{"slug":"ca-bulletin-2013-2","jurisdiction":"CA","agency":"CDI","doc_type":"bulletin","citation":"CDI Bulletin 2013-2","title":"Bulletin 2013-2: Notification of Fee Increase (Effective 6/15/2013)","official_source_url":"https://www.insurance.ca.gov/0250-insurers/0300-insurers/0200-bulletins/bulletin-notices-commiss-opinion/upload/FandL2013IncreaseNotice.pdf","access_class":"statutory-public","access_notes":"insurance.ca.gov disclaimer: content considered public domain; gate-zero CA-a","first_seen_at":"2026-07-19T16:30:04.785561+00:00","last_checked_at":"2026-07-20T06:27:54.834034+00:00","versions":[{"fetched_at":"2026-07-19T16:30:04.785561+00:00","version_no":1,"text_length":3322,"effective_date":null,"content_sha256_short":"1925f61fd6c8"}],"text":"STATE OF CALIFORNIA                                                             Dave Jones, Insurance Commissioner\nDEPARTMENT OF INSURANCE\nADMINISTRATION AND LICENSING SERVICES BRANCH\n300 CAPITOL MALL, SUITE 1600\nSACRAMENTO, CA 95814\n(916) 492-3500\n(916) 327-3482 (FAX)\nwww.insurance.ca.gov\n\n      BULLETIN NO.           2013-2\n\n      DATE:                  March 15, 2013\n\n      TO:                    All Admitted Insurers and Other Interested Parties\n\n      SUBJECT:               Notification of Fee Increase\n\n      In accordance with Insurance Code Section 12978, we respectfully notify you that the\n      California Department of Insurance is increasing fees by 10 percent for all insurance\n      producers, bail agents, insurance adjusters, and insurers operating in the State of\n      California. The increase will be effective June 15, 2013. As an example, an insurance\n      agent or broker will see an increase of only $12 for each biennial license or renewal, which\n      amounts to only $6 per year.\n\n      This will be the first increase of these fees in almost a decade, as the last increase\n      implemented by the Department was in January 2004. In fact, since January 2004, these\n      fees were decreased by 12 percent. Even with a 10 percent increase, fees will still be\n      below 2004 levels.\n\n      The Department has worked diligently to create operational efficiencies and control costs\n      while striving to improve service levels. For example, in the Licensing area:\n\n          •   License applicants can now obtain their license in two to three weeks compared to\n              the two to three month timeframe previously experienced.\n          •   Through enhanced automation, the Department achieved significant savings by\n              sending license renewal notices via email and enabling licensees to instantaneously\n              download their new and renewed licenses on its website.\n          •   License applicants are able to take their qualifying examination at 21 locations\n              statewide, including evenings and weekends, compared to only four locations\n              previously provided.\n          •   The Department recently converted its licensing process to exam-first from\n              application-first, thus reducing initial licensure costs to applicants and industry.\n              While positively impacting applicants and industry, this change significantly reduced\n              the Department’s revenue in fiscal year 2012-13.\n\n      Pursuant to Insurance Code Section 12978, the Department has the responsibility to set\n      fees that provide sufficient revenue to support the Department's budget and meet critical\n      workload demands to protect California's insurance consumers as well as to ensure the\n\n                      Consumer Hotline (800) 927-HELP • Producer Licensing (800) 967-9331\nsolvency of the Insurance Fund. The Department will continue to monitor the Fund in order\nto ensure its financial integrity.\n\nThe new fee schedule is available for your reference. If you have any questions, please\ncontact our Producer Licensing Bureau at (800) 967-9331.\n\nPLEASE BE SURE THIS INFORMATION IS DISSEMINATED TO ALL YOUR\nAPPOINTED AGENTS IN CALIFORNIA.\n\nERIKA SPERBECK\nDeputy Commissioner\nAdministration & Licensing Services Branch\n\nAttachment","text_length":3322}
{"slug":"ca-bulletin-2012-2","jurisdiction":"CA","agency":"CDI","doc_type":"bulletin","citation":"CDI Bulletin 2012-2","title":"Bulletin 2012-2: Stranger-Originated Annuity Transactions","official_source_url":"https://www.insurance.ca.gov/0250-insurers/0300-insurers/0200-bulletins/bulletin-notices-commiss-opinion/upload/BulletinNumber2012-2.pdf","access_class":"statutory-public","access_notes":"insurance.ca.gov disclaimer: content considered public domain; gate-zero CA-a","first_seen_at":"2026-07-19T16:30:04.785561+00:00","last_checked_at":"2026-07-20T06:27:54.834034+00:00","versions":[{"fetched_at":"2026-07-19T16:30:04.785561+00:00","version_no":1,"text_length":3523,"effective_date":null,"content_sha256_short":"cd0d02631e1d"}],"text":"STATE OF CALIFORNIA\n                               DEPARTMENT OF INSURANCE\n                                  45 FREMONT STREET\n                                SAN FRANCISCO, CA 94105\n\n                                                                           BULLETIN NO. 2012-2\n                                                                               MARCH 15, 2012\n\nTO: ALL INSURERS SELLING LIFE INSURANCE OR ANNUITIES IN CALIFORNIA\n\nSUBJECT: STRANGER-ORIGINATED ANNUITY TRANSACTIONS\n\nInsurance companies are encouraged to put safeguards in place to prevent or limit their exposure\nto stranger-originated annuity transactions (STOAs).\n\nLike stranger-originated life insurance transactions (STOLI), in stranger-originated annuity\ntransactions (STOAs), some producers and/or investors offer an individual, who is usually a\n“stranger” to the producer and/or investor, a nominal fee for the use of the individual’s identity\nas the annuitant, or measuring life, in an investment-oriented annuity. Typically, individuals\ntargeted to serve as annuitants are in extremely poor health and are not expected to live beyond\nthe first year of the policy. In order to find individuals who meet the aforementioned criteria,\nthese producers and/or investors have been known to take out advertisements in papers as well as\nsolicit individuals residing in nursing homes or hospice.\n\nOnce an individual has agreed to the set of conditions posed, the producer will complete the\nannuity application, ensuring that particular riders, such as a bonus rider or a guaranteed\nminimum death benefit, are in place to maximize the rate of return for those financing the\ntransaction. Depending on the number of companies the producer represents and the commission\npolicies in effect, the producer may seek to use multiple policies from various companies.\n\nTo avoid added scrutiny of the policy or detection of the scheme, producers involved in STOAs\nwill often take precautions to ensure that the dollar amount of the annuity falls below specific\nunderwriting guidelines. A trust or an organization may additionally be named as beneficiary of\nthe annuity in order to hide the true identity of those who will benefit from the annuitant’s death.\n\nAs the financial implications of STOA transactions could be detrimental to both companies and\nconsumers, it is suggested that companies:\n\nReview chargeback policies and consider reserving the right to adjust commissions if a\npolicy is annuitized or a death benefit is paid within its first policy year and the facts indicate the\npolicy was used to facilitate STOA transactions.\n\nCreate detection methods to identify STOA transactions and those producers who may be\ninvolved in facilitating such transactions, including controls to flag questionable applications.\nRevisit annuity application processes to ensure that specific questions are posed with regard\nto the relationship between the annuitant and contract owner, and the manner in which the\ncontract is being funded.\n\nReport actual and potential STOA transactions to the California Department of Insurance.\n\nInquiries regarding this Bulletin may be directed to:\n\n       Jennifer Chambers\n       Senior Staff Counsel\n       California Department of Insurance\n       45 Fremont Street, 24th Floor\n       San Francisco, CA 94105\n       (415) 538-4145\n       Jennifer.Chambers@insurance.ca.gov\n\n                                                        DAVE JONES\n                                                        Insurance Commissioner","text_length":3523}
{"slug":"ca-bulletin-2014-4","jurisdiction":"CA","agency":"CDI","doc_type":"bulletin","citation":"CDI Bulletin 2014-4","title":"Bulletin 2014-4: Life and Annuity Consumer Protection Fund","official_source_url":"https://www.insurance.ca.gov/0250-insurers/0300-insurers/0200-bulletins/bulletin-notices-commiss-opinion/upload/Bulletin2014-4.pdf","access_class":"statutory-public","access_notes":"insurance.ca.gov disclaimer: content considered public domain; gate-zero CA-a","first_seen_at":"2026-07-19T16:30:04.785561+00:00","last_checked_at":"2026-07-20T06:27:54.834034+00:00","versions":[{"fetched_at":"2026-07-19T16:30:04.785561+00:00","version_no":1,"text_length":2010,"effective_date":null,"content_sha256_short":"f2c62edee314"}],"text":"STATE OF CALIFORNIA\n                              DEPARTMENT OF INSURANCE\n                                    45 Fremont Street\n                              San Francisco, California 94105\n\n                                                                        BULLETIN NO. 2014-4\n                                                                               May 14, 2014\n\nTO:          All Admitted Life Insurance Companies and Other Interested Persons\n\nSUBJECT:     LIFE AND ANNUITY CONSUMER PROTECTION FUND\n\nThe purpose of this Bulletin is to inform affected licensees and interested members of the\npublic of the revisions made to Section 10127.17 of the Insurance Code.\n\nEffective January 1, 2014, SB 476 (Chapter 347, Statutes of 2013) made two substantive\nrevisions to Section 10127.17 of the Insurance Code. The requirement that each individual life\ninsurance policy and each individual annuity product have a value of $15,000 or more in order\nfor the special assessment to apply was deleted. The assessment applies to all newly issued\nindividual life insurance policies and individual annuity products. Additionally, the date of\nrepeal of the Life and Annuity Consumer Protection Fund was deleted.\n\nSelf-assessments containing data related to each individual life insurance policy and\neach individual annuity product issued to a resident of California will begin with the\nJanuary-June 2014 reporting period (due July 10, 1014). Self-assessments are to continue\nto be submitted semi-annually (by January 10th and July 10th) via the California Department of\nInsurance Internet Life & Annuity Data Collection Application - - ILAD.\n\nQuestions regarding this Bulletin may be directed to:\n\nRachelle Gunther\nLife & Annuity Program Analyst\nCalifornia Department of Insurance\n45 Fremont Street, 23rd Floor\nSan Francisco, CA 94105\n(415) 538-4359\nRachelle.Gunther@insurance.ca.gov\n\n                                                DAVE JONES\n                                                Insurance Commissioner","text_length":2010}
{"slug":"ca-bulletin-2013-3","jurisdiction":"CA","agency":"CDI","doc_type":"bulletin","citation":"CDI Bulletin 2013-3","title":"Bulletin 2013-3: Notification of Fee Increase (Effective 3/17/2014)","official_source_url":"https://www.insurance.ca.gov/0250-insurers/0300-insurers/0200-bulletins/bulletin-notices-commiss-opinion/Bulletin2013-3.cfm","access_class":"statutory-public","access_notes":"insurance.ca.gov disclaimer: content considered public domain; gate-zero CA-a","first_seen_at":"2026-07-19T16:30:04.785561+00:00","last_checked_at":"2026-07-20T06:27:54.834034+00:00","versions":[{"fetched_at":"2026-07-19T20:55:31.716534+00:00","version_no":2,"text_length":10989,"effective_date":null,"content_sha256_short":"f51937d48ff5"},{"fetched_at":"2026-07-19T16:30:04.785561+00:00","version_no":1,"text_length":10989,"effective_date":null,"content_sha256_short":"8769096a3e0e"}],"text":"Bulletin 2013-3: Notification of Fee Increase Effective March 17, 2014\n\n  -->\n\n  -->\n\n  Skip to Main Content\n\n Search this site:\n\n      \n  File a Complaint\n  Consumers\n\n  File a Complaint\n Ask a question or file a complaint\n\n  Check License Status\n Check License Status\n\n  Types of Insurance\n Understand different types of insurance\n\n  Health Insurance Information\n Learn about health insurance\n\n  Company and Agent/Broker Information\n Find information about insurance companies, agents and brokers\n\n  Laws & Regulations\n Search insurance laws and regulations\n\n  Virtual Viewing Room\n This virtual viewing room allows you to see insurance company rate filings, examination reports, and related information.\n\n  Dealing with Catastrophes\n Prepare for natural disasters\n\n  Administrative Hearings and Public Programs\n Learn about administrative hearings and other public programs\n\n  Cannabis and Insurance\n Find out more about Cannabis and Insurance.\n\n  Bail Bonds\n Learn more about surety bail bonds\n\n  Climate Change\n Climate Change and Insurance\n\n  Information Guides\n Information Guides\n\n  Wildfire Response and Readiness\n Wildfire Response and Readiness\n\n  Seniors\n\n  Alerts\n Review important Alerts, Advisories & Press Releases that impact Seniors.\n\n  Before You Buy Insurance\n Things you should know before you buy insurance.\n\n  Health Coverage\n Health plans are important for Seniors. Please review this important information.\n\n  Long Term Care\n Find out if Long Term Care insurance is something for you.\n\n  Information Guides\n Read information guides specifically designed for seniors.\n\n  Other Resources\n We are providing additional information that you may find helpful.\n\n  Agents & Brokers\n\n  Check a License\n Search for license status information based on license number or name.\n\n  Licensing Online Services\n Convenience & Security at your Fingertips: Apply for an Insurance License, Schedule Examination, License Renewal, Change Your Address, and more.\n\n  Applying for a License\n How to apply for a license for individual resident license, individual non-resident license, and business entity licenses.\n\n  Seeking Prelicensing / Continuing Education\n Prelicensing and continuing education is required by law. Find how and where to get prelicensing and continuing education in this section.\n\n  Licensing Background Information\n Information relating to licensing, background issues and information for producer license applicants regarding Proposition 64, the “Adult Use of Marijuana Act”.\n\n  Check License Application Status Service (CLASS)\n Check License Application Status Service (CLASS)\n\n  Licensing Forms\n List of necessary qualifications, requirements, fees and interactive forms for producer licensing. Plus prelicensing/continuing education forms.\n\n  Licensing Fees\n Licensing Fees\n\n  Resident License Renewal\n All you need to know about renewing your license.\n\n  Non-Resident License Renewal\n All you need to know about renewing your non-resident license.\n\n  Print or Download Your License\n Print or download license\n\n  Updating Licensee Info\n Report a change of address, email address, add an endorsee to a business entity, and producer licensing background review guidelines.\n\n  Licensing Services Division Frequently Asked Questions\n Producer Licensing Frequently Asked Questions\n\n  Applying to Become an Approved Education Provider\n Education provider on-line programs to assist education providers in processing rosters and class schedules and in filing for provider status, course approval, and course development.