Life, Accident & Health (doi.sc.gov/lah)


Summary
Statutes & Regulations
Bulletins & Positions
PPACA Resources 2017 ACA Filing Resources Updated 5/19/17
Filing Resources

Notice: Bulletin 2017-11 has been issued to notify insurers and HMOs of a recent legislative change impacting the electronic delivery of insurance transactions in South Carolina.  This law goes into effect January 1, 2018.  Filings related to this change should be made in accordance with the timelines outlined in Section V of the bulletin (p.6).  

Notice:
 Bulletin 2017-12 has been issued to notify insurers and HMOs of a recent legislative change impacting certain accident and health insurance policies issued in the individual market.  Policies subject to 2017 S.C. Act No. 42 that are issued or renewed after Dec. 31, 2017 will no longer be permitted to use the optional intoxicants and narcotics exclusion found in S.C. Code Section 38-71-370(9).  Filings related to this change should be made in SERFF no later than 11/1/2017.  Please see the bulletin for full details.

Summary

The Life, Accident, and Health Unit reviews and analyzes rates, rules, forms, and certifications for life, accident, and health insurance products, including products offered by health maintenance organizations (HMOs). 

The information contained on this webpage is intended to be used as a tool by LA&H insurers and HMOs to properly prepare and submit filings to the South Carolina Department of Insurance.  Please know that improper and/or incomplete filings will result in a rejection or disapproval of the filing.

All rate, form, and annual certification filings must be submitted via SERFF.  Filings must be submitted by insurer and by line of business.  Multiple insurers within a group may not submit a single SERFF filing.  For more information about SERFF, please contact SERFF (1-816-783-8787 or serffmktg@naic.org).  

The South Carolina Department of Insurance participates in the Interstate Insurance Product Regulation Compact.  For more information on the IIPRC, visit insurancecompact.org.

The South Carolina Department of Insurance will review filings for compliance; however it remains the responsibility of the insurer to adhere to all applicable federal and State of South Carolina insurance laws, regulations and policies.

Statutes and Regulations

South Carolina Code of Laws, Title 38: Insurance
South Carolina Code of Regulations, Chapter 69: Department of Insurance

Key Statutes and Regulations
Definitions 
  • SC Code Section 38-1-20
Accident and Health 
  • Title 38, Chapter 71
  • Regulation 69-17
  • Regulation 69-34
  • Regulation 69-43
Credit Accident and Health 
  • SC Code Section 37-4-203
Credit Life 
  • SC Code Section 37-4-203
Group Life Insurance 
  • Title 38, Chapter 65
  • Regulation 63-12.1
  • Regulation 69-40
Health Maintenance Organizations 
  • Title 38, Chapter 33
  • Regulation 69-22
Insurance Contracts Generally 
  • Title 38, Chapter 63
  • Regulation 63-12.1
  • Regulation 69-30
Long Term Care Insurance 
  • Title 38, Chapter 72
  • Regulation 69-44
Medicare Supplement Insurance 
  • Regulation 69-46


Bulletins and Positions

For a complete listing of bulletins and orders, click here.

