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Life, Accident & Health (doi.sc.gov/lah)
- Summary
- Statutes & Regulations
- Bulletins and Positions
- PPACA Resources - Updated May 12, 2023
- Filing Resources
Life, Accident & Health Exhibits
Medicare Supplement Interrogatories
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).
Withdrawal from the Interstate Insurance Product Regulation Compact
The South Carolina Department of Insurance participated in the Interstate Insurance Product Regulation Compact from 2008 until May 16, 2022. See Bulletin Number 2022-03 and the FAQ Document for information about the Withdrawal from the Compact.
- Bulletin 2022-03 - Withdrawal from the Interstate Insurance Product Regulation Compact - Effective May 16, 2022
- FAQs Regarding South Carolina's Withdrawal from the Interstate Insurance Product Regulation Company - Updated 10/18/2022
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.
- 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
For a complete listing of bulletins and orders, click here.
Key Bulletins and Orders
- Bulletin 8-84: SCID 1504 Form
- Bulletin 89-1: Group policies issued outside of this state 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 2016-15: 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
- Bulletin 2017-11: Electronic Delivery of Insurance Policies
- Bulletin 2017-12: Repeal of Optional Intoxication and Narcotics Exclusion
- Bulletin 2018-02: South Carolina Insurance Data Security Act
- Bulletin 2018-08: Requirements Applicable to Short-Term, Limited-Duration Insurance (STLDI) Policies
- Bulletin 2019-02: Compliance with S.C. Code §38-63-220(d) Rescission of a Life Insurance Policy
- Order No. 2019-04: Rates for Credit Accident and Health Insurance Sold in Conjunction with Loans Subject To 1966 S.C. Act No. 988 - Approved Rate for 2020 Basic Statistical Plan
- Order No. 2019-05: 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 2020 Basic Statistical Plan
- Bulletin 2019-09: Autism Spectrum Disorder Maximum Benefit for Coverage for Behavioral Therapy
- Bulletin 2021-09 - No Surprises Act - Compliance with the Consolidated Appropriations Act of 2021
- Bulletin 2022-09 - Policyholder Notification of Proposed Premium Rate Increase
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
- 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
- Bulletin 2013-01: Rate Filing Procedures
- Bulletin 2013-04: Form Filings and Additional Filing Requirements
- Bulletin 2015-08: Impact of the PACE Act on the Small Group Market
- CMS Rate Review Data Resources
- SCDOI Memorandum: Network Adequacy Standards – Annual Certifications Due February 1st
Filing Requirements and Resources for 2024 Plans (2023 Filing Period) - Updated 5/12/2023
- SCDOI Rate/Form and Plan Management Binder Filing Requirements
- Major Medical Filings - Updated 5/12/2023
- Exchange-Certified Stand Alone Dental Filings - NEW! Added 5/11/2023
- SCDOI ACA Filing Exhibit: High Level Summary
- Major Medical Filings - NEW! Added 5/4/2023
- Exchange-Certified Stand Alone Dental Filings - NEW! Added 5/4/2023
- Actuarial Memorandum Dataset Supplement - NEW! Added 5/5/2023
- Self-Compliance Tool for the Mental Health Parity and Addiction Equity Act (MHPAEA) released in 2020 - Added 5/5/2023
- SCDOI ACA Filing Exhibit: Consolidated Certification of Compliance - Added 5/4/2023
- CCIIO: Key Dates for Calendar Year 2024 - Added 4/6/2023
- CCIIO: Rate Review Timeline Bulletin - NEW! Added 5/4/2023
- CMS: 2022 Unified Rate Review Instructions - Coming Soon
- CMS: Final PY2024 Payment Notice - NEW! Added 5/4/2023
- CMS: QHP Certification Website - Added 4/6/2023
- CCIIO: PY2024 Final Letter to Issuers - NEW! Added 5/4/2023
- Standardized Plan Design Chart - NEW! Added 5/5/2023
- FAQs-Part 45 - Mental Health and Substance Use Disorder Parity - Added 5/5/2023
Filing Requirements and Resources for 2023 Plans (2022 Filing Period)
- SCDOI Rate/Form and Plan Management Binder Filing Requirements
- SCDOI ACA Filing Exhibit: High Level Summary
- Actuarial Memorandum Dataset Supplement
- Self-Compliance Tool for the Mental Health Parity and Addiction Equity Act (MHPAEA) released in 2020
- SCDOI ACA Filing Exhibit: Consolidated Certification of Compliance
- CCIIO: Key Dates for Calendar Year 2023
- CCIIO: Rate Review Timeline Bulletin
- CMS: 2022 Unified Rate Review Instructions
- CMS: Final 2023 Payment Notice
- CMS: QHP Certification Website
- CCIIO: 2023 Final Letter to Issuers
- Standardized Plan Design Chart
- FAQs-Part 45 - Mental Health and Substance Use Disorder Parity
Transitional Policy for Non-grandfathered Health Insurance Coverage
Bulletins
- Bulletin 2013-12: Transitional Policy for Non-grandfathered Health Insurance Coverage
- Bulletin 2013-12, Addendum A: Response to Federal Guidance Specific to Required Notices to Impacted Policyholders
- Bulletin 2014-05, Addendum B to Bulletin 2013-12: Federal Extension of Transitional Policy and Application of Transitional Policy to Current Large Groups with 51 to 100 Employees
- Bulletin 2016-01, Addendum C to Bulletin 2013-12: Federal Extension of Transitional Policy through CY 2017
- Bulletin 2017-02, Addendum D to Bulletin 2013-12: Federal Extension of Transitional Policy through CY 2018
- Bulletin 2018-01, Addendum E to Bulletin 2013-12: Federal Extension of Transitional Policy through CY 2019
- Bulletin 2019-01, Addendum F to Bulletin 2013-12: Federal Extension of Transitional Policy through CY 2020
- Bulletin 2020-01, Addendum G to Bulletin 2013-12: Federal Extension of Transitional Policy through CY 2021
- Bulletin 2021-01, Addendum H to Bulletin 2013-12: Federal Extension of Transitional Policy through CY 2022
- Bulletin 2022-02, Addendum I to Bulletin 2013-12: Federal Extension of Transitional Policy through CY 2023 and later benefit years
Resources
- List: Companies Participating in Transitional Relief Pursuant to Bulletin 2013-12
- Instructions Manual: HHS Rate Review Justification Instructions for Transitional Policies (Updated April 9, 2018)
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
Filing Checklists
Resources
- Procedural Guidelines (updates coming soon)
- SERFF LAH Filing Set Up Tutorial (updates coming soon)
- Product Line Table
- Filing Type Table
- LA&H Type of Insurance Matrix