\n\n  Agent & Broker ALERT\n Agent & Broker ALERT Provided by California Insurance Commissioner's office\n\n  What’s New in the Licensing Services Division\n Major changes in the Licensing Services Division since 2010 including regulations, programs, fees, etc.\n\n  Licensing Services Division Notices\n Licensing Services Division Notices since 2010.\n\n  Mailing List for Producer\n Mailing lists for active individuals, agencies, and insurance companies and order forms.\n\n  Insurers\n\n  Insurers\n Insurers Applications, Forms and Filings, Bulletins & Notices, Programs, Officially Filed Reports of Examination\n\n  Electronic Funds Transfer (EFT) Programs\n Convenient method for the payment of Invoices and Premium Tax remittances. Separate enrollment is required for the Invoice Payments EFT Program and Tax EFT Program.\n\n  OASIS\n Online Assistance System for Insurer Submittals (OASIS)\n\n  Legal Information\n Insurance Code and Regulations, Proposed Regulations, Decisions and Rulings, Hearing Calendar.\n\n  Data & Reports\n Market Share Reports, Consumer Complaint Study,Residential and Commercial Earthquake Insurance Coverage Study, Annual Report of the Commissioner, and More.\n\n  COIN\n California Organized Investment Network (COIN) Is a Collaborative Effort Between the California Department of Insurance, the Insurance Industry, Community Affordable Housing and Economic Development Organizations, and Community Advocates.\n\n  Insurance Diversity Initiative\n IDI is an effort to encourage Supplier Diversity and Governing Board Diversity within California’s insurance industry\n\n  P&C Rate Filing\n Prior Approval Regulations, Workers' Compensation Rate Filings, Public Notices of Rate Filings.\n\n  CRC\n Company Complaint Response Center\n\n  LRS\n Auto Body Repair Labor Rate Survey Tool\n\n  Climate Risk Carbon Initiative\n Interactive database that provides information on insurers' investments in fossil fuel\n\n  Climate Risk Disclosure Survey\n View the Climate Risk Disclosure Survey Results\n\n  Fraud\n\n  Fraud Division Overview\n The Fraud Division investigates suspected fraud committed by consumers or organized criminal elements perpetrated against insurance companies.\n\n  Investigation Division Overview\n The Investigation Division investigates suspected fraud committed by insurance agents, brokers, public adjusters, bail agents, insurance companies and other individuals and entities transacting the business of insurance who perpetrate fraud against consumers.\n\n  File a Commendation or Complaint\n Professional Standards Unit Civilian Commendation/Complaint Forms\n\n  Report Fraud\n Link to CDI’s two suspected insurance fraud reporting systems – 1) Insurance Company Suspected Fraud Reporting Portal and, 2) Consumer Suspected Fraud Reporting Portal.\n\n  Insurance Fraud Grant Programs\n Insurance Fraud Grant Programs\n\n  News\n\n  Press Releases\n Official announcements, news releases.\n\n  Advisories\n Advising media events and activities\n\n  CA Consumer Alerts\n CA Consumer Alerts\n\n  Consumer Success Stories\n Consumer success stories\n\n  Featured Topics\n Provides links to featured topics\n\n  Studies, Reports & Publications\n Market share reports, consumer complaint study, residential and commercial earthquake insurance coverage study, annual report of the commissioner, and more.\n\n  Multimedia\n Video press conferences, public service announcements, hearings and public forums\n\n  About Us\n\n  Meeting Requests\n Scheduling an appointment with Commissioner Lara\n\n  About the Commissioner\n Information about the Commissioner\n\n  About the Department\n Information about the Department's history and organization\n\n  Commissioner Appointments\n Information about the Commissioner's  Appointments to Boards and Committees\n\n  Career Opportunities\n Employment opportunities within the Department of Insurance\n\n  Contact Us\n Contact information for offices and entities\n\n             Maintenance Notice    -->\n\n Insurers Overview\n/\n Insurers\n/\n Bulletins & Notices\n/\n Bulletins, Notices and Commissioners Opinions\n/ Bulletin 2013-3: Notification of Fee Increase Effective March 17, 2014\n\n Bulletin 2013-3: Notification of Fee Increase Effective March 17, 2014\n        Bulletin No.  2013-3\n  Date:  December 16, 2013\n  To:  All Admitted Insurers and Other Interested Parties\n  Subject:  Notification of Fee Increase\n In accordance with Insurance Code Section 12978, we are providing notification that the California Department of Insurance is increasing fees by 10 percent for all insurance producers, bail agents, insurance adjusters, and insurers operating in the State of California effective March 17, 2014. As an example, an insurance agent or broker will see an increase of only $14 for each biennial license or renewal, which amounts to just $7 per year.\n Pursuant to Insurance Code Section 12978, the Department has the responsibility to set fees that provide sufficient revenue to support the Department's budget and meet critical workload demands to protect California's insurance consumers as well as ensure the solvency of the Insurance Fund. The Department works diligently to create operational efficiencies and control costs while improving service levels; however, Fees an License revenue has not kept pace with the cost of doing business. Expenditures in recent years, most outside of the Department's control, continue to outpace revenue growth. For example, employee compensation and statewide administrative costs have increased. Additionally, several newly enacted legislative mandates have increased the Department's workload and required additional resources. Therefore, this increase, only the second in a decade, is necessary to ensure revenues are sufficient to support expenditures. As always, the Department will continue to monitor the Insurance Fund in order to ensure its financial integrity.\n The  new fee schedule is available  for your reference. If you have any questions, please contact our Producer Licensing Bureau at (800) 967-9331.\n  Please be sure this information is disseminated to all your appointed agents in California .\n  \n Erika Sperbeck\nDeputy Commissioner\nAdministration & Licensing Services Branch\n  A printable version of this Bulletin is available .\n\n   Insurers Overview\n\n Insurers\n Applications, Forms & Filings  Bulletins & Notices  Programs  Officially Filed Reports of Examination\n\n Electronic Funds Transfer (EFT) Programs\n\n OASIS\n\n Legal Information\n\n Data & Reports\n\n COIN\n\n Insurance Diversity Initiative\n\n P&C Rate Filing\n\n CRC\n\n LRS\n\n Privacy Policy\n ADA Compliance\n Site Map\n Career Opportunities\n Internships\n Free Document Readers\n Scheduled Site Maintenance\n\nCopyright © California Department of Insurance\n\n  \n\n   Google™ Translation Disclaimer\n  X\n This Google™ translation feature is provided for informational purposes only.\n The Department of Insurance is unable to guarantee the accuracy of this translation and is therefore not liable for any inaccurate information resulting from the translation application tool.\n The Department of Insurance is also unable to guarantee the same page layout for all the languages. Depending on the languages, the page layout may look strange from the original.\n Please consult with a translator for accuracy if you are relying on the translation or are using this site for official business.\n A copy of this disclaimer can also be found on our  Disclaimer  page.\n Select a Language Below /  Seleccione el Idioma Abajo\n\n Close this box or use the [X]","text_length":10989}
{"slug":"ca-bulletin-2013-1","jurisdiction":"CA","agency":"CDI","doc_type":"bulletin","citation":"CDI Bulletin 2013-1","title":"Bulletin 2013-1: Export List","official_source_url":"https://www.insurance.ca.gov/0250-insurers/0300-insurers/0200-bulletins/bulletin-notices-commiss-opinion/upload/ExportListBulletin.pdf","access_class":"statutory-public","access_notes":"insurance.ca.gov disclaimer: content considered public domain; gate-zero CA-a","first_seen_at":"2026-07-19T16:30:04.785561+00:00","last_checked_at":"2026-07-20T06:27:54.834034+00:00","versions":[{"fetched_at":"2026-07-19T16:30:04.785561+00:00","version_no":1,"text_length":5547,"effective_date":null,"content_sha256_short":"e8c84e93f009"}],"text":"STATE OF CALIFORNIA\n                            DEPARTMENT OF INSURANCE\n                                45 FREMONT STREET\n                             SAN FRANCISCO, CA 94105\n\n                                                                 Bulletin No. 2013- 1\n                                                                 January 8, 20f3\n\nTO:     All Surplus Line Brokers, Admitted Insurers, and Other Interested Persons\n\nSUBJECT: Export List\n\nPursuant to Insurance Code Section 1763.1, the Commissioner may by order declare\neligible for placement with a nonadmitted insurer and exempt from all the requirements\nof Section 1763, except the filing of a confidential written report, any type of insurance\ncoverage or risk for which he finds after a public hearing that there is not a reasonable\nor adequate market among admitted insurers.\n\nThis year the Department held a public hearing and comment period regarding the\nannual renewal of the list as required by the statute. There is one new item added to\nthe list and the item is liability coverage for Physician/Medical Group/Hospital Billing\nErrors and Omissions.\n\nThe Department reminds you that risks and coverages not appearing on this list may\nstill be exportable but subject to the full documentation of the diligent search being\nperformed with respect to insurance issued to a home state insured as required by\nInsurance Code Section 1763.\n\nA public hearing will be held annually or more often at the Commissioner's discretion\nregarding the attached export list. The Commissioner or his designee shall notify all\nsurplus line brokers of any removal from the list. The contact person is\nCarol Frair, Senior Staff Counsel, Department of Insurance, 45 Fremont Street, San\nFrancisco, CA 94105, (415) 538-4408.\n\n                                 DAVE JONES\n                                 Insurance Commissioner\n\n                              By;V ~\n                                 Nettie Hoge, chiefoStaff\n\n#756704v1\nEXPORT LIST 2013\n\nACCIDENT /DISABILITY\n\n   BRIDGE PLAN .!.\n\n  HIGH LIMITS DISABILITY .!.,!_\n\n  INTERNATIONAL MAJOR MEDICAL\n\nAUTOMOBILES\n\n  EXOTIC/CLASSIC/ANTIQUE AUTOS WITH A VALUE IN EXCESS OF $100,000\n\nAVIATION\n\n  AVIATION EXCESS LIABILITY\n\n  SHORT TERM MEDIA/ENTERTAINMENT NON-OWNED CONTINGENT AIRCRAFT\n  LIABILITY (FILM/ENTERTAINMENT PRODUCTIONS)\n\nCRIME\n\n  EXCESS CRIME\n\n  KIDNAP & RANSOM\n\nFIRE & ALLIED LINES\n\n  AMUSEMENT PARKS/CARNIVALS AND AMUSEMENT DEVICES\n\n  COMMERCIAL DIC/STAND ALONE EARTHQUAKE\n\n  DISASTER INCOME PROTECTION\n\n  EXCESS FLOOD\n\n  EXPLOSIVE MANUFACTURING/SALES/STORAGE\n\n  HAY IN THE OPEN\n\n  HOMEOWNERS EARTHQUAKE/EXCESS LIMITS OR DEDUCTIBLE BUYBACK\n\n  INDIVIDUAL INSUREDS WITH LARGE SCHEDULES WHERE THE TIV(TOTAL\n  INSURED VALUES)AR E IN EXCESS OF $500 MILLION\n\n  SAWMILLS\n\n  VACANT BUILDINGS\n\nGENERAL LIABILITY\n\n  AMBULANCE SERVICES INCLUDING PROFESSIONAL LIABILITY\n\n  AMUSEMENT PARKS/CARNIVALS/DEVICES\n\n  BLASTING CONTRACTORS\n\n#756941v2\n  : BUILDING MOVING\n\n   CLINICAL AND SIMILAR TESTS OF PHA_RMACEUTICAL, MEDICAL, BIOLOGICAL &\n   OTHER SIMI LAR PRODUCTS                                 .\n\n   CONTRACTORS ENGAGED IN CONSTRUCTION OF NEW TRACT HOMES AND/OR\n   NEW CONDOMINIUMS\n\n   CRANE & RIGGING CONTRACTORS\n\n   DEMOLITION CONTRACTORS\n\n   EMPLOYMENT PRACTICES LIABILITY\n\n   ENVIRONMENTAL IMPAIRMENT REMEDIATION AND POLLUTION LIABILITY\n\n   EXCESS LIABILITYWHERE PART OF UNDERLYING rs. NONADMITTED\n\n   EXPLOSIVES INCLUDING MANUFACTURING/SALES/STORAGE\n\n   FIREWORKS DISPLAYS\n\n   FOSTER FAMILY (OCCURRENCE BASED ONLY)\n\n   HOT AIR BALLOON\n\n  LIMITS THAT ATTACH IN EXCESS OF $150 MILLION\n\n  OILFiELD CONTRACTORS\n\n  OUTFITTERS AND GUIDES\n\n  PATENT/TRADEMARK/COPYRIGHT INFRINGEMENT\n\n  PRO.DUCTS RECALL\n\n  PRODUCTS/COMPLETED OPERATIONS(WRITTEN ON A STAND ALONE BASIS)\n\n  SEASONAL OR MOBILE FAIRS, CONCESSIONAIRES,- VENDORS AND FAIRS, WITH\n  OR WITHOUT LIQUOR LIABILITY .\n\n  SECURITY GUARD SERVICES\n\n  SHORT TERM MEDIA/ENTERTAiNMENT RAILROAD PROJECTIVE LIABILITY\n  (FILM/ENTERTAINME NT PRODUCTIONS)\n\n  SHORT TERM SPECIAL EVENTS (EXCLUDING HOLE-IN-ONE)\n\n  TATTOO AND BODY PIERCING SHOPS\n\nINLAND MARINE\n\n  ALL VESSELS IN EXCESS OF 30 FEET AND RATED WITH A MAXIMUM SPEED OF\n  45 MPH\n\n  ANY VESSEL/WITH A MAXIMUM RATED SPEED IN EXCESS OF 55 MPH\n\n  EXCESS MOTOR TRUCK CARGO\n\n  PERSONAL ARTICLES FLOATERS WRITTEN ON A STAND ALONE BASIS WHERE\n  THE VALUE-OF THE SCHEDULE IS IN EXCESS OF·$1M OR CONTAINS A SINGLE\n  ITEM(S) OVER $100,000\n\n#756941v2\n  MISCELLANEOUS\n\n     EVENT CANCELLATION\n\n     POLITICAL RISKS INCLUDING EXPROPRIATION, CONFISCATION, UNFAIR\n     CALLING\n\n     PRIZE INDEMNIFICATION (EXCLUDING HOLE-IN-ONE COVERAGE)\n\n     SHORT TERM MEDIA/ENTERTAINMENT FAILURE TO SURVIVE FOR $5 MILLION\n     AND OVER (FILM/ENTERTAINMENT PRODUCTIONS)\n\n  PROFESSIONAL LIABILITY /ERRORS & OMISSION\n\n     ARCHITECTS & ENGINEERS/CONDO COVERAGE ONLY\n\n     CAMPAIGN TREASURERS\n\n     CREDITORS' COMMITTEES\n\n     PHYSICIAN/MEDICAL GROUP/HOSPITAL BILLING E/0\n\n     TATTOO & BODY PIERCING SHOPS E/0\n\n* The Bridge Plan covers 65 year old people who must wait a certain period before they can enroll\nin Medicare. These people either 1) failed to meet the residency requirement of Medicare and\nmust wait 5 years to meet the residency requirement or 2) failed to enroll during the proper\nMedicare enrollment period and now must wait a brief period before they are eligible to enroll.\n** High Limits Disability is coverage that offers benefit amounts over the admitted market\nmaximum issue and participation limits and/or includes occupations which are not eligible.\n\n  #756941v2","text_length":5547}
{"slug":"ca-bulletin-2012-3","jurisdiction":"CA","agency":"CDI","doc_type":"bulletin","citation":"CDI Bulletin 2012-3","title":"Bulletin 2012-3: Fraud General Annual Assessment Adjustment","official_source_url":"https://www.insurance.ca.gov/0250-insurers/0300-insurers/0200-bulletins/bulletin-notices-commiss-opinion/upload/FraudGeneralAssessment.pdf","access_class":"statutory-public","access_notes":"insurance.ca.gov disclaimer: content considered public domain; gate-zero CA-a","first_seen_at":"2026-07-19T16:30:04.785561+00:00","last_checked_at":"2026-07-20T06:27:54.834034+00:00","versions":[{"fetched_at":"2026-07-19T16:30:04.785561+00:00","version_no":1,"text_length":1762,"effective_date":null,"content_sha256_short":"f543fb904736"}],"text":"STATE OF CALIFORNIA                                                       Dave Jones, Insurance Commissioner\nDEPARTMENT OF INSURANCE\nADMINISTRATION & LICENSING SERVICES BRANCH\n300 CAPITOL MALL, SUITE 1600\nSACRAMENTO, CA 95814\n(916) 492-3500\n(916) 327-3482 (FAX)\nwww.insurance.ca.gov\n\n        BULLETIN NO.:            2012-3\n\n        DATE:                    March 30, 2012\n\n        TO:                      All Insurers\n\n        SUBJECT:                 Fraud General Annual Assessment Adjustment\n\n        Pursuant to Insurance Code Sections 1872.86 and 12978, this bulletin is informing all\n        affected parties that the Fraud General Annual Assessment will be adjusted from\n        $2,100 to $4,200 effective July 1, 2012. This assessment was adjusted from $5,100 to\n        $2,100 three years ago by the prior Insurance Commissioner, who kept vacant fraud\n        enforcement positions open, thereby reducing the Department’s fraud enforcement\n        efforts and operational expenditures such that the fee could be lowered. A partial\n        restoration of this assessment to $4,200 is necessary at this time to ensure the\n        Department has sufficient revenue to fully fund its existing, authorized, and critical fraud\n        enforcement activities.\n\n        There will be no change to your annual billing process. You should anticipate receiving\n        an invoice in July/August 2012. Please contact Dennis Dunbar at (916) 854-5748 for\n        fraud prevention program operations, or Theresa Li at (916) 492-3237 for billing related\n        inquiries.\n\n        ERIKA SPERBECK\n        Deputy Commissioner\n        Administration & Licensing Services Branch\n\n                       Consumer Hotline (800) 927-HELP * Producer Licensing (800) 967-9331","text_length":1762}
