04I.500 Other Rate None 01-10 100/400 No rate filing required for life insurance

L06G Group Life - Variable

of 103





How Filing Handled

L06G.001 Single Life - Fixed Premium


01-40 100/300/500 Exempt

L06G.001 Single Life - Fixed Premium

Rate None 01-40 100/300/500 No rate filing required for life insurance

L06G.002 Single Life - Flexible Premium


01-40 100/300/500 Exempt

L06G.002 Single Life - Flexible Premium




01-40 100/300/500 Exempt



L06G.004 Single Life - Modified Single Premium


01-40 100/300/500 Exempt

L06G.004 Single Life - Modified Single Premium


L06G.101 Joint (First to Die) - Fixed Premium


01-40 100/300/500 Exempt

of 103





How Filing Handled

Applicable

L06G.101 Joint (First to Die) - Fixed Premium


L06G.102 Joint (First to Die) - Flexible Premium


01-40 100/300/500 Exempt

L06G.102 Joint (First to Die) - Flexible Premium




01-40 100/300/500 Exempt



L06G.104 Joint (First to Die) - Modified Single Premium


01-40 100/300/500 Exempt

L06G.104 Joint (First to Die) - Modified Single Premium


L06G.201 Joint (Last Survivor) - Fixed Premium


01-40 100/300/500 Exempt

of 103





How Filing Handled

Applicable

L06G.201 Joint (Last Survivor) - Fixed Premium


L06G.202 Joint (Last Survivor) - Flexible Premium


01-40 100/300/500 Exempt

L06G.202 Joint (Last Survivor) - Flexible Premium




01-40 100/300/500 Exempt



L06G.204 Joint (Last Survivor) - Modified Single Premium


01-40 100/300/500 Exempt

L06G.204 Joint (Last Survivor) - Modified Single Premium

Rate None N/A 01-40 100/300/500 No rate filing required for life insurance

L06I Individual Life - Variable

of 103


Type of Insurance



How Filing Handled

Sub-Type of Insurance L06I.001 Single Life - Fixed Premium


01-30 100/400/500 Exempt

L06I.001 Single Life - Fixed Premium


L06I.002 Single Life - Flexible Premium


01-30 100/400/500 Exempt




Form Cover letter, Certificate 01-30 100/400/500 Exempt



L06I.004 Single Life - Modified Single Premium


01-30 100/400/500 Exempt

L06I.004 Single Life - Modified Single Premium


L06I.101 Joint (First to Die) - Fixed Premium


01-30 100/400/500 Exempt

L06I.101 Joint (First to Die) - Fixed Premium


of 103





How Filing Handled

L06I.102 Joint (First to Die) - Flexible Premium


01-30 100/400/500 Exempt

L06I.102 Joint (First to Die) - Flexible Premium




01-30 100/400/500 Exempt



L06I.104 Joint (First to Die) - Modified Single Premium


01-30 100/400/500 Exempt

L06I.104 Joint (First to Die) - Modified Single Premium


L06I.201 Joint (Last Survivor) - Fixed Premium


01-30 100/400/500 Exempt

L06I.201 Joint (Last Survivor) - Fixed Premium


of 103


Type of Insurance



How Filing Handled

Sub-Type of Insurance L06I.202 Joint (Last Survivor) - Flexible Premium


01-30 100/400/500 Exempt

L06I.202 Joint (Last Survivor) - Flexible Premium




01-30 100/400/500 Exempt



L06I.204 Joint (Last Survivor) - Modified Single Premium


01-30 100/400/500 Exempt

L06I.204 Joint (Last Survivor) - Modified Single Premium


L07G Group Life - Whole L07G.101

Fixed/Indeterminate Premium - Single Life


01-23 100/300 Exempt

L07G.101 Fixed/Indeterminate Premium - Single Life


of 103





How Filing Handled

L07G.102 - Fixed/Indeterminate Premium - Joint (First to Die)


01-23 100/300 Exempt

L07G.102 - Fixed/Indeterminate Premium - Joint (First to Die)


L07G.103 - Fixed/Indeterminate Premium -Joint (Last Survivor)


01-23 100/300 Exempt

L07G.103 - Fixed/Indeterminate Premium -Joint (Last Survivor)


L07G.104 Fixed/Indeterminate Premium - Single Life - Funeral Expense


01-23 100/300 Exempt

L07G.104 Fixed/Indeterminate Premium - Single Life - Funeral Expense


L07G.111 Single Premium - Single Life


01-23 100/300 Exempt

L07G.111 Single Premium - Single Life


of 103





How Filing Handled

L07G.112 Single Premium - Joint (First to Die)


