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


Life, Accident & Health Exhibits

In an effort to expedite the rate filing review process, the SCDOI encourages insurers to complete these interrogatories and include them in their rate filings.  While not exhaustive, the interrogatories provide the information most commonly requested by the SCDOI when reviewing rate filings.  

Medicare Supplement Interrogatories - New!  Added 3/3/2021 


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. 


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 8-84: 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

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 2022 Plans (2021 Filing Period) - Updated - 4/29/2021



    Filing Requirements and Resources for 2021 Plans (2020 Filing Period) Last updated 5/15/2020
     


    • SCDOI Memorandum: Revised Filing Timeline for Plan/ Policy Years Beginning in 2021 
    • SCDOI Memorandum: Filing Timeline for Plan/ Policy Years Beginning in 2021 and Guidance for Student Health Plans  



    Filing Requirements for Student Health Plans - Updated 3/9/2021

      


    Transitional Policy for Non-grandfathered Health Insurance Coverage



    Bulletins 


    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



    LA&H Filing Resources

    Filing Checklists


     Resources