Key Bulletins and Orders

  • Bulletin 8-84SCID 1504 Form
  • Bulletin 89-1: Group policies issued outside of this sate which extend coverage to residents of this state 
  • Bulletin 2003-12: Interpretive Bulletin Relating to the Use of Endorsements, Amendments and Riders for all Individuals and Group Policies
  • Bulletin 2003-13: List of "Exempt" Policy Forms, Filing Procedures for "Exempt" and "Prior Approval"
  • Bulletin 2006-08: Service and Administrative Fees
  • Bulletin 2007-11: Service and Administrative Fees
  • Bulletin 2009-02: South Carolina Health Care Financial Recovery and Protection Act (Prompt Pay)
  • Bulletin 2009-22: Retaliatory Fees
  • Bulletin 2011-04: Compliance with the External Review Requirements of the Patient Protection and Affordable Care Act
  • Bulletin 2011-09: Mandatory Use of SERFF for all Insurance Rate, Rule, and Form Filings
  • Bulletin 2012-06: Reduced Agent Compensation for Medicare Supplement Policies Sold
  • Bulletin 2013-11: Service and Policy Fee
  • Bulletin 2015-08: Impact of the PACE Act on the Small Group Market
  • Bulletin 2016-06: Autism Spectrum Disorder Maximum Benefit for Coverage for Behavioral Therapy
  • Order No. 2016-06Rates for Credit Accident and Health Insurance Sold in Conjunction with Consumer Credit Transaction subject to South Carolina Consumer Protection Code (S.C. Code Ann. 37-1-101 et seq.) Other Than Loans Made Under 1966 S.C. Act No. 988 - Approved Rates for 2015 Basic Statistical Plan
  • Order No. 2016-07: Rates for Credit Accident and Health Insurance Sold in Conjunction with Loans Subject to 1966 S.C. Act No. 988- Approved Rates for 2016 Basic Statistical Plan
  • Bulletin 2016-15: Compliance with SC Code Ann. Section 38-71-242 (actual charges)
  • Bulletin 2017-01: Requirements Applicable to Hospital Indemnity or other Fixed Indemnity Policies Sold in South Carolina
  • Order No. 2017-02: Rates for Credit Accident and Health Insurance Sold in Conjunction with Loans Subject To 1966 S.C. Act No. 988-Approved Rate for 2018 Basic Statistical Plan
  • Order No. 2017-03: Rates for Credit Accident and Health Insurance Sold in Conjunction with Consumer Credit Transactions subject to the South Carolina Consumer Protection Code (S.C. Code Ann.§ 37-1-101 et seq.), Other Than Loans Made Under 1966 S.C. Act No. 988 - Approved Rates for 2018 Basic Statistical Plan
  • Bulletin 2017-07: Notice of Tentative 2018 Credit Accident and Health Insurance Rates and Opportunity to Request a Hearing
  • Bulletin 2017-08: Notice of Tentative 2018 Accident and Health Insurance Rates for 3-day Retro Accident and Health Insurance and Opportunity to Request a Hearing 
  • Bulletin 2017-09: Autism Spectrum Disorder Maximum Benefit for Coverage for Behavioral Therapy
  • Bulletin 2017-11: Electronic Delivery of Insurance Policies
  • Bulletin 2017-12: Repeal of Optional Intoxication and Narcotics Exclusion

Position Highlights
  • Enrollment Forms are required for all group policy filings.
  • SCID 1504 Form is required for all individual filings and group rate filings unless specifically exempted.
  • This Department takes exception to wording which indicates that the statements of the applicant are other than representations. Hence the word “certify” must be deleted.
  • The SCDOI requires all notices of discontinuations or market exits to be filed in SERFF (filings should be made under the Form type).  The Department has published guidance for health insurance issuers regarding these submissions as follows: Added 5/5/15


PPACA Resources


2014 Market Reforms


Filing Procedures and Requirements
Filing Requirements and Resources for 2018 Plans (2017 Filing Period) Updated 5-19-17

Filing Requirements and Resources for 2017 Plans (2016 Filing Period)

Filing Requirements and Resources for 2017 Student Health Plans (2016 Filing Period)


Transitional Policy for Non-grandfathered Health Insurance Coverage

Bulletins Important Update - See Bulletin 2017-02 below, published 4-21-16

Resources
  • List: Companies Participating in Transitional Relief Pursuant to Bulletin 2013-12
  • Instructions Manual: HHS Rate Review Justification Instructions for Transitional Policies and Student Health Plans (Updated April 1, 2015)

Immediate Market Reforms

Filing Procedures and Requirements
  • Bulletin 2011-03: New Rate Filing Procedures to Comply with 45 CFR Part 154
  • Bulletin 2011-11: Application of New Rate Filing Procedures to Comply with 45 CFR Part 154 to Association-based Coverage
Resources

LA&H Filing Resources

Filing Checklists