{"slug":"ca-bulletin-2014-6","jurisdiction":"CA","agency":"CDI","doc_type":"bulletin","citation":"CDI Bulletin 2014-6","title":"Bulletin 2014-6: Notification of Fee Increase (Effective 3/1/2015)","official_source_url":"https://www.insurance.ca.gov/0250-insurers/0300-insurers/0200-bulletins/bulletin-notices-commiss-opinion/Bulletin2014-6.cfm","access_class":"statutory-public","access_notes":"insurance.ca.gov disclaimer: content considered public domain; gate-zero CA-a","first_seen_at":"2026-07-19T16:30:04.785561+00:00","last_checked_at":"2026-07-20T06:27:54.834034+00:00","versions":[{"fetched_at":"2026-07-19T20:55:31.716534+00:00","version_no":2,"text_length":11006,"effective_date":null,"content_sha256_short":"8b05315a3340"},{"fetched_at":"2026-07-19T16:30:04.785561+00:00","version_no":1,"text_length":11006,"effective_date":null,"content_sha256_short":"4188d92e8030"}],"text":"Bulletin 2013-3: Notification of Fee Increase Effective March 17, 2014\n\n  -->\n\n  -->\n\n  Skip to Main Content\n\n Search this site:\n\n      \n  File a Complaint\n  Consumers\n\n  File a Complaint\n Ask a question or file a complaint\n\n  Check License Status\n Check License Status\n\n  Types of Insurance\n Understand different types of insurance\n\n  Health Insurance Information\n Learn about health insurance\n\n  Company and Agent/Broker Information\n Find information about insurance companies, agents and brokers\n\n  Laws & Regulations\n Search insurance laws and regulations\n\n  Virtual Viewing Room\n This virtual viewing room allows you to see insurance company rate filings, examination reports, and related information.\n\n  Dealing with Catastrophes\n Prepare for natural disasters\n\n  Administrative Hearings and Public Programs\n Learn about administrative hearings and other public programs\n\n  Cannabis and Insurance\n Find out more about Cannabis and Insurance.\n\n  Bail Bonds\n Learn more about surety bail bonds\n\n  Climate Change\n Climate Change and Insurance\n\n  Information Guides\n Information Guides\n\n  Wildfire Response and Readiness\n Wildfire Response and Readiness\n\n  Seniors\n\n  Alerts\n Review important Alerts, Advisories & Press Releases that impact Seniors.\n\n  Before You Buy Insurance\n Things you should know before you buy insurance.\n\n  Health Coverage\n Health plans are important for Seniors. Please review this important information.\n\n  Long Term Care\n Find out if Long Term Care insurance is something for you.\n\n  Information Guides\n Read information guides specifically designed for seniors.\n\n  Other Resources\n We are providing additional information that you may find helpful.\n\n  Agents & Brokers\n\n  Check a License\n Search for license status information based on license number or name.\n\n  Licensing Online Services\n Convenience & Security at your Fingertips: Apply for an Insurance License, Schedule Examination, License Renewal, Change Your Address, and more.\n\n  Applying for a License\n How to apply for a license for individual resident license, individual non-resident license, and business entity licenses.\n\n  Seeking Prelicensing / Continuing Education\n Prelicensing and continuing education is required by law. Find how and where to get prelicensing and continuing education in this section.\n\n  Licensing Background Information\n Information relating to licensing, background issues and information for producer license applicants regarding Proposition 64, the “Adult Use of Marijuana Act”.\n\n  Check License Application Status Service (CLASS)\n Check License Application Status Service (CLASS)\n\n  Licensing Forms\n List of necessary qualifications, requirements, fees and interactive forms for producer licensing. Plus prelicensing/continuing education forms.\n\n  Licensing Fees\n Licensing Fees\n\n  Resident License Renewal\n All you need to know about renewing your license.\n\n  Non-Resident License Renewal\n All you need to know about renewing your non-resident license.\n\n  Print or Download Your License\n Print or download license\n\n  Updating Licensee Info\n Report a change of address, email address, add an endorsee to a business entity, and producer licensing background review guidelines.\n\n  Licensing Services Division Frequently Asked Questions\n Producer Licensing Frequently Asked Questions\n\n  Applying to Become an Approved Education Provider\n Education provider on-line programs to assist education providers in processing rosters and class schedules and in filing for provider status, course approval, and course development.\n\n  Agent & Broker ALERT\n Agent & Broker ALERT Provided by California Insurance Commissioner's office\n\n  What’s New in the Licensing Services Division\n Major changes in the Licensing Services Division since 2010 including regulations, programs, fees, etc.\n\n  Licensing Services Division Notices\n Licensing Services Division Notices since 2010.\n\n  Mailing List for Producer\n Mailing lists for active individuals, agencies, and insurance companies and order forms.\n\n  Insurers\n\n  Insurers\n Insurers Applications, Forms and Filings, Bulletins & Notices, Programs, Officially Filed Reports of Examination\n\n  Electronic Funds Transfer (EFT) Programs\n Convenient method for the payment of Invoices and Premium Tax remittances. Separate enrollment is required for the Invoice Payments EFT Program and Tax EFT Program.\n\n  OASIS\n Online Assistance System for Insurer Submittals (OASIS)\n\n  Legal Information\n Insurance Code and Regulations, Proposed Regulations, Decisions and Rulings, Hearing Calendar.\n\n  Data & Reports\n Market Share Reports, Consumer Complaint Study,Residential and Commercial Earthquake Insurance Coverage Study, Annual Report of the Commissioner, and More.\n\n  COIN\n California Organized Investment Network (COIN) Is a Collaborative Effort Between the California Department of Insurance, the Insurance Industry, Community Affordable Housing and Economic Development Organizations, and Community Advocates.\n\n  Insurance Diversity Initiative\n IDI is an effort to encourage Supplier Diversity and Governing Board Diversity within California’s insurance industry\n\n  P&C Rate Filing\n Prior Approval Regulations, Workers' Compensation Rate Filings, Public Notices of Rate Filings.\n\n  CRC\n Company Complaint Response Center\n\n  LRS\n Auto Body Repair Labor Rate Survey Tool\n\n  Climate Risk Carbon Initiative\n Interactive database that provides information on insurers' investments in fossil fuel\n\n  Climate Risk Disclosure Survey\n View the Climate Risk Disclosure Survey Results\n\n  Fraud\n\n  Fraud Division Overview\n The Fraud Division investigates suspected fraud committed by consumers or organized criminal elements perpetrated against insurance companies.\n\n  Investigation Division Overview\n The Investigation Division investigates suspected fraud committed by insurance agents, brokers, public adjusters, bail agents, insurance companies and other individuals and entities transacting the business of insurance who perpetrate fraud against consumers.\n\n  File a Commendation or Complaint\n Professional Standards Unit Civilian Commendation/Complaint Forms\n\n  Report Fraud\n Link to CDI’s two suspected insurance fraud reporting systems – 1) Insurance Company Suspected Fraud Reporting Portal and, 2) Consumer Suspected Fraud Reporting Portal.\n\n  Insurance Fraud Grant Programs\n Insurance Fraud Grant Programs\n\n  News\n\n  Press Releases\n Official announcements, news releases.\n\n  Advisories\n Advising media events and activities\n\n  CA Consumer Alerts\n CA Consumer Alerts\n\n  Consumer Success Stories\n Consumer success stories\n\n  Featured Topics\n Provides links to featured topics\n\n  Studies, Reports & Publications\n Market share reports, consumer complaint study, residential and commercial earthquake insurance coverage study, annual report of the commissioner, and more.\n\n  Multimedia\n Video press conferences, public service announcements, hearings and public forums\n\n  About Us\n\n  Meeting Requests\n Scheduling an appointment with Commissioner Lara\n\n  About the Commissioner\n Information about the Commissioner\n\n  About the Department\n Information about the Department's history and organization\n\n  Commissioner Appointments\n Information about the Commissioner's  Appointments to Boards and Committees\n\n  Career Opportunities\n Employment opportunities within the Department of Insurance\n\n  Contact Us\n Contact information for offices and entities\n\n             Maintenance Notice    -->\n\n Insurers Overview\n/\n Insurers\n/\n Bulletins & Notices\n/\n Bulletins, Notices and Commissioners Opinions\n/ Bulletin 2014-6: Notification of Fee Increase Effective March 1, 2015\n\n Bulletin 2014-6: Notification of Fee Increase Effective March 1, 2015\n        Bulletin No.  2014-6\n  Date:  December 1, 2014\n  To:  All Admitted Insurers and Other Interested Parties\n  Subject:  Notification of Fee Increase\n In accordance with Insurance Code Section 12978, we are\nproviding notification that the California Department of Insurance is\nincreasing fees by 10 percent for all insurance producers, bail agents,\ninsurance adjusters, and insurers operating in the State of California\neffective March 1, 2015. As an example,\nan insurance agent or broker will see an increase of only $16 for each biennial\nlicense or renewal, which amounts to just $8 per year.\n\nPursuant to Insurance Code Section 12978, the Department\nhas the responsibility to set fees that provide sufficient revenue to support\nthe Department's budget and meet critical workload demands to protect\nCalifornia's insurance consumers as well as ensure the solvency of the\nInsurance Fund. The Department works\ndiligently to create operational efficiencies and control costs while improving\nservice levels;however, revenue has not kept pace with the cost of doing\nbusiness. Expenditures in recent years, most outside of the Department's\ncontrol, continue to outpace revenue growth. For example, recent employee compensation increases negotiated by the\nGovernor and approved by the Legislature, and employer pension contributions\nadopted by CalPERS beginning July 1, 2014, significantly increase the\nDepartment's costs, a portion of which must be covered by Fees and Licenses. Therefore, this increase is necessary to\nensure revenues are sufficient to support expenditures. As always, the Department will continue to\nmonitor the Insurance Fund in order to ensure its financial integrity.\n\n The  new fee schedule is available  for your reference. If you have any questions, please contact our Licensing Hotline at (800) 967-9331.\n  Please be sure this information is disseminated to all your appointed agents in California .\n  \n Erika Sperbeck\nDeputy Commissioner\nAdministration & Licensing Services Branch\n  A printable version of this Bulletin is available .\n\n   Insurers Overview\n\n Insurers\n Applications, Forms & Filings  Bulletins & Notices  Programs  Officially Filed Reports of Examination\n\n Electronic Funds Transfer (EFT) Programs\n\n OASIS\n\n Legal Information\n\n Data & Reports\n\n COIN\n\n Insurance Diversity Initiative\n\n P&C Rate Filing\n\n CRC\n\n LRS\n\n Privacy Policy\n ADA Compliance\n Site Map\n Career Opportunities\n Internships\n Free Document Readers\n Scheduled Site Maintenance\n\nCopyright © California Department of Insurance\n\n  \n\n   Google™ Translation Disclaimer\n  X\n This Google™ translation feature is provided for informational purposes only.\n The Department of Insurance is unable to guarantee the accuracy of this translation and is therefore not liable for any inaccurate information resulting from the translation application tool.\n The Department of Insurance is also unable to guarantee the same page layout for all the languages. Depending on the languages, the page layout may look strange from the original.\n Please consult with a translator for accuracy if you are relying on the translation or are using this site for official business.\n A copy of this disclaimer can also be found on our  Disclaimer  page.\n Select a Language Below /  Seleccione el Idioma Abajo\n\n Close this box or use the [X]","text_length":11006}
{"slug":"ca-bulletin-2014-5","jurisdiction":"CA","agency":"CDI","doc_type":"bulletin","citation":"CDI Bulletin 2014-5","title":"Bulletin 2014-5: New Mortality Table for use in Determining Minimum Reserve Liabilities for Individual Annuity and Pure Endowment Contracts","official_source_url":"https://www.insurance.ca.gov/0250-insurers/0300-insurers/0200-bulletins/bulletin-notices-commiss-opinion/upload/2014MortalityTableBulletin.pdf","access_class":"statutory-public","access_notes":"insurance.ca.gov disclaimer: content considered public domain; gate-zero CA-a","first_seen_at":"2026-07-19T16:30:04.785561+00:00","last_checked_at":"2026-07-20T06:27:54.834034+00:00","versions":[{"fetched_at":"2026-07-19T16:30:04.785561+00:00","version_no":1,"text_length":15380,"effective_date":null,"content_sha256_short":"3b83e92d5e1f"}],"text":"STATE OF CALIFORNIA\n                               DEPARTMENT OF INSURANCE\n                                 300 Capitol Mall 17th Floor\n                                Sacramento, California 95814\n\n                                         Bulletin 2014-5\n                                        October 30, 2014\n\nTO:            All Admitted Life Insurers and Other Interested Parties\n\nSUBJECT:       New Mortality Table for use in Determining Minimum Reserve Liabilities\n               for Individual Annuity and Pure Endowment Contracts\n\nSection 1. Authority\n\nThis bulletin is issued under the authority of Insurance Code § 10489.3.\n\nSection 2. Purpose\n\nFor individual annuity and pure endowment contracts issued and proceeds applied on or after\nJanuary 1, 2015, this bulletin requires use of the 2012 Individual Annuity Reserving (2012 IAR)\nTable, recently adopted by the National Association of Insurance Commissioners (NAIC), for\nuse in determining the minimum standard of valuation for individual annuity and pure\nendowment contracts, and withdraws approval of previously adopted valuation standards.\n\nSection 3. Definitions\n\n(a) “Period Table” means a table of mortality rates applicable to a given calendar year (the\nPeriod).\n\n(b) “Generational mortality table” means a mortality table containing a set of mortality rates that\ndecrease for a given age from one year to the next based on a combination of a Period Table and\na projection scale containing rates of mortality improvement.\n\n(c) “2012 Individual Annuity Mortality (2012 IAM) Period Table” means the Period Table\ncontaining loaded mortality rates for calendar year 2012. This table contains rates, qx2012+n,\ndeveloped by the Society of Actuaries Committee on Life Insurance Research and is shown in\nAppendices I - II.\n\n                                                 1\n(d) “Projection Scale G2 (Scale G2)” is a table of annual rates, G2x, of mortality improvement\nby age for projecting future mortality rates beyond calendar year 2012. This table was developed\nby the Society of Actuaries Committee on Life Insurance Research and is shown in Appendices\nIII - IV.\n\n(e) “2012 IAR Table” means that generational mortality table developed by the Society of\nActuaries Committee on Life Insurance Research and containing rates, qx2012+n, derived from a\ncombination of the 2012 IAM Period Table and Projection Scale G2, using the methodology\nstated in Section 4.