01-23 100/300 Exempt

L07G.112 Single Premium - Joint (First to Die)


L07G.113 Single Premium -Joint (Last Survivor)


01-23 100/300 Exempt

L07G.113 Single Premium -Joint (Last Survivor)


L07G.114 Single Premium - Single Life - Funeral Expense


01-23 100/300 Exempt

L07G.114 Single Premium - Single Life - Funeral Expense


L07G.121 Graded Premium - Single Life


01-23 100/300 Exempt

L07G.121 Graded Premium - Single Life


of 103





How Filing Handled

L07G.122 Graded Premium - Joint (First to Die)


01-23 100/300 Exempt

L07G.122 Graded Premium - Joint (First to Die)


L07G.123 Graded Premium -Joint (Last Survivor)


01-23 100/300 Exempt

L07G.123 Graded Premium -Joint (Last Survivor)


L07G.201 Early Duration Reduced Benefit -Level Premium - Any Policy Design


01-23 100/300 Exempt

L07G.201 Early Duration Reduced Benefit -Level Premium - Any Policy Design


L07G.202 Early Duration Reduced Benefit -Level Premium - Any Policy Design - Funeral Expense


01-23 100/300 Exempt

L07G.202 Early Duration Reduced Benefit -Level Premium - Any Policy Design - Funeral Expense


of 103


Type of Insurance



How Filing Handled

Sub-Type of Insurance

L07G.211 Early Duration Reduced Benefit -Single Premium - Any Policy Design


01-23 100/300 Exempt

L07G.211 Early Duration Reduced Benefit -Single Premium - Any Policy Design


L07G.212 Early Duration Reduced Benefit -Single Premium - Any Policy Design - Funeral Expense


01-23 100/300 Exempt

L07G.212 Early Duration Reduced Benefit -Single Premium - Any Policy Design - Funeral Expense


L07G.301 Current Assumption - Fixed Premium -Single Life


01-23 100/300 Exempt

L07G.301 Current Assumption - Fixed Premium -Single Life


L07G.302 Current Assumption - Fixed Premium -Joint (First to Die)


01-23 100/300 Exempt

L07G.302 Current Assumption - Fixed Premium -Joint (First to Die)


of 103





How Filing Handled

L07G.303 Current Assumption - Fixed Premium -Joint (Last Survivor)


01-23 100/300 Exempt

L07G.303 Current Assumption - Fixed Premium -Joint (Last Survivor)


L07G.311 Current Assumption - Single Premium - Single Life


01-23 100/300 Exempt

L07G.311 Current Assumption - Single Premium - Single Life


L07G.312 Current Assumption - Single Premium - Joint (First to Die)


01-23 100/300 Exempt

L07G.312 Current Assumption - Single Premium - Joint (First to Die)


L07G.313 Current Assumption - Single Premium -Joint (Last Survivor)


01-23 100/300 Exempt

L07G.313 Current Assumption - Single Premium -Joint (Last Survivor)


of 103





How Filing Handled

L07G.321 Current Assumption - Indeterminate Premium - Single Life


01-23 100/300 Exempt

L07G.321 Current Assumption - Indeterminate Premium - Single Life


L07G.322 Current Assumption - Indeterminate Premium - Joint (First to Die)


01-23 100/300 Exempt

L07G.322 Current Assumption - Indeterminate Premium - Joint (First to Die)


L07G.323 Current Assumption - Indeterminate Premium -Joint (Last Survivor)


01-23 100/300 Exempt

L07G.323 Current Assumption - Indeterminate Premium -Joint (Last Survivor)


L07G.401 Adjustable - Current Assumption -Indeterminate Premium - Single Life


01-23 100/300 Exempt

of 103





How Filing Handled

L07G.401 Adjustable - Current Assumption -Indeterminate Premium - Single Life


L07G.402 Adjustable - Current Assumption -Indeterminate Premium - Joint (First to Die)


01-23 100/300 Exempt

L07G.402 Adjustable - Current Assumption -Indeterminate Premium - Joint (First to Die)


L07G.403 Adjustable - Current Assumption -Indeterminate Premium -Joint (Last Survivor)


01-23 100/300 Exempt

L07G.403 Adjustable - Current Assumption -Indeterminate Premium -Joint (Last Survivor)


L07G.501 External Index- Level Premium -Single Life


01-23 100/300 Exempt

L07G.501 External Index- Level Premium -Single Life


of 103





How Filing Handled

L07G.502 External Index - Level Premium -Joint (First to Die)


01-23 100/300 Exempt

L07G.502 External Index - Level Premium -Joint (First to Die)


