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Indiana Department of Insurance

IDOI > Company Compliance > Accident & Health  > Product Filing Information/Instructions  > GRANDFATHERED INDIVIDUAL FILING INSTRUCTIONS for MAJOR MEDICAL, HMO and DENTAL GRANDFATHERED INDIVIDUAL FILING INSTRUCTIONS for MAJOR MEDICAL, HMO and DENTAL

(INCLUDING NON-EMPLOYER ASSOCIATIONS and/or TRUSTS)

All filings must be submitted via SERFF and include the following information for form and/or rate filings:

Form Filing Instructions

  1. Complete the appropriate checklist for the filing submitted.
    1. 10 Individual Checklist
    2. 12 Individual HMO Checklist
    3. 20(C) Out of State Association/Trust Products Checklist
  2. Include applicable filing requirements.
    1. 4.1 Individual New Rate/Form 
      1. Requirement applies to new rates and/or forms filed.
        (Provide data for sections II and III if the form filing affects rates or benefit structure.)
    2. Provide the SERFF Tracking Number(s) for prior and/or current rate filings related to the form filing within the last 18 months. Include data under the General Information tab in the Filing Description field.
    3. Please complete the PPACA Uniform Compliance Summary checklist as applicable.
  3. Add the form number to the lower left-hand corner of the first page of the policy to relevant documents, such as riders and amendments.
    1. Documents must be in final print form.
    2. Form numbers cannot be variable.

Rate Filing Instructions

  1. Complete the appropriate checklist for the filing submitted.
    (Some sections may not be relevant to rate filings.)
    1. 10 Individual Checklist
    2. 12 Individual HMO Checklist
    3. 20(C) Out of State Association/Trust Products Checklist
  2. Include applicable filing requirements.
    1. 4.1 Individual New Rate/Form
      1. Requirement applies to new rates and/or forms filed.
    2. 7.0 Individual Rate Adjustment 
      1. Requirement applies to rate adjustments for existing rates as an increase, decrease or rate neutral.
  3. Include related policy form numbers.
  4. Complete Major Medical Experience Workbook.
    1. Applicable to rate adjustments for existing rates.
    2. Include as an attachment under the Supporting Documentation tab in SERFF with the file name “Experience Workbook.”
  5. Complete filing Attestations.

*Product filings fees for rates and policy forms must be submitted via Electronic Funds Transfer (EFT) at the time of filing submission. View General Instructions in SERFF for additional details.