\n\nSection 4. 2012 IAR Mortality Table\n\nThe 2012 IAR Mortality Table shall be used for determining the minimum standard of valuation\nfor any individual annuity or pure endowment contract issued or proceeds applied on or after\nJanuary 1, 2015.\n\nIn using the “2012 IAR Mortality Table,” the mortality rate for a person age x in year (2012 + n)\nis calculated as follows:\n\n                qx2012+n =qx2012 (1 – G2x) n\n\nThe resulting qx2012+n shall be rounded to three decimal places per 1,000, e.g., 0.741 deaths per\n1,000. Also, the rounding shall occur according to the formula above, starting at the 2012 Period\nTable rate.\n\nFor example, for a male age 30, qx2012= 0.741.\nqx2013= 0.741 * (1 – 0.010) ^ 1 = 0.73359, which is rounded to 0.734.\nqx2014= 0.741 * (1 – 0.010) ^ 2 = 0.7262541, which is rounded to 0.726.\n\nIt is incorrect to use the rounded qxn to calculate qxn+1.\n\nSection 5. Contracts issued and proceeds applied prior to January 1, 2015\n\nFor contracts issued and proceeds applied prior to January 1, 2015 the mortality tables in effect\nat the issuance of the annuity or pure endowment contract will continue to be applicable. See\nBulletin Numbers 85-14, 91-12, and 98-1. Approval for use of such tables for individual annuity\ncontracts issued and proceeds applied on or after January 1, 2015 is hereby withdrawn.\n\nSection 6. Effective Date\n\nThis bulletin is effective January 1, 2015.\n\n                                                   2\nSection 7. Questions\n\nQuestions regarding this bulletin may be referred to:\n\nAhmad Kamil, FSA, FIA, MAAA\nSenior Life Actuary\nCalifornia Department of Insurance\n300 South Spring St., 14th Floor\nLos Angeles, CA 90013\nPhone: (213) 346-6147\nE-mail: Ahmad.Kamil@insurance.ca.gov\n\n                                             DAVE JONES\n                                             Insurance Commissioner\n\n                                             By: __________________________\n                                                 GEOFFREY F. MARGOLIS\n                                                 Deputy Commissioner & Special Counsel\n\n                                                3\n                                APPENDIX I\n                             2012 IAM Period Table\n                           Female, Age Nearest Birthday\n\nAge   1000·qx 2012   Age    1000·qx 2012       Age    1000·qx 2012   Age   1000·qx 2012\n\n 0    1.621          30      0.300             60      3.460         90      88.377\n 1    0.405          31      0.321             61      3.916         91      97.491\n 2    0.259          32      0.338             62      4.409         92     107.269\n 3    0.179          33      0.351             63      4.933         93     118.201\n 4    0.137          34      0.365             64      5.507         94     130.969\n 5    0.125          35      0.381             65      6.146         95     146.449\n 6    0.117          36      0.402             66      6.551         96     163.908\n 7    0.110          37      0.429             67      7.039         97     179.695\n 8    0.095          38      0.463             68      7.628         98     196.151\n 9    0.088          39      0.504             69      8.311         99     213.150\n10    0.085          40      0.552             70      9.074         100    230.722\n11    0.086          41      0.600             71      9.910         101    251.505\n12    0.094          42      0.650             72     10.827         102    273.007\n13    0.108          43      0.697             73     11.839         103    295.086\n14    0.131          44      0.740             74     12.974         104    317.591\n15    0.156          45      0.780             75     14.282         105    340.362\n16    0.179          46      0.825             76     15.799         106    362.371\n17    0.198          47      0.885             77     17.550         107    384.113\n18    0.211          48      0.964             78     19.582         108    400.000\n19    0.221          49      1.051             79     21.970         109    400.000\n20    0.228          50      1.161             80     24.821         110    400.000\n21    0.234          51      1.308             81     28.351         111    400.000\n22    0.240          52      1.460             82     32.509         112    400.000\n23    0.245          53      1.613             83     37.329         113    400.000\n24    0.247          54      1.774             84     42.830         114    400.000\n25    0.250          55      1.950             85     48.997         115    400.000\n26    0.256          56      2.154             86     55.774         116    400.000\n27    0.261          57      2.399             87     63.140         117    400.000\n28    0.270          58      2.700             88     71.066         118    400.000\n29    0.281          59      3.054             89     79.502         119    400.000\n                                                                     120   1000.000\n\n                                           4\n                                     APPENDIX II\n                               2012 IAM Period Table\n                              Male, Age Nearest Birthday\n\n Age    1000·qx 2012   Age   1000·qx 2012        Age       1000·qx 2012   Age    1000·qx 2012\n\n 0     1.605           30    0.741                60        5.096          90        109.993\n 1     0.401           31    0.751                61        5.614          91        123.119\n 2     0.275           32    0.754                62        6.169          92        137.168\n 3     0.229           33    0.756                63        6.759          93        152.171\n 4     0.174           34    0.756                64        7.398          94        168.194\n 5     0.168           35    0.756                65        8.106          95        185.260\n 6     0.165           36    0.756                66        8.548          96        197.322\n 7     0.159           37    0.756                67        9.076          97        214.751\n 8     0.143           38    0.756                68        9.708          98        232.507\n 9     0.129           39    0.800                69       10.463          99        250.397\n10     0.113           40    0.859                70       11.357          100       268.607\n11     0.111           41    0.926                71       12.418          101       290.016\n12     0.132           42    0.999                72       13.675          102       311.849\n13     0.169           43    1.069                73       15.150          103       333.962\n14     0.213           44    1.142                74       16.860          104       356.207\n15     0.254           45    1.219                75       18.815          105       380.000\n16     0.293           46    1.318                76       21.031          106       400.000\n17     0.328           47    1.454                77       23.540          107       400.000\n18     0.359           48    1.627                78       26.375          108       400.000\n19     0.387           49    1.829                79       29.572          109       400.000\n20     0.414           50    2.057                80       33.234          110       400.000\n21     0.443           51    2.302                81       37.533          111       400.000\n22     0.473           52    2.545                82       42.261          112       400.000\n23     0.513           53    2.779                83       47.441          113       400.000\n24     0.554           54    3.011                84       53.233          114       400.000\n25     0.602           55    3.254                85       59.855          115       400.000\n26     0.655           56    3.529                86       67.514          116       400.000\n27     0.688           57    3.845                87       76.340          117       400.000\n28     0.710           58    4.213                88       86.388          118       400.000\n29     0.727           59    4.631                89       97.634          119      400.000\n                                                                           120     1000.000\n\n                                            5\n                             APPENDIX III\n                          Projection Scale G2\n                      Female, Age Nearest Birthday\n\nAge    G2x    Age    G2x              Age        G2x   Age    G2x\n\n 0    0.010   30    0.010              60      0.013    90   0.006\n 1    0.010   31    0.010              61      0.013    91   0.006\n 2    0.010   32    0.010              62      0.013    92   0.005\n 3    0.010   33    0.010              63      0.013    93   0.005\n 4    0.010   34    0.010              64      0.013    94   0.004\n 5    0.010   35    0.010              65      0.013    95   0.004\n 6    0.010   36    0.010              66      0.013    96   0.004\n 7    0.010   37    0.010              67      0.013    97   0.003\n 8    0.010   38    0.010              68      0.013    98   0.003\n 9    0.010   39    0.010              69      0.013    99   0.002\n10    0.010   40    0.010              70      0.013   100   0.002\n11    0.010   41    0.010              71      0.013   101   0.002\n12    0.010   42    0.010              72      0.013   102   0.001\n13    0.010   43    0.010              73      0.013   103   0.001\n14    0.010   44    0.010              74      0.013   104   0.000\n15    0.010   45    0.010              75      0.013   105   0.000\n16    0.010   46    0.010              76      0.013   106   0.000\n17    0.010   47    0.010              77      0.013   107   0.000\n18    0.010   48    0.010              78      0.013   108   0.000\n19    0.010   49    0.010              79      0.013   109   0.000\n20    0.010   50    0.010              80      0.013   110   0.000\n21    0.010   51    0.010              81      0.012   111   0.000\n22    0.010   52    0.011              82      0.012   112   0.000\n23    0.010   53    0.011              83      0.011   113   0.000\n24    0.010   54    0.011              84      0.010   114   0.000\n25    0.010   55    0.012              85      0.010   115   0.000\n26    0.010   56    0.012              86      0.009   116   0.000\n27    0.010   57    0.012              87      0.008   117   0.000\n28    0.010   58    0.012              88      0.007   118   0.000\n29    0.010   59    0.013              89      0.007   119   0.000\n                                                       120   0.000\n\n                                6\n                                  APPENDIX IV\n                                Projection Scale G2\n                            Male, Age Nearest Birthday\n\nAge   G2x     Age     G2x                 Age       G2x   Age   G2x\n\n0     0.010   30    0.010                 60     0.015    90    0.007\n1     0.010   31    0.010                 61     0.015    91    0.007\n2     0.010   32    0.010                 62     0.015    92    0.006\n3     0.010   33    0.010                 63     0.015    93    0.005\n4     0.010   34    0.010                 64     0.015    94    0.005\n5     0.010   35    0.010                 65     0.015    95    0.004\n6     0.010   36    0.010                 66     0.015    96    0.004\n7     0.010   37    0.010                 67     0.015    97    0.003\n8     0.010   38    0.010                 68     0.015    98    0.003\n9     0.010   39    0.010                 69     0.015    99    0.002\n10    0.010   40    0.010                 70     0.015    100   0.002\n11    0.010   41    0.010                 71     0.015    101   0.002\n12    0.010   42    0.010                 72     0.015    102   0.001\n13    0.010   43    0.010                 73     0.015    103   0.001\n14    0.010   44    0.010                 74     0.015    104   0.000\n15    0.010   45    0.010                 75     0.015    105   0.000\n16    0.010   46    0.010                 76     0.015    106   0.000\n17    0.010   47    0.010                 77     0.015    107   0.000\n18    0.010   48    0.010                 78     0.015    108   0.000\n19    0.010   49    0.010                 79     0.015    109   0.000\n20    0.010   50    0.010                 80     0.015    110   0.000\n21    0.010   51    0.011                 81     0.014    111   0.000\n22    0.010   52    0.011                 82     0.013    112   0.000\n23    0.010   53    0.012                 83     0.013    113   0.000\n24    0.010   54    0.012                 84     0.012    114   0.000\n25    0.010   55    0.013                 85     0.011    115   0.000\n26    0.010   56    0.013                 86     0.010    116   0.000\n27    0.010   57    0.014                 87     0.009    117   0.000\n28    0.010   58    0.014                 88     0.009    118   0.000\n29    0.010   59    0.015                 89     0.008    119   0.000\n                                                          120   0.000\n\n                                     7","text_length":15380}
{"slug":"ca-bulletin-2014-2","jurisdiction":"CA","agency":"CDI","doc_type":"bulletin","citation":"CDI Bulletin 2014-2","title":"Bulletin 2014-2: Transaction of Insurance in Other States and Territories","official_source_url":"https://www.insurance.ca.gov/0250-insurers/0300-insurers/0200-bulletins/bulletin-notices-commiss-opinion/upload/Bulletin2014-2.pdf","access_class":"statutory-public","access_notes":"insurance.ca.gov disclaimer: content considered public domain; gate-zero CA-a","first_seen_at":"2026-07-19T16:30:04.785561+00:00","last_checked_at":"2026-07-20T06:27:54.834034+00:00","versions":[{"fetched_at":"2026-07-19T16:30:04.785561+00:00","version_no":1,"text_length":4644,"effective_date":null,"content_sha256_short":"3880b17b48d7"}],"text":"STATE OF CALIFORNIA\n                                        Department of Insurance\n                                        45 Fremont Street, 24th Floor\n                                        San Francisco, CA 94105\n\nBULLETIN NO. 14-2\nFebruary 28, 2014\n\nTO:             ALL DOMESTIC INSURERS AND RECIPROCAL STATES AND TERRITORIES\n\nSUBJECT:        TRANSACTION OF INSURANCE IN OTHER STATES AND TERRITORIES\n\nPlease take notice that, pursuant to the provisions of Section 706.7 of the California Insurance Code, the\nfollowing States and Territories of the United States are hereby recognized as \"reciprocal States\" within\nthe meaning of said Section:\n\n 1.     ALASKA (Sec. 21.69.420, Alaska Statutes)\n 2.     COLORADO (Sec. 10-1-117, Colorado Revised Statutes)\n 3.     DELAWARE (Title 18, Sec. 4925, Delaware Code)\n 4.     FLORIDA (Title 37, Sec. 628.291, Florida Statutes)\n 5.     HAWAII (Sec. 431:4-127, Hawaii Revised Statutes)\n 6.     IDAHO (Sec. 41-2851, Idaho Code)\n 7.     KANSAS (Sec. 40-214, Kansas Statutes)\n 8.     LOUISIANA (Sec. 22:1905, Louisiana Revised Statutes)\n 9.     MAINE (Title 24-A, Sec. 3421, Maine Revised Statutes)\n10.     MARYLAND (Sec. 3-128, Maryland Ins. Code Annotated)\n11.     MICHIGAN (Sec. 500.5208(1), Michigan Compiled Laws )\n12.     MISSISSIPPI (Sec. 83-19-69, Mississippi Code Annotated)\n13.     MONTANA (Sec. 33-3-502, Montana Code Annotated)\n14.     NEBRASKA (Sec. 44-2501, Nebraska Revised Statutes Annotated)\n15.     NEW HAMPSHIRE (Sec. 402:54, New Hampshire Revised Statutes Annotated)\n16.     NEW MEXICO (Sec. 59A-34-33, New Mexico Statutes Annotated)\n17.     NORTH CAROLINA (Sec. 58-14-5, North Carolina General Statutes)\n18.     NORTH DAKOTA (Sec. 26.1-05-34, North Dakota Ins. Code)\n19.     OHIO (Sec. 3905.44, Ohio Revised Code Annotated)\n20.     OREGON (Title 56, Sec. 731.454, Oregon Revised Statutes)\n21.     PUERTO RICO (Title 26, Sec. 2932(3), Laws of Puerto Rico Annotated)\n22.     