L07G.503 External Index - Level Premium -Joint (Last Survivor)


01-23 100/300 Exempt

L07G.503 External Index - Level Premium -Joint (Last Survivor)


L07G.511 External Index - Single Premium -Single Life


01-23 100/300 Exempt

L07G.511 External Index - Single Premium -Single Life


L07G.512 External Index - Single Premium -Joint (First to Die)


01-23 100/300 Exempt

L07G.512 External Index - Single Premium -Joint (First to Die)


of 103





How Filing Handled

L07G.513 External Index - Single Premium -Joint (Last Survivor)


01-23 100/300 Exempt

L07G.513 External Index - Single Premium -Joint (Last Survivor)

Rate None N/A 01-23 100/300

L07I Individual Life - Whole L07I.101

Fixed/Indeterminate Premium - Single Life


01-13 100/400 Exempt

L07I.101 Fixed/Indeterminate Premium - Single Life


L07I.102 Fixed/Indeterminate Premium - Joint (First to Die)


01-13 100/400 Exempt

L07I.102 Fixed/Indeterminate Premium - Joint (First to Die)


L07I.103 Fixed/Indeterminate Premium - Joint (Last Survivor)


01-13 100/400 Exempt

L07I.103 Fixed/Indeterminate Premium - Joint (Last Survivor)


of 103





How Filing Handled

L07I.104 Fixed/Indeterminate Premium - Single Life - Funeral Expense


01-13 100/400 Exempt

L07I.104 Fixed/Indeterminate Premium - Single Life - Funeral Expense


L07I.111 Single Premium - Single Life


01-13 100/400 Exempt

L07I.111 Single Premium - Single Life


L07I.112 Single Premium - Joint (First to Die)


01-13 100/400 Exempt

L07I.112 Single Premium - Joint (First to Die)


L07I.113 Single Premium -Joint (Last Survivor)


01-13 100/400 Exempt

L07I.113 Single Premium -Joint (Last Survivor)


of 103





How Filing Handled

L07I.114 Single Premium - Single Life - Funeral Expense


01-13 100/400 Exempt

L07I.114 Single Premium - Single Life - Funeral Expense


L07I.121 Graded Premium - Single Life


01-13 100/400 Exempt

L07I.121 Graded Premium - Single Life


L07I.122 Graded Premium - Joint (First to Die)


01-13 100/400 Exempt

L07I.122 Graded Premium - Joint (First to Die)


L07I.123 Graded Premium -Joint (Last Survivor)


01-13 100/400 Exempt

L07I.123 Graded Premium -Joint (Last Survivor)


of 103





How Filing Handled

L07I.124 Graded Premium - Jumping Juvenile (Term to Age X, Whole Life Thereafter)


01-13 100/400 Exempt

L07I.124 Graded Premium - Jumping Juvenile (Term to Age X, Whole Life Thereafter)


L07I.201 Early Duration Reduced Benefit - Level Premium - Any Policy Design


01-13 100/400 Exempt

L07I.201 Early Duration Reduced Benefit - Level Premium - Any Policy Design


L07I.202 Early Duration Reduced Benefit - Level Premium - Any Policy Design - Funeral Expense


01-13 100/400 Exempt

L07I.202 Early Duration Reduced Benefit - Level Premium - Any Policy Design - Funeral Expense


L07I.211 Early Duration Reduced Benefit -Single Premium - Any Policy Design


01-13 100/400 Exempt

L07I.211 Early Duration Reduced Benefit -Single


of 103





How Filing Handled

Premium - Any Policy Design

L07I.212 Early Duration Reduced Benefit -Single Premium - Any Policy Design - Funeral Expense


01-13 100/400 Exempt

L07I.212 Early Duration Reduced Benefit -Single Premium - Any Policy Design - Funeral Expense


L07I.301 Current Assumption - Fixed Premium -Single Life


01-13 100/400 Exempt

L07I.301 Current Assumption - Fixed Premium -Single Life


L07I.302 Current Assumption - Fixed Premium -Joint (First to Die)


01-13 100/400 Exempt

L07I.302 Current Assumption - Fixed Premium -Joint (First to Die)


L07I.303 Current Assumption - Fixed Premium -Joint (Last Survivor)


01-13 100/400 Exempt

L07I.303 Current Assumption - Fixed Premium -Joint (Last


of 103





How Filing Handled

Survivor)

L07I.311 Current Assumption - Single Premium Single Life


01-13 100/400 Exempt

L07I.311 Current Assumption - Single Premium Single Life


L07I.312 Current Assumption - Single Premium Joint (First to Die)