SOUTH DAKOTA (Sec. 58-5-100, South Dakota Codified Laws)\n23.     UTAH (Sec. 31A-5-602, Utah Code Annotated)\n24.     VIRGIN ISLANDS (Title 22, Sec. 314, Virgin Islands Code)\n25.     VIRGINIA (Sec. 38.2-3102, Virginia Code Annotated [Life & Annuities Only])\n26.     WASHINGTON (Sec. 48.07.150, Revised Code of Washington)\n27.     WEST VIRGINIA (Sec. 33-4-19, West Virginia Code)\n28.     WYOMING (Sec. 26-24-140, Wyoming Statutes)\n\nPlease take further notice that this Department has notified the respective Insurance Commissioners,\nDirectors or Superintendents of the above-named States and Territories that their jurisdictions constitute\n\"reciprocal States\" under the provisions of said Section, and has requested such Commissioners, Directors\nor Superintendents to notify this Department of any and all violations by any of our domestic insurers\nwith respect to the above-captioned matter occurring in their respective jurisdictions.\n\n                                                                   DAVE JONES\n                                                               Insurance Commissioner\n                                     California Insurance Code\n                                          Section 706.7\n\n   As used in this Section, the term “reciprocal State” means a State the laws of which prohibit\nan insurer domiciled therein from insuring the lives or persons of residents of, or property or\noperations located in, the State of California unless it then holds a valid and subsisting certificate\nof authority issued by the Insurance Commissioner of this State. Such prohibition may be subject\nto the exceptions herein set forth.\n\n  Subject to the exceptions herein set forth, a domestic insurer shall not enter into a contract of\ninsurance upon the life or person of a resident of, or property or operations located in, a\nreciprocal State unless it is authorized pursuant to the laws of that State to transact such\ninsurance therein. The Commissioner shall, every four years, mail notice to every domestic\ninsurer, specifying the reciprocal States.\n\nThe exceptions to the provisions of this section are the following:\n\n(a) Contracts entered into where the prospective insurant is personally present in the State\nin which the insurer is authorized to transact insurance when he signs the application.\n\n(b) The issuance of certificates under a lawfully transacted group life or group disability\npolicy, where the master policy was entered into in a State in which the insurer was  then\nauthorized to transact insurance.\n\n(c)    The renewal or continuance in force, with or without modification, of contracts\notherwise lawful and which were not originally executed in violation of this section.","text_length":4644}
{"slug":"ca-bulletin-2014-1","jurisdiction":"CA","agency":"CDI","doc_type":"bulletin","citation":"CDI Bulletin 2014-1","title":"Bulletin 2014-1: Export List","official_source_url":"https://www.insurance.ca.gov/0250-insurers/0300-insurers/0200-bulletins/bulletin-notices-commiss-opinion/upload/Bulletin-2014-1.pdf","access_class":"statutory-public","access_notes":"insurance.ca.gov disclaimer: content considered public domain; gate-zero CA-a","first_seen_at":"2026-07-19T16:30:04.785561+00:00","last_checked_at":"2026-07-20T06:27:54.834034+00:00","versions":[{"fetched_at":"2026-07-19T16:30:04.785561+00:00","version_no":1,"text_length":5457,"effective_date":null,"content_sha256_short":"adf5571e6122"}],"text":"STATE OF CALIFORNIA\n                            DEPARTMENT OF INSURANCE\n                                45 FREMONT STREET\n                             SAN FRANCISCO, CA 94105\n\n                                                                  Bulletin No. 2014- 1\n                                                                  January 8, 2014\n\nTO:     All Surplus Line Brokers, Admitted Insurers, and Other Interested Persons\n\nSUBJECT: Export List\n\nPursuant to Insurance Code Section 1763.1, the Commissioner may by order declare\neligible for placement with a nonadmitted insurer and exempt from all the requirements\nof Section 1763, except the filing of a confidential written report, any type of insurance\ncoverage or risk for which he finds after a public hearing that there is not a reasonable\nor adequate market among admitted,insurers.\n\nThis year the Department held a public hearing and comment period regarding the\nannual renewal of the list as required by the statute. No changes were made to the\nExport List.\n\nThe Department reminds you that risks and coverages not appearing on this list may\nstill be exportable but subject to the full documentation of the diligent search being\nperformed with respect to insurance issued to a home state insured as required by\nInsurance Code Section 1763.\n\nA public hearing will be held annually or more often at the Commissioner's discretion\nregarding the attached export list. The Commissioner or his designee shall noJify all\nsurplus line brokers of any removal from the list. The contact person is\nCarol Frair, Senior Staff Counsel, Department of Insurance, 45 Fremont Street, San\nFrancisco, CA 94105, (415) 538-4408.\n\n                                 DAVE JONES\n                                 Insurance Commissioner\n\n                              By,/-!,-:.:......=.l£_-=~----+-_,,,~--\n                                 Nettie Hoge\n\n#824191v1\nEXPORT LIST 2014\n\nACCIDENT/DISABILITY\n\n  BRIDGE PLAN .!\n\n  HIGH LIMITS DISABILITY ~\n\n  INTERNATIONAL MAJOR MEDICAL\n\nAUTOMOBILES\n\n  EXOTIC/CLASSIC/ANTIQUE AUTOS WITH A VALUE IN EXCESS OF $100,000\n\nAVIATION\n\n  AVIATION EXCESS LIABILITY\n  SHORT TERM MEDIA/ENTERTAINMENT NON-OWNED CONTINGENT AIRCRAFT\n  LIABILITY (FILM/ENTERTAINMENT PRODUCTIONS)\n\nCRIME\n\n  EXCESS CRIME\n\n  KIDNAP & RANSOM\n\nFIRE & ALLIED LINES\n\n  AMUSEMENT PARKS/CARNIVALS AND AMUSEMENT DEVICES\n  COMMERCIAL DIC/STAND ALONE EARTHQUAKE\n\n  DISASTER INCOME PROTECTION\n\n  EXCESS FLOOD\n  EXPLOSIVE MANUFACTURING/SALES/STORAGE\n  HAY IN THE OPEN\n  HOMEOWNERS EARTHQUAKE/EXCESS LIMITS OR DEDUCTIBLE BUYBACK\n\n  INDIVIDUAL INSUREDS WITH LARGE SCHEDULES WHERE THE TIV(TOTAL\n  INSURED VALUES)AR E IN EXCESS OF $500 MILLION\n\n  SAWMILLS\n\n  VACANT BUILDINGS\n\nGENERAL LIABILITY\n\n  AMBULANCE SERVICES INCLUDING PROFESSIONAL LIABILITY\n\n  AMUSEMENT PARKS/CARNIVALS/DEVICES\n\n   BLASTING CONTRACTORS\n\n#824192v1\n    BUILDING MOVING\n\n  . CLINICAL AND SIMILAR TESTS OF PHARMACEUTICAL, MEDICAL, BIOLOGICAL &.\n    OTHER SIMI LAR PRODUCTS\n\n   CONTRACTORS ENGAGED IN CONSTRUCTION OF NEW TRACT HOMES AND/OR\n   NEW CONDOMINIUMS\n\n   CRANE& RIGGING CONTRACTORS\n\n   DEMOLITION CONTRACTORS\n\n   EMPLOYMENT PRACTICES LIABILITY\n\n   ENVIRONMENTAL IMPAIRMENT REMEDIATION AND POLLUTION LIABILITY\n\n   EXCESS LIABILITYWHERE PART OF UNDERLYING IS NONADMITTED\n\n   EXPLOSIVES INCLUDING MANUFACTURING/SALES/STORAGE\n\n   FIREWORKS DISPLAYS\n\n   FOSTER FAMILY (OCCURRENCE BASED ONLY)\n\n   HOT AIR BALLOON\n\n   LIMITS THAT ATTACH IN EXCESS OF $150 MILLION\n\n   OILFIELD CONTRACTORS\n\n   OUTFITTERS AND GUIDES\n\n   PATENT/TRADEMARK/COPYRIGHT INFRINGEMENT\n\n   PRODUCTS RECALL\n\n   PRODUCTS/COMPLETED OPERATIONS(WRITTEN ON A STAND ALONE BASIS)\n\n   SEASONAL OR MOBILE FAIRS, CONCESSIONAIRES, VENDORS AND FAIRS, WITH\n   OR WITHOUT LIQUOR LIABILITY\n\n   SECURITY GUARD SERVICES\n\n   SHORT TERM MEDIA/ENTERTAINMENT RAILROAD PROTECTIVE LIABILITY\n   (FILM/ENTERTAINMENT PRODUCTIONS)\n\n   SHORT TERM SPECIAL EVENTS (EXCLUDING HOLE-IN-ONE)\n\n  TATTOO AND BODY PIERCING SHOPS\n\nINLAND MARINE\n\n  ALL VESSELS IN EXCESS OF 30 FEET AND RATED WITH A MAXIMUM SPEED OF\n  45 MPH\n\n  ANY VESSEL/WITH A MAXIMUM RATED SPEED IN EXCESS OF 55 MPH\n\n  EXCESS MOTOR TRUCK CARGO\n\n  PERSONAL ARTICLES FLOATERS WRITTEN ON A STAND ALONE BASIS WHERE\n  THE VALUE OF THE SCHEDULE IS IN EXCESS OF $1M OR CONTAINS A SINGLE\n  ITEM(S) OVER $100,000\n\n#824192vl\n     MISCELLANEOUS\n\n       EVENT CANCELLATION\n\n       POLITICAL RISKS INCLUDING EXPROPRIATION, CONFISCATION, UNFAIR\n       CALLING\n\n       PRIZE INDEMNIFICATION (EXCLUDING HOLE-IN-ONE COVERAGE)\n\n       SHORT TERM MEDIA/ENTERTAINMENT FAILURE TO SURVIVE FOR $5 MILLION\n       AND OVER (FILM/ENTERTAINMENT PRODUCTIONS)\n\n     PROFESSIONAL LIABILITY /ERRORS & OMISSION\n\n       ARCHITECTS & ENGINEERS/CONDO COVERAGE ONLY\n\n       CAMPAIGN TREASURERS\n\n       CREDITORS' COMMITTEES\n\n       PHYSICIAN/MEDICAL GROUP/HOSPITAL BILLING E/O\n\n       TATTOO & BODY PIERCING SHOPS E/O\n\n* The Bridge Plan covers 65 year old people who must wait a certain period before they can enroll\nin Medicare. These people either 1) failed to meet the residency requirement of Medicare and\nmust wait 5 years to meet the residency requirement or 2) failed to enroll during the proper\nMedicare enrollment period and now must wait a brief period before they are eligible to enroll.\n**High Limits Disability is coverage that offers benefit amounts over the admitted market\nmaximum issue and participation limits and/or includes occupations which are not eligible.\n\n    #824192v1","text_length":5457}
{"slug":"ca-bulletin-2011-2","jurisdiction":"CA","agency":"CDI","doc_type":"bulletin","citation":"CDI Bulletin 2011-2","title":"Bulletin 2011-2: Implementation of Reinsurance Provisions of the Federal Nonadmitted and Reinsurance Reform Act","official_source_url":"https://www.insurance.ca.gov/0250-insurers/0300-insurers/0200-bulletins/bulletin-notices-commiss-opinion/upload/Bulletin-2011-2.pdf","access_class":"statutory-public","access_notes":"insurance.ca.gov disclaimer: content considered public domain; gate-zero CA-a","first_seen_at":"2026-07-19T16:30:04.785561+00:00","last_checked_at":"2026-07-20T06:27:54.834034+00:00","versions":[{"fetched_at":"2026-07-19T16:30:04.785561+00:00","version_no":1,"text_length":12579,"effective_date":null,"content_sha256_short":"bf5e2d7dd619"}],"text":"STATE OF CALIFORNIA\n                              DEPARTMENT OF INSURANCE\n                                     45 Fremont Street\n                               San Francisco, California 94105\n\n                                                                         BULLETIN NO. 2011-2\n                                                                               April 11, 2011\n\nTO:            All Admitted Insurers and Other Interested Persons\n\nSUBJECT:       IMPLEMENTATION OF REINSURANCE PROVISIONS OF THE\n               FEDERAL NONADMITTED AND REINSURANCE REFORM ACT\n\nThe purpose of this Bulletin is to inform admitted insurers and other interested persons of the\ninitial response by the California Department of Insurance (\"Department\") to the enactment of\nprovisions of the Dodd-Frank Wall Street Reform and Consumer Protection Act (the \"Dodd-\nFrank Act\") relating to reinsurance transactions, in order to provide legal clarity on these matters\nfor the California insurance market.\n\nIntroduction\n\nPresident Barack Obama signed the Dodd-Frank Act on July 21, 2010. Title V of the Dodd-\nFrank Act includes, as a separate subtitle, the Nonadmitted and Reinsurance Reform Act\n(\"NRRA\"). Under its terms, the reinsurance provisions of the NRRA, § 531 et seq, will become\neffective on July 21, 2011.\n\nThe NRRA requires that changes be made to the prevailing state-based system governing the\nregulation of reinsurance. Under the NRRA no state may deny financial statement credit for\nreinsurance, if the credit is recognized by the ceding insurer's state of domicile. It also provides\nthat the laws of nondomestic states, except those with respect to taxes and assessments on\ninsurance companies, are preempted to the extent they apply to reinsurance agreements. The\nNRRA further provides that for a defined category of insurers principally engaged in the\nbusiness of reinsurance (hereafter \"Professional Reinsurers\"), the state of domicile shall be solely\nresponsible for regulating solvency. Finally, non-domestic states are specifically prohibited from\nrequiring Professional Reinsurers to provide financial information other than the financial\ninformation required by their domiciliary states.\n\nThe NRRA limits its reinsurance preemption provisions to states that are accredited by the\nNational Association of Insurance Commissioners (\"NAIC\") or that meet requirements that are\n\"substantially similar\" to the NAIC’s financial solvency requirements. Currently all states meet\nthis threshold requirement.\nThe Department intends to pursue any necessary legislation and regulations reconciling\nCalifornia law to the reinsurance provisions of the NRRA in a deliberate and thorough manner,\nwith due consideration to developments at the NAIC and in sister states.\n\nCalifornia Law\n\nThe Department has undertaken a review of the California Insurance Code (\"CIC\") and Title 10\n§ 2303 of the California Code of Regulations (\"CCR\") to identify key provisions that regulate\nadmitted non-domestic insurers' reinsurance transactions or statutory financial statement credit\nfor ceded reinsurance. The Department acknowledges that this review may not be exhaustive.\nWith respect to any statutes or regulations not specifically addressed below, the Department\ninvites insurers to address any assertions of NRRA preemption to the Department, in writing, for\nindividual analysis.\n\nKey Provisions\n\nCommencing July 1, 2011, the effective date of this Bulletin, the Department intends to exercise\nits regulatory discretion in the following manner:\n\n1.     CIC § 717(d) and CIC § 700(c)\n\nSections 717 and 700(c) reference license requirements for domestic and foreign insurers that\noperate in California on an admitted basis. Section 717(d) requires the Department to consider\nan insurer’s reinsurance arrangements in deciding whether to grant or continue a certificate of\nauthority to transact insurance in California. Section 700(c), and its implementing regulation, 10\nCCR § 2303.15(q), require an admitted insurer to continue to meet the requirements of CIC §\n717. In considering reinsurance arrangements under these code Sections, the Department will\nnot deny financial statement credit for reinsurance that has been recognized by a ceding insurer’s\ndomestic state regulator.\n\n2.     CIC § 922.6\n\nSubdivision (b) of this statute, and the implementing regulation found at 10 CCR § 2303.10,\nprovide the Department discretion to disallow financial statement credit claimed by a non-\ndomestic insurer. The Department will not exercise that discretion for reinsurance that has been\nrecognized by a ceding insurer’s domestic state regulator. Therefore, the statutory statement\ncredit oversight authority contained in 10 CCR §§ 2303.3, 2303.11, 2303.12, 2303.13 and\n2303.19 will be exercised only as regards domestic insurers, pursuant to the Department's\nreserved discretion in 10 CCR § 2303.1.\n\n3.     CIC § 1011\n\nSubdivision (c) of this statute gives the Department discretion to conserve any insurer which has\nentered into certain reinsurance transactions without obtaining the Department’s prior consent.\nThe subject reinsurance transactions are defined and the requirements set forth in 10 CCR §\n2303.15 (c) through (f).) The Department will not exercise its discretion to conserve a non-\n\n                                                2\ndomestic insurer for failure to obtain prior consent to such reinsurance transactions; and,\npursuant to its retained discretion in 10 CCR § 2303.1, the Department will not apply the related\nregulations, 10 CCR § 2303.15 (c) through (f), to non-domestic insurers.\n\nHowever, non-domestic insurers remain subject to the CIC § 1011(c) provisions regarding prior\nconsent to mergers, consolidations and sale transactions. And, all provisions of CIC § 1011(c)\nand 10 CCR § 2303.15 remain applicable to domestic insurers.\n\n4.     CIC § 1215.5(b)(3)\n\nUnder CIC § 1215.13, non-domestic insurers meeting the definition of \"commercially domiciled\ninsurer\" are generally made subject to compliance with the California Insurance Holding\nCompany System Regulatory Act (\"HCA\") as if they were California domestic insurers. Section\n1215.5(b)(3) of the HCA in effect requires prior consent to reinsurance agreements or\nmodifications thereto among affiliated insurers in excess of specified thresholds.\n\nSubdivision (b) of CIC § 1215.13 gives discretion to the California Insurance Commissioner\n(“Commissioner”) to exempt commercially domiciled insurers from some or all of these\nrequirements under \"circumstances that he or she deems appropriate.\" The Commissioner\nintends to exercise that discretion and, commencing July 1, 2011, will deem commercially\ndomiciled insurers to be exempt from compliance with CIC § 1215.5(b)(3).\n\n5.     10 CCR §§ 2303.11 and 2303.12\n\nThese Sections implement CIC § 922.3 and set forth risk transfer requirements to permit\nstatement credit for reinsurance. As explained in Paragraphs 1 and 2 above, the Department will\nnot deny financial statement credit for reinsurance that has been recognized by an insurer’s\ndomestic state regulator, and therefore these Sections will apply only to domestic insurers.\n\n6.     10 CCR § 2303.14\n\nThis Section implements CIC § 717(d) and sets forth requirements for contract provisions in\nreinsurance agreements for which statement credit is claimed, and, where an agreement is\nnonconforming, gives the Commissioner discretion under specified circumstances to find that the\ninsurer’s reinsurance arrangements are materially deficient for purposes of CIC § 717 and 700(c).\nThe Commissioner will not exercise his discretion to make such a finding concerning the\nreinsurance agreements of a non-domestic insurer.\n\n7.     10 CCR § 2303.15\n\nSubdivision (b) of this Section implements CIC § 717(d) and gives the Commissioner discretion\nto find an insurer’s reinsurance arrangements materially deficient if the insurer does not retain at\nleast 10% of direct premium written per line of business ceded to a non-affiliate. The\nCommissioner will not exercise his discretion to make such a finding concerning a non-domestic\ninsurer.\n\n                                                 3\nSubdivisions (e) and (f) of this Section implement CIC § 1011(c) and set forth requirements for\ncessions of 75% or more of direct premium written. For the reasons explained in Paragraph 3 of\nthis Bulletin, Subdivisions (e) and (f) will be applied only to domestic insurers.\n\nSubdivision (f) of this Section (to be applied only to domestic insurers) implements CIC §\n1011(c) and conditions the Commissioner’s consent for a 100% cession of direct premium\nwritten on prospective business to an inter-company pool upon the retrocession of an amount not\nless than 10% of the direct written premium. Pursuant to the Department’s reserved discretion in\n10 CCR § 2303.1, the Commissioner will not deny consent for a cession to an admitted affiliate\nsolely on the basis that the agreement does not include a retrocession to or retention by the\nceding insurer. As a result, 100% cessions to admitted affiliates will generally be permitted.\n\nSubdivision (g) of this Section implements CIC § 730, which gives the Commissioner discretion\nto require an examination of any scope or nature. Subdivision (g) is an expression of that\ndiscretion and requires certain licensees to submit for prior review certain reinsurance\ntransactions which comprise 50% or more of the licensee’s premium or liabilities. Pursuant to\nthe Department's reserved discretion in 10 CCR § 2303.1, examination filings under Subdivision\n(g) will no longer be required for any insurer.\n\nSubdivision (i) of this Section implements CIC § 717(d) and gives the Commissioner discretion,\nfor agreements filed pursuant to Subdivisions (e) and (g), to require contract provisions as\nnecessary to protect the ceding insurer when specific collateral is not provided for the cession.\nAs explained in Paragraph 3 of this Bulletin, Subdivision (e) will apply only to domestics; and as\nexplained in this Paragraph 7, the Department will no longer require filings under Subdivision\n(g). Therefore, Subdivision (i) will apply only to domestic insurers.\n\nSubdivision (j) of this Section implements CIC § 1011(c) and states conditions for the\nCommissioner’s consent to agreements filed under Subdivisions (e) and (g), where payments are\nto be made through a reinsurance intermediary. As explained in Paragraph 3 of this Bulletin,\nSubdivision (e) will apply only to domestics; and as explained in this Paragraph 7, the\nDepartment will no longer require filings under Subdivision (g). Therefore, Subdivision (j) will\napply only to domestic insurers.\n\n8.     10 CCR § 2303.19\n\nThis Section states the procedures applicable to a denial of statement credit. As explained in\nParagraphs 1 and 2 of this Bulletin, the Department will not deny financial statement credit for\nreinsurance that has been recognized by an insurer’s domestic state regulator.\n\n9.     10 CCR § 2303\n\nThe California Reinsurance Oversight Regulations include many provisions which are not\nexpressly applicable to financial statement credit or reinsurance agreements. Unless a provision\nis modified by this Bulletin, the provision remains in effect as to all licensees.\n\n                                                4\nBulletin Effective Date\n\nThis Bulletin shall be effective July 1, 2011. Reinsurance transactions executed prior to July 1,\n2011 are subject to all CIC and CCR standards and prior approval requirements. Statement\ncredit for ceded reinsurance taken on a financial statement with an “as of” date on or before June\n30, 2011 is subject to existing California law.\n\nThis Bulletin shall not preclude the acceptance and review of applications voluntarily submitted\nby admitted, nondomestic insurers. Nothing in this Bulletin restricts the Department’s statutory\ndiscretion to consider specific circumstances that may be presented.\n\nQuestions regarding this Bulletin may be directed to:\n\n                              Arlene Joyce\n                              Senior Staff Counsel\n                              California Department of Insurance\n                              45 Fremont Street, 24th Floor\n                              San Francisco, California 94105\n                              (415) 538-4424\n                              JoyceA@insurance.ca.gov\n\n                                             DAVE JONES\n                                             Insurance Commissioner\n\n                                                 ADAM M. COLE\n                                                 General Counsel","text_length":12579}
{"slug":"ca-bulletin-2012-1","jurisdiction":"CA","agency":"CDI","doc_type":"bulletin","citation":"CDI Bulletin 2012-1","title":"Bulletin 2012-1: Export List","official_source_url":"https://www.insurance.ca.gov/0250-insurers/0300-insurers/0200-bulletins/bulletin-notices-commiss-opinion/upload/Bulletin2012-1.pdf","access_class":"statutory-public","access_notes":"insurance.ca.gov disclaimer: content considered public domain; gate-zero CA-a","first_seen_at":"2026-07-19T16:30:04.785561+00:00","last_checked_at":"2026-07-20T06:27:54.834034+00:00","versions":[{"fetched_at":"2026-07-19T16:30:04.785561+00:00","version_no":1,"text_length":5676,"effective_date":null,"content_sha256_short":"3d356249c528"}],"text":"STATE OF CALIFORNIA\n                            DEPARTMENT OF INSURANCE\n                                45 FREMONT STREET\n                             SAN FRANCISCO, CA 94105\n\n                                                                 Bulletin No. 2012-1\n                                                                 January 23, 2012\n\nTO:    All Surplus Line Brokers, Admitted Insurers, and Other Interested Persons\n\nSUBJECT: Export List.\n\nPursuant to Insurance Code Section 1763.1, the Commissioner may by order declare\neligible for placement with a nonadmitted insurer and exempt from all the requirements\nof Section 1763, except the filing of a confidential written report, any type of insurance\ncoverage or risk for which he finds after a public hearing that there is not a reasonable\nor adequate market among admitted insurers.\n\nThis year the Department held a public hearing and comment period regarding the\nannual renewal of the list as required by the statute. There were no new items added\nto the list.\n\nThe Department reminds you that risks and coverages not appearing on this list may\nstill be exportable but subject to the full documentation of the diligent search being\nperformed with respect to insurance issued to a home state insured as required by\nInsurance Code Section 1763.\n\nA public hearing will be held annually or more often at the Commissioner's discretion\nregarding the attached export list. The Commissioner or his designee shall notify all\nsurplus line brokers of any removal from the list. The contact person is\nCarol Frair, Senior Staff Counsel, Department of Insurance, 45 Fremont Street, San\nFrancisco, CA 94105, (415) 538-4408.\n\n                                 DAVE JONES\n                                 Insurance Commissioner\n\n                              By~~\n                              Nettie Hoge, Chief of Staff\n         EXPORT LIST 2012\n\nAutomobile\nExotic/Classic/Antique Autos With a Value in Excess of\n $100,000\n\nAviation\nAviation Excess Liability\nShort Term Media/Entertainment Non-Owned Contingent Aircraft Liability\n       (Film/Entertainment Productions)\n\nCrime\nExcess Crime\nKidnap,& Ransom\n\nDisability\nBridge Plan*\nHigh Limits Disability**\nInternational Major Medical\n\nEvent Coverage\nEvent Cancellation\n\nFire & Allied Lines\nAmusement Parks/Carnivals and Amusement Devices\nCommercial DIC/Stand Alone Earthquake\nDisaster Income Protection\nExcess Flood\nExplosive Manufacturing/Sales/Storage\nHay in the Open\nHomeowners Earthquake-Excess Limits or Deductible Buyback\nIndividual Insureds With Large Schedules Where the TIV(Total\n  Insured Values)Are in Excess Of $500 million\nSawmills\nVacant Buildings\n\nGeneral Liability\nAmbulance Service Including Professional Liability\nAmusement Parks/Carnivals/Devices\nBlasting Contractors\nBuilding Moving\nContractors Engaged In Construction of New Tract Homes\n And/Or New Condominiums\nClinical and Similqr Tests of Pharmaceutical, Medical, Biological and Other\n Similar Products\n        Crane and Rigging Contractors\n        Demolition Contractors\n        Employment Practices Liability\n        Environmental Impairment Remediation and Pollution Liability\n        Excess Liability Where Part of Underlying Is Nonadmitted\n        Explosives Including Manufacturing/Sales/Storage\n        Fireworks Displays\n        Foster Family(occurrence based only)\n        Hot Air Balloon\n        Limits That Attach In Excess of $150 Million\n        Oilfield Contractors\n        Outfitters & Guides\n        Patent/Trademark/Copyright Infringement\n        Products/Completed Operations (written on a stand alone basis)\n        Products Recall\n        Security Guard Services\n        Seasonal or Mobile, Concessionaires, Vendors and Fairs, with or without\n         Liquor Liability\n        Short Term Special Event(excluding hole-in-one-coverage)\n        Tattoo and Body Piercing Shops\n\n        Inland Marine\n        All vessels in excess of 30 feet and rated with a maximum speed\n          of 45 mph\n        Any vessel with a Maximum Rated Speed in Excess of 55 mph\n        Excess Motor Truck Cargo\n        Personal Articles Floaters Written On a Stand Alone Basis where the value of\n         the schedule is in excess in of $1,000,000 or contains a single item(s) over\n         $100,000\n\n        Political\n        Political Risks lnciuding Expropriation, Confiscation, Unfair Calling\n\n        Prize\n        Prize Indemnification (excluding hole-in-one-coverage)\n\n        Professional Liability\n        Architects & Engineers/Condo coverage only\n        Campaign Treasl!.rers\n        Creditors' Committees\n        Tattoo and Body Piercing Shops\n\n        Railroad\n        Short Term Media/Entertainment Railroad Protective Liability (Film/Entertainment\n           Productions)\n\n#716160v1\n        Miscellaneous\n        Short Term Media/Entertainment Failure to Survive Coverage for $5 million and\n           over (Film/Entertainment Productions)\n\n        The items in bold:are headings only and not export items in and of themselves.\n\n        *The Bridge Plan ·covers- 65 year old people who must wait a certain period\n        before they can enroll in Medicare. These people either 1) failed to meet the\n        residency requirement of Medicare and must wait 5 years to meet the res·idency\n        requirement or 2) failed to enroll during the proper Medicare enrollment period\n        and now must wait a brief period before they are eligible to enroll.\n\n        **High Limits Disability is coverage that offers benefit amounts over the admitted\n        market maximum issue and participation limits and/or includes occupations\n        which are not eligible through the admitted markets.\n\n#716160v1","text_length":5676}
{"slug":"fl-oir-23-05m","jurisdiction":"FL","agency":"FLOIR","doc_type":"bulletin","citation":"OIR-23-05M","title":"OIR-23-05M","official_source_url":"https://floir.gov/docs-sf/default-source/informational-memoranda/oir-23-05m_final.pdf","access_class":"statutory-public","access_notes":"floir.gov self-hosted-gov; gate-zero FL-a","first_seen_at":"2026-07-19T16:15:49.214513+00:00","last_checked_at":"2026-07-20T06:19:37.597463+00:00","versions":[{"fetched_at":"2026-07-19T16:15:49.214513+00:00","version_no":1,"text_length":6940,"effective_date":null,"content_sha256_short":"95cbed140ab1"}],"text":"INFORMATIONAL MEMORANDUM\n                                                  OIR-23-05M\n                                                    ISSUED\n                                                  August 28, 2023\n                                               Florida Office of Insurance Regulation\n                                                Michael Yaworsky, Commissioner\n\n         NOTIFICATION TO ALL AUTHORIZED RESIDENTIAL PROPERTY INSURERS\n\n                    ~ Guidance for Tropical Storm Idalia Preparedness and Response ~\n\nAs Tropical Storm Idalia approaches the State of Florida, the Florida Office of Insurance Regulation\n(OIR) is issuing this Informational Memorandum to all authorized residential property insurers to\nprovide guidance on hurricane preparedness and response. Insurers are directed to review all aspects of\ntheir disaster preparedness and response plans to ensure they are in compliance with Florida law.\n\nAdditionally, OIR expects insurers to be prepared to implement their claims-handling manuals which\nmeet the requirements of the Florida Insurance Code and meet minimum, usual and customary industry\nclaims-handling practices. Insurers were required to attest that it maintains adequate resources available\nto implement the requirements of its claims-handling manuals at all times, including during natural\ndisasters and catastrophic events. More information regarding claims-handling manual attestations can\nbe found here.\n\nAdditional information regarding consumer protection legislation signed by Governor DeSantis to\nsupport Florida policyholders when disaster strikes is available here.\n\nInsurance Commissioner Michael Yaworsky and OIR continue to monitor Tropical Storm Idalia’s\nprojected path and will issue updates to authorized insurers as more information becomes available.