01-13 100/400 Exempt

L07I.312 Current Assumption - Single Premium Joint (First to Die)


L07I.313 Current Assumption - Single Premium Joint (Last Survivor)


01-13 100/400 Exempt

L07I.313 Current Assumption - Single Premium Joint (Last Survivor)


L07I.321 Current Assumption - Indeterminate Premium - Single Life


01-13 100/400 Exempt

L07I.321 Current Assumption -


of 103





How Filing Handled

Indeterminate Premium - Single Life

L07I.322 Current Assumption - Indeterminate Premium - Joint (First to Die)


01-13 100/400 Exempt

L07I.322 Current Assumption - Indeterminate Premium - Joint (First to Die)


L07I.323 Current Assumption - Indeterminate Premium -Joint (Last Survivor)


01-13 100/400 Exempt

L07I.323 Current Assumption - Indeterminate Premium -Joint (Last Survivor)


L07I.401 Adjustable - Current Assumption -Indeterminate Premium - Single Life


01-13 100/400 Exempt

L07I.401 Adjustable - Current Assumption -Indeterminate Premium - Single Life


L07I.402 Adjustable - Current Assumption -Indeterminate Premium - Joint (First to Die)


01-13 100/400 Exempt

of 103





How Filing Handled

L07I.402 Adjustable - Current Assumption -Indeterminate Premium - Joint (First to Die)


L07I.403 Adjustable - Current Assumption -Indeterminate Premium -Joint (Last Survivor)


01-13 100/400 Exempt

L07I.403 Adjustable - Current Assumption -Indeterminate Premium -Joint (Last Survivor)


L07I.501 External Index - Level Premium


01-13 100/400 Exempt

L07I.501 External Index - Level Premium


L07I.502 External Index - Level Premium - Joint (First to Die)


01-13 100/400 Exempt

L07I.502 External Index - Level Premium - Joint (First to Die)


L07I.503 External Index - Level Premium - Joint (Last Survivor)


01-13 100/400 Exempt

L07I.503 External Index - Level Premium - Joint


of 103





How Filing Handled

(Last Survivor)

L07I.511 External Index - Single Premium


01-13 100/400 Exempt

L07I.511 External Index - Single Premium


L07I.512 External Index - Single Premium - Joint (First to Die)


01-13 100/400 Exempt

L07I.512 External Index - Single Premium - Joint (First to Die)


L07I.513 External Index - Single Premium - Joint (Last Survivor)


01-13 100/400 Exempt

L07I.513 External Index - Single Premium - Joint (Last Survivor)


L08 Life - Other L08.000 Life - Other Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

01-00 100/200/300/400/ 500

Exempt

L08.000 Life - Other Rate None N/A 01-00 100/200/300/ 4 00/500

No rate filing required for life insurance

L09G Group Life - Flexible Premium Adjustable Life

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How Filing Handled

L09G.001 Single Life Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

01-20 100/300 Exempt

L09G.001 Single Life Rate None N/A 01-20 100/300 No rate filing required for life insurance

L09G.002 Joint (Last Survivor)

Form Cover letter, Certificate 01-20 100/300 Exempt

L09G.002 Joint (Last Survivor)


L09G.003 Joint (First to Die)


01-20 100/300 Exempt

L09G.003 Joint (First to Die)


L09G.101 External Indexed - Single Life


01-20 100/300 Exempt

L09G.101 External Indexed - Single Life


L09G.102 External Indexed - Joint (First to Die)


01-20 100/300 Exempt

L09G.102 External Indexed - Joint (First to Die)


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How Filing Handled

L09G.103 External Indexed - Joint (Last Survivor)


01-20 100/300 Exempt

L09G.103 External Indexed - Joint (Last Survivor)


L09I Individual Life - Flexible Premium Adjustable Life

L09I.001 Single Life Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

01-10 100/400 Exempt

L09I.001 Single Life Rate None N/A 01-10 100/400 No rate filing required for life insurance

L09I.002 Joint (Last Survivor)


01-10 100/400 Exempt

L09I.002 Joint (Last Survivor)


L09I.003 Joint (First to Die)


01-10 100/400 Exempt

L09I.003 Joint (First to Die)


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How Filing Handled

L09I.101 External Indexed - Single Life


01-10 100/400 Exempt

L09I.101 External Indexed - Single Life


L09I.102 External Indexed - Joint (First to Die)


01-10 100/400 Exempt

L09I.102 External Indexed - Joint (First to Die)


L09I.103 External Indexed - Joint (Last Survivor)