\n\n                                            Claims Handling\n\nInsurers are directed to consider all aspects of claims handling within their hurricane preparedness plans\nto ensure continuous operation, offer sufficient claims adjustment staff, and provide effective consumer\nservice resources for policyholders. Section 627.70131(1)(d), F.S., authorizes insurers to use electronic\nmethods to investigate the loss that is reported in a claim. Insurers are encouraged to use all available\nresources to effectively facilitate the claims process for consumers. Methods that may be used include,\nbut are not limited to:\n\n   •   Electronic photographs;\n   •   Video recordings of the loss;\n\n                                               Page 1 of 3\n   •   Video conferencing between the adjuster and the policyholder which includes video recording of\n       the loss; and\n   •   Video recordings or photographs of the loss using a drone, driverless vehicle, or other machine\n       that can move independently or through remote control.\n\nAn insurer may allow the policyholder to use such electronic methods to assist in the investigation of the\nclaim. An insurer may assign a licensed adjuster to physically inspect the property even if electronic\nmethods are used to investigate the loss.\n\nInsurers’ claim handling practices should not only comply with required provisions of Florida law, but\nalso do everything possible to respond to the needs of affected Floridians, restore a sense of normalcy,\nand facilitate restoration and recovery in impacted communities. Policyholders have the right to expect\nprompt, efficient, and fair claims adjustment service, especially after a catastrophic loss. Insurers are\nencouraged to be responsive to their policyholders and communicate with them throughout the claims\nprocess.\n\n                                          Maintaining Records\n\nInsurers should be prepared to maintain records related to a policyholder's claim in accordance with\napplicable Florida Laws. Section 627.70131(4)(b), F.S., requires insurers to maintain the following\nrecords, including:\n\n   •   Any claim-related communication made between the insurer and the policyholder or the\n       policyholder’s representative;\n   •   The insurer’s receipt of the policyholder’s proof-of-loss statement;\n   •   Any claim-related request for information made by the insurer to the policyholder or the\n       policyholder’s representative;\n   •   Any claim-related inspection of the property made by the insurer;\n   •   Any detailed estimate of the amount of the loss generated by the insurer’s adjuster;\n   •   The beginning and end of any tolling period; and\n   •   The insurer’s payment or denial of the claim.\n\n                                                  Fines\n\nOIR will use the fullest extent of its regulatory authority to ensure policyholders are protected. Section\n624.4211(1), F.S., provides that if OIR finds that one or more grounds exist for the discretionary\nrevocation or suspension of a certificate or authority issued under Chapter 624, OIR may, in lieu of such\nrevocation or suspension, impose a fine upon the insurer. Upon examination, a violation of the Florida\nInsurance Code could result in any of the following:\n\n   •   For nonwillful violations, OIR may issue fines up to $25,000 per violation, up to an\n       aggregate amount of $100,000 for all nonwillful violations arising out of the same action, related\n       to a covered loss or claim caused by an emergency for which the Governor declared a state of\n       emergency pursuant to s. 252.36, F.S.\n   •   For all other nonwillful violations arising out of the same action, OIR may issue fines up to\n       $12,500 per violation, up to an aggregate amount of $50,000.\n\n                                               Page 2 of 3\n   •   For knowing and willful violations of a lawful order or rule of the office or commission or a\n       provision of this code, OIR may impose a fine upon the insurer up to $200,000 for each such\n       violation, up to an aggregate amount of $1 million for violations arising out of the same action,\n       related to a covered loss or claim caused by an emergency for which the Governor declared a\n       state of emergency pursuant to s. 252.36, F.S.\n   •   For all other knowing and willful violations arising out of the same action, OIR may issue fines\n       up to $100,000 per violation, up to an aggregate amount of $500,000.\n\nOIR’s primary concern is that consumers’ issues are properly and timely resolved. Communication is a\ncritical part of the claims process, and consumers have the right to expect consistent and accurate\ninformation be provided to them as they navigate one of the toughest times in their lives - recovery from\na major catastrophic event. Insurers are directed to use every channel available to them to communicate\nwith their policyholders to share information and resources during the claims handling process.\n\nIf you have questions regarding this memorandum, please contact OIR\nat InformationalMemoranda@floir.com.\n\n                                               Page 3 of 3","text_length":6940}
{"slug":"fl-oir-16-07m","jurisdiction":"FL","agency":"FLOIR","doc_type":"bulletin","citation":"OIR-16-07M","title":"OIR-16-07M","official_source_url":"https://floir.gov/docs-sf/default-source/informational-memoranda/oir-16-07m.pdf","access_class":"statutory-public","access_notes":"floir.gov self-hosted-gov; gate-zero FL-a","first_seen_at":"2026-07-19T16:15:49.214513+00:00","last_checked_at":"2026-07-20T06:19:37.597463+00:00","versions":[{"fetched_at":"2026-07-19T16:15:49.214513+00:00","version_no":1,"text_length":2466,"effective_date":null,"content_sha256_short":"f9db66481db7"}],"text":"INFORMATIONAL MEMORANDUM\n                                         OIR-16-07M\n                                           ISSUED\n                                        October 3, 2016\n                                      Florida Office of Insurance Regulation\n                                         David Altmaier, Commissioner\n\n      To Residential Property Insurers in the State of Florida\n Deductible Applicable to Tropical Storm/Hurricane Hermine Claims\n\nThe purpose of this informational memorandum is to remind property insurers that\nTropical Storm/Hurricane Hermine was not declared a hurricane by the National\nHurricane Center of the National Weather Service until Thursday, September 1,\n2016, at 1:55 P.M. CDT.\n\nBefore Thursday, September 1, 2016, at 1:55 P.M. CDT, Tropical Storm/Hurricane\nHermine was classified as a Tropical Storm. Section 627.4025(2)(a), Florida\nStatutes, specifically defines “hurricane coverage” as coverage for loss or\ndamage caused by the peril of windstorm during a hurricane. Furthermore, (2)(b)\nprovides “Windstorm” for purposes of paragraph (a) means wind, wind gusts, hail,\nrain, tornadoes, or cyclones caused by or resulting from a hurricane which results\nin direct physical loss or damage to property and 2(c) defines “Hurricane” for the\npurposes of paragraphs (a) and (b) as a storm system that has been declared to be a\nhurricane by the National Hurricane Center of the National Weather Service.\n\nInsurers are hereby notified that the hurricane deductible shall not apply to\nproperty losses associated with a Hurricane Hermine damage claim that occurred\nprior to Thursday, September 1, 2016, at 1:55 P.M. CDT nor after Monday,\nSeptember 5, 2016, at 5:00 A.M. EDT, which is 72 hours following the last\nhurricane watch or warning issued for Hermine by the National Hurricane Center.\nFor these property losses, all insurers must apply the deductible that is unrelated\nto hurricane, generally referred to as the “all other perils deductible” or “other\nthan hurricane deductible.” An insurer that fails to apply the appropriate\ndeductible is subject to administrative action.\n\nTo view information regarding deductibles and other important insurance related\nmatters, please visit http://www.floir.com/.\n\nIf you have any questions regarding this memorandum, please contact Robert\nRidenour, Director of Property and Casualty Financial Oversight, Florida Office of\nInsurance Regulation at robert.ridenour@floir.com or 850-413-5227","text_length":2466}
{"slug":"fl-oir-16-06m","jurisdiction":"FL","agency":"FLOIR","doc_type":"bulletin","citation":"OIR-16-06M","title":"OIR-16-06M","official_source_url":"https://floir.gov/docs-sf/default-source/informational-memoranda/oir-16-06m.pdf","access_class":"statutory-public","access_notes":"floir.gov self-hosted-gov; gate-zero FL-a","first_seen_at":"2026-07-19T16:15:49.214513+00:00","last_checked_at":"2026-07-20T06:19:37.597463+00:00","versions":[{"fetched_at":"2026-07-19T16:15:49.214513+00:00","version_no":1,"text_length":3943,"effective_date":null,"content_sha256_short":"fec65a4812a3"}],"text":"INFORMATIONAL MEMORANDUM\n                                             OIR-16-06M\n                                                ISSUED\n                                           September 1, 2016\n                                          Florida Office of Insurance Regulation\n                                             David Altmaier, Commissioner\n\nTo All Health Maintenance Organizations (HMOs) participating in the Statewide Medicaid\nManaged Care Program Managed Medical Assistance Program (MMA)\n\nThe purpose of this memorandum is to provide HMOs with accounting guidance with regard to\nreceivables owed to a HMO participating in MMA.\n\nIn April 2016, the Agency for Health Care Administration (AHCA) informed certain insured plans\nthat it identified a mismatch between certain Medicaid aid categories and the rate cells to which\nthey were assigned. The mismatch led to AHCA paying Temporary Assistance for Needy Families\n(TANF) rates for certain persons—particularly MEDS-AD recipients over age 55—when it should\nhave paid Supplemental Security Income (SSI) rates. It began at the outset of the program in May\n2014, due to programming that occurred in 2013.\n\nAHCA indicated it is pursuing all necessary authorities to pay all monies owed to participants.\n\nAccounting Guidance:\n\nSSAP No. 84, Paragraph 23, discusses accounting treatment for amounts received under\ngovernment issued plans, including amounts over 90 days due. Paragraph 23 states in part as\nfollows:\n\n       Amounts receivable under government insured plans, including amounts over 90\n       days due, that qualify as accident and health contracts in accordance with SSAP No.\n       50 – Classifications of Insurance or Managed Care Contracts shall be admitted\n       assets. Amounts receivable under government insured plans include but are not\n       limited to receivables under Medicare, Medicaid and similarly funded government\n       insured plans. Evaluation of the collectability of amounts receivable under\n       government insured plans shall be made periodically. If in accordance with SSAP\n       No. 5R, it is probable the balance is uncollectible, any uncollectible receivable shall\n       be written off and charged to income in the period the determination is made. . . .\n\nSSAP Number 5R, Paragraph 6, Subparagraph a., defines probable as “[t]he future event or events\nare likely to occur.”\n\nBeginning with the June 30, 2016, quarterly financial statement and until such time as final\ndetermination is made by AHCA, SSAP No. 84, Paragraph 23, and the following accounting\ntreatment should be utilized to report the reimbursement payment on financial statements:\n      Receivable amounts shall be reported as an admitted asset on the Asset page, line 25-\n       Aggregate write-ins for other than invested assets. The description of “Medicaid\n       Underpayment” should be provided in the Details of Write-Ins section.\n      A disclosure shall be provided in Notes to Financial Statements, Note 28 – Health Care\n       Receivables. Companies shall provide a detailed explanation of the Medicaid\n       Underpayment as well as including the number of persons affected in its plan.\n\nIn order for amounts reported as “Medicaid Underpayment” to be considered an admitted asset,\nHMOs are required to provide supporting documentation to the Office of Insurance Regulation\nwith each financial statement filing that demonstrates amounts owed from AHCA.\n\nEvaluation of the collectability of amounts receivable related to the mismatch shall be made\nperiodically. If at any time in the future, the receivable amounts are found to be uncollectible in\naccordance with SSAP No. 5R, companies will be required to write off any uncollectible\nreceivable and charge to income in the period the determination is made.\n\nQuestions concerning this memorandum may be directed to:\n\nCarolyn Morgan\nDirector, Life & Health Financial Oversight\n850-413-5233\ncarolyn.morgan@floir.com","text_length":3943}
{"slug":"fl-oir-17-02m","jurisdiction":"FL","agency":"FLOIR","doc_type":"bulletin","citation":"OIR-17-02M","title":"OIR-17-02M","official_source_url":"https://floir.gov/docs-sf/default-source/informational-memoranda/oir-17-02m.pdf","access_class":"statutory-public","access_notes":"floir.gov self-hosted-gov; gate-zero FL-a","first_seen_at":"2026-07-19T16:15:49.214513+00:00","last_checked_at":"2026-07-20T06:19:37.597463+00:00","versions":[{"fetched_at":"2026-07-19T16:15:49.214513+00:00","version_no":1,"text_length":3253,"effective_date":null,"content_sha256_short":"a8170f1e15ff"}],"text":"INFORMATIONAL\n                                                         MEMORANDUM\n                                                           OIR-17-02M\n                                                              ISSUED\n                                                          October 19, 2017\n                                                 Florida Office of Insurance Regulation\n                                                    David Altmaier, Commissioner\n\n   TO ALL PROPERTY AND CASUALTY INSURERS AUTHORIZED TO DO\n                     BUSINESS IN FLORIDA\n\n                   2016 PROFIT AND CONTINGENCY FACTORS\n\nPursuant to Rule 69O-170.003, Florida Administrative Code, the Office of Insurance Regulation\nannually establishes underwriting profit and contingency factors that may be used in rate filings.\nInsurers may use the profit and contingency factors referenced below when they are unable to\nproduce credible profit and contingency factors from their own data.\n\n       LINE OF BUSINESS                                                           2016 FACTOR\n       ALLIED LINES                                                                  3.8%\n       BOILER & MACHINERY                                                            2.1%\n       BURGLARY & THEFT                                                              4.0%\n       COMMERCIAL AUTO LIABILITY                                                     0.6%\n       COMMERCIAL AUTO PHYSICAL DAMAGE                                               4.9%\n       COMMERCIAL MULTIPLE PERIL (BUSINESS OWNERS)                                   1.8%\n       CREDIT                                                                        3.9%\n       EARTHQUAKE                                                                    3.7%\n       FARMOWNERS                                                                    4.2%\n       FIDELITY                                                                      2.3%\n       FINANCIAL GUARANTY                                                            5.0%\n       FIRE                                                                          3.8%\n       HOMEOWNERS                                                                    4.2%\n       INLAND MARINE                                                                 3.8%\n       MEDICAL MALPRACTICE - CLAIMS MADE                                            -2.8%\n       MEDICAL MALPRACTICE - OCCURRENCE                                             -7.9%\n       MORTGAGE GUARANTY                                                             0.8%\n       OTHER LIABILITY - CLAIMS MADE                                                -3.3%\n       OTHER LIABILITY - OCCURRENCE                                                 -4.3%\n       PRODUCTS LIABILITY - CLAIMS MADE                                             -8.2%\n       PRODUCTS LIABILITY - OCCURRENCE                                              -6.3%\n       SURETY                                                                        3.3%\n\nIf you have questions regarding this memorandum, please contact Joe Boor, Actuary, Property and\nCasualty Product Review, Florida Office of Insurance Regulation at Joe.Boor@floir.com or (850)\n413-5330.","text_length":3253}