01-10 100/400 Exempt

L09I.103 External Indexed - Joint (Last Survivor)


LTC01 Long Term Care - Assumption Agreement

LTC01.000 Long Term Care - Assumption Agreement



LTC02G Group Long Term Care - Home Health Care Only

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How Filing Handled

LTC02G.001 Qualified Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable


LTC02G.001 Qualified Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

55-60 100/200/400 Exempt

LTC02G.002 Non Qualified Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

55-60 100/200/400 Exempt

LTC02G.002 Non Qualified Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

55-60 100/200/400 Exempt

LTC02I Individual Long Term Care -Home Health Care Only

LTC02I.001 Qualified Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



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How Filing Handled

LTC02I.002 Non Qualified Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



LTC03G Group Long Term Care




55-60 100/200/400 Exempt

LTC03G.002 Non Qualified Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable

55-60 100/200/400 Exempt

LTC03I Individual Long Term Care




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How Filing Handled




LTC04G Group Long Term Care - Nursing Home




55-60 100/200/400 Exempt


55-60 100/200/400 Exempt

LTC04I Individual Long Term Care - Nursing Home




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How Filing Handled




LTC05G Group Long Term Care -Nursing Home & Home Health Care




55-60 100/200/400 Exempt


55-60 100/200/400 Exempt

LTC05I Individual Long Term Care - Nursing Home & Home Health Care




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How Filing Handled




MS01 Medicare Supplement -Assumption Agreement

MS01.000 Medicare Supplement - Assupmtion Agreement



MS02G Group Medicare Supplement -Pre-Standardized

MS02G.000 Medicare Supplement - Pre-Standardized




MS02I Individual Medicare Supplement -Pre-Standardized

MS02I.000 Medicare Supplement - Pre-Standardized




MS03G Group Medicare Supplement -Medicare + Choice

MS03G.000 Medicare Supplement - Medicare + Choice




MS03I Individual Medicare Supplement -Medicare + Choice

MS03I.000 Medicare Supplement - Medicare + Choice




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How Filing Handled

MS04G Group Medicare Supplement - Medicare Select

MS04G.001 Plan A Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS04G.002 Plan B Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS04G.003 Plan C Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS04G.004 Plan D Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS04G.005 Plan E Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



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How Filing Handled

MS04G.006 Plan F (Basic) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS04G.007 Plan F (High) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS04G.008 Plan G Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS04G.009 Plan H Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS04G.010 Plan I Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



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How Filing Handled

MS04G.011 Plan J (Basic) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS04G.012 Plan J (High) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS04G.013 Plan K Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS04G.014 Plan L Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS04I Individual Medicare Supplement -Medicare Select


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Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form


How Filing Handled Rate

MS04I.001 Plan A Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS04I.002 Plan B Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS04I.003 Plan C Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS04I.004 Plan D Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS04I.005 Plan E Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



of 103






MS04I.006 Plan F (Basic) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS04I.007 Plan F (High) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS04I.008 Plan G Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS04I.009 Plan H Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS04I.010 Plan I Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS04I.011 Plan J (Basic) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



of 103






MS04I.012 Plan J (High) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS04I.013 Plan K Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS04I.014 Plan L Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS05G Group Medicare Supplement -Standard Plans


MS05G.001 Plan A Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS05G.002 Plan B Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



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How Filing Handled

MS05G.003 Plan C Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS05G.004 Plan D Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS05G.005 Plan E Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS05G.006 Plan F (Basic) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS05G.007 Plan F (High) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS05G.008 Plan G Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



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How Filing Handled

MS05G.009 Plan H Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS05G.010 Plan I Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS05G.011 Plan J (Basic) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS05G.012 Plan J (High) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS05G.013 Plan K Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS05G.014 Plan L Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



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How Filing Handled

MS05I Individual Medicare Supplement -Standard Plans


MS05I.001 Plan A Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS05I.002 Plan B Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS05I.003 Plan C Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS05I.004 Plan D Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS05I.005 Plan E Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



of 103





How Filing Handled

MS05I.006 Plan F (Basic) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS05I.007 Plan F (High) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS05I.008 Plan G Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS05I.009 Plan H Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS05I.010 Plan I Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS05I.011 Plan J (Basic) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



of 103






MS05I.012 Plan J (High) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS05L013 Plan K Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



MS05L014 Plan L Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable



ML01 Multi-Line - Assumption Agreement

ML01.000 Multi-Line - Assumption Agreement



ML02 Multi-Line - Other ML02.000 Multi-Line - Other


01-55-10

100/200/300 Prior Approval

ML02 Multi-Line - Other ML02.000 Multi-Line - Other


01-55-20

100/200/400 Exempt

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South Carolina Department of Insurance Life, Accident and ...

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