{"slug":"fl-oir-16-04m","jurisdiction":"FL","agency":"FLOIR","doc_type":"bulletin","citation":"OIR-16-04M","title":"OIR-16-04M","official_source_url":"https://floir.gov/docs-sf/default-source/informational-memoranda/oir-16-04m.pdf","access_class":"statutory-public","access_notes":"floir.gov self-hosted-gov; gate-zero FL-a","first_seen_at":"2026-07-19T16:15:49.214513+00:00","last_checked_at":"2026-07-20T06:19:37.597463+00:00","versions":[{"fetched_at":"2026-07-19T16:15:49.214513+00:00","version_no":1,"text_length":3356,"effective_date":null,"content_sha256_short":"2aaeac4b1ef9"}],"text":"INFORMATIONAL MEMORANDUM\n                                                   OIR-16-04M\n                                                      ISSUED\n                                                    June 7, 2016\n                                                 Florida Office of Insurance Regulation\n                                                    David Altmaier, Commissioner\n\n   TO ALL PROPERTY AND CASUALTY INSURERS AUTHORIZED TO DO\n                     BUSINESS IN FLORIDA\n\n                   2015 PROFIT AND CONTINGENCY FACTORS\n\nPursuant to Rule 69O-170.003, Florida Administrative Code, the Office of Insurance Regulation\nannually establishes underwriting profit and contingency factors that may be used in rate filings.\nInsurers may use the profit and contingency factors referenced below when they are unable to\nproduce credible profit and contingency factors from their own data.\n\n      LINE OF BUSINESS                                                           2015 FACTOR\n      ALLIED LINES                                                                         3.6%\n      BOILER & MACHINERY                                                                   1.9%\n      BURGLARY & THEFT                                                                     3.9%\n      COMMERCIAL AUTO LIABILITY                                                            0.0%\n      COMMERCIAL AUTO PHYSICAL DAMAGE                                                      4.8%\n      COMMERCIAL MULTIPLE PERIL (BUSINESS OWNERS)                                          1.2%\n      CREDIT                                                                               3.8%\n      EARTHQUAKE                                                                           3.5%\n      FARMOWNERS                                                                           4.0%\n      FIDELITY                                                                             1.9%\n      FINANCIAL GUARANTY                                                                   5.0%\n      FIRE                                                                                 3.6%\n      HOMEOWNERS                                                                           4.0%\n      INLAND MARINE                                                                        3.6%\n      MEDICAL MALPRACTICE - CLAIMS MADE                                                   -3.9%\n      MEDICAL MALPRACTICE - OCCURRENCE                                                   -11.0%\n      MORTGAGE GUARANTY                                                                    0.2%\n      OTHER LIABILITY - CLAIMS MADE                                                       -4.1%\n      OTHER LIABILITY - OCCURRENCE                                                        -5.8%\n      PRODUCTS LIABILITY - CLAIMS MADE                                                    -4.9%\n      PRODUCTS LIABILITY - OCCURRENCE                                                     -9.5%\n      SURETY                                                                               3.0%\n\nIf you have questions regarding this memorandum, please contact Joe Boor, Actuary, Property\nand Casualty Product Review, Florida Office of Insurance Regulation at Joe.Boor@floir.com or\n(850) 413-5330.\n\n                                          Page 1 of 1","text_length":3356}
{"slug":"fl-oir-16-03m","jurisdiction":"FL","agency":"FLOIR","doc_type":"bulletin","citation":"OIR-16-03M","title":"OIR-16-03M","official_source_url":"https://floir.gov/docs-sf/default-source/informational-memoranda/oir-16-03m.pdf","access_class":"statutory-public","access_notes":"floir.gov self-hosted-gov; gate-zero FL-a","first_seen_at":"2026-07-19T16:15:49.214513+00:00","last_checked_at":"2026-07-20T06:19:37.597463+00:00","versions":[{"fetched_at":"2026-07-19T16:15:49.214513+00:00","version_no":1,"text_length":3875,"effective_date":null,"content_sha256_short":"9bbd1a027a2c"}],"text":"INFORMATIONAL MEMORANDUM\n                                                 OIR-16-03M\n                                                   ISSUED\n                                                 May 24, 2016\n                                              Florida Office of Insurance Regulation\n                                                 David Altmaier, Commissioner\n\n   TO ALL WORKERS’ COMPENSATION INSURERS AUTHORIZED TO TRANSACT\n                       INSURANCE IN FLORIDA\n\nThe purpose of this memorandum is to address the use of unfiled side agreements in conjunction\nwith workers’ compensation and employer’s liability insurance policies applicable to risks and\nexposures in Florida.\n\nThe Office of Insurance Regulation (“Office”) has become aware that some insurance companies\nare entering into side agreements related to workers’ compensation and employer’s liability\ninsurance policies. These side agreements sometimes alter the rules, rates, rating plans, forms, or\nendorsements that were approved by the Office for use.\n\nThe Office would like to remind insurers of pertinent Florida Statutes and Florida Administrative\nCode Rules governing workers’ compensation and employer’s liability insurances. Specifically,\nSection 627.091(1), Florida Statutes, provides in part: “As to workers’ compensation and\nemployer’s liability insurances, every insurer shall file with the office every manual of\nclassifications, rules, and rates, every rating plan, and every modification of any of the foregoing\nwhich it proposes to use.” Section 627.410(1), Florida Statutes, provides:\n\n       A basic insurance policy or annuity contract form, or application form where written\n       application is required and is to be made a part of the policy or contract, group\n       certificates issued under a master contract delivered in this state, or printed rider or\n       endorsement form or form of renewal certificate, may not be delivered or issued for\n       delivery in this state unless the form has been filed with the office by or on behalf of the\n       insurer that proposes to use such form and has been approved by the office or filed\n       pursuant to s. 627.4102.\n\nRule 69O-189.016, Florida Administrative Code, implements Sections 627.091 and 627.410,\nFlorida Statutes, and requires in part that each insurer “file with the Office every manual of\nclassifications, rules, rates, rating plans, deviations and every modification of any of the\nforegoing, which it proposes to use.” Rule 69O-189.016(3), Florida Administrative Code, further\nrequires each insurer to “file with the Office all policy forms and endorsements as defined in\nSection 627.402, F.S., which it proposes to use.” The term “policy” is defined in Section\n627.402(3), Florida Statutes, to mean “a written contract of insurance or written agreement for or\neffecting insurance, or the certificate thereof, by whatever name called, and includes all clauses,\nriders, endorsements, and papers that are a part thereof.”\n\n                                            Page 1 of 2\nSection 627.191, Florida Statutes, prohibits insurers from making or issuing “a contract or policy\nof workers’ compensation or employer’s liability insurance except in accordance with the filings\nwhich are in effect for such insurer, as provided in the applicable provisions of this part, or in\naccordance with s. 627.171.” Section 626.9541(1)(h)1.a., Florida Statutes, further prohibits\ninsurers from knowingly “[p]ermitting, or offering to make, or making, any contract or\nagreement as to such contract other than as plainly expressed in the insurance contract issued\nthereon.”\n\nIf you have any questions regarding the contents of this memorandum, please contact Theresa\nRandall, Workers’ Compensation Administrator for the Office of Insurance Regulation, at 850-\n413-3821.\n\n                                           Page 2 of 2","text_length":3875}
{"slug":"fl-oir-16-02m","jurisdiction":"FL","agency":"FLOIR","doc_type":"bulletin","citation":"OIR-16-02M","title":"OIR-16-02M","official_source_url":"https://floir.gov/docs-sf/default-source/informational-memoranda/oir-16-02m.pdf","access_class":"statutory-public","access_notes":"floir.gov self-hosted-gov; gate-zero FL-a","first_seen_at":"2026-07-19T16:15:49.214513+00:00","last_checked_at":"2026-07-20T06:19:37.597463+00:00","versions":[{"fetched_at":"2026-07-19T16:15:49.214513+00:00","version_no":1,"text_length":2625,"effective_date":null,"content_sha256_short":"69a8eec29f14"}],"text":"INFORMATIONAL MEMORANDUM\n                                                                 OIR-16-02M\n                                                                   ISSUED\n                                                                 April 4, 2016\n                                                 Florida Office of Insurance Regulation\n                                                  Kevin M. McCarty, Commissioner\n\n              All Private Passenger Motor Vehicle Insurers in the State of Florida\n\n                     Electronic Submission of Report of Rescinded Policies\n\nThe Office of Insurance Regulation has implemented an electronic filing system to simplify\nreporting rescinded policies. Section 627.728, Florida Statutes, requires private passenger\nautomobile insurers to complete the underwriting of the policy and make a final determination of\nthe correct premium for coverage within sixty (60) days after the effectuation of coverage unless\nan incorrect premium was charged due to material misrepresentation or fraud on the part of the\ninsured in the application for insurance. Rule 69O-167.002, Florida Administrative Code,\nrequires insurers asserting a common law right of rescission or otherwise asserting rights to void\ninsurance policies ab initio, to report such action to the Office within ninety (90) days of taking\nsuch action.\n\nThe Office has developed an Excel spreadsheet as a template for reporting the same information\ncollected in paper form OIR-B3-493, “Report of Rescinded Policy,” rev. 7/90. Insurers may now\nreport rescissions of private passenger motor vehicle policies by utilizing the policy rescission\nfeature found in the Data Collection and Analysis Modules (DCAM) System in the Industry\nPortal on the Office’s website.\n\nEach company should have an existing logon account for DCAM, which should be accessed at\nhttps://apps8.fldfs.com/DCAM/logon.aspx. If an account for the Industry Portal does not exist,\nfollow directions on how to set up an account and create a filing at\nhttp://www.floir.com/siteDocuments/MCRP_DCAM_Account_Instructions.pdf. Detailed filing\ninstructions for entering rescinded policy data are available within the template and at the\nfollowing location: http://www.floir.com/siteDocuments/MCRP_Filing_Instructions.pdf.\n\nThis method for reporting rescinded policy information in the DCAM System is available\nimmediately.\n\nIf you have questions regarding the submission of the Report of Rescinded Policies via the\nDCAM System, please contact the Market Research and Technology Unit, Florida Office of\nInsurance Regulation at MCRP@floir.com or at (850) 413-3147.","text_length":2625}
{"slug":"fl-oir-16-01m","jurisdiction":"FL","agency":"FLOIR","doc_type":"bulletin","citation":"OIR-16-01M","title":"OIR-16-01M","official_source_url":"https://floir.gov/docs-sf/default-source/informational-memoranda/oir-16-01m.pdf","access_class":"statutory-public","access_notes":"floir.gov self-hosted-gov; gate-zero FL-a","first_seen_at":"2026-07-19T16:15:49.214513+00:00","last_checked_at":"2026-07-20T06:19:37.597463+00:00","versions":[{"fetched_at":"2026-07-19T16:15:49.214513+00:00","version_no":1,"text_length":2219,"effective_date":null,"content_sha256_short":"75fcfca895d8"}],"text":"INFORMATIONAL MEMORANDUM\n                                                                 OIR-16-01M\n                                                                   ISSUED\n                                                                  3/30/2016\n                                                 Florida Office of Insurance Regulation\n                                                  Kevin M. McCarty, Commissioner\n\n TO: All Health Maintenance Organizations (HMOs) and Insurers Authorized to Write Life &\n                          Health Insurance Products in Florida\n\n                           Quarterly Comprehensive Health Reporting\n\nThis is a notice that the Office of Insurance Regulation (Office) will be initiating a data call on\n04/01/2016 for the purpose of Quarterly Comprehensive Health (QCH) data reporting. This data\ncall is designed to replace the Quarterly Accident & Health Premium and Enrollment Reporting\n(commonly referred to as the SMG) which supplied information that was incorporated into the\nManaged Care Report. By including indemnity companies along with the HMOs, the Office will\nbe able to create a full report of the comprehensive major medical and Medicare Advantage\nmarkets in Florida. Also, a new template is included as part of this data call. The template is a\nreplica of the Annual Statement Analysis of Operations by Line of Business designed to collect\ndata on a quarterly basis.\n\nThe data is to be reported on a quarterly basis with the following deadlines:\n       First Quarter is due Monday, May 16, 2016\n       Second Quarter is due Monday, August 15, 2016\n       Third Quarter is due Tuesday, November 15, 2016\n       Fourth Quarter is due Wednesday, March 1, 2017\n\nEach company should have an existing login account for the Industry Portal. If an account does\nnot exist, visit https://apps8.fldfs.com/DCAM/logon.aspx for directions on how to set up an\naccount. Detailed instructions for completion of the template can be found at:\n\n              http://www.floir.com/siteDocuments/QCHReportingInstructions.pdf\n\nIf you have any questions regarding this request, please contact the Market Research and\nTechnology Unit at 850-413-3147 or via email at QCHReporting@floir.com.","text_length":2219}
{"slug":"fl-oir-16-05m","jurisdiction":"FL","agency":"FLOIR","doc_type":"bulletin","citation":"OIR-16-05M","title":"OIR-16-05M","official_source_url":"https://floir.gov/docs-sf/default-source/informational-memoranda/oir-16-05m.pdf","access_class":"statutory-public","access_notes":"floir.gov self-hosted-gov; gate-zero FL-a","first_seen_at":"2026-07-19T16:15:49.214513+00:00","last_checked_at":"2026-07-20T06:19:37.597463+00:00","versions":[{"fetched_at":"2026-07-19T16:15:49.214513+00:00","version_no":1,"text_length":2369,"effective_date":null,"content_sha256_short":"433547c1bf37"}],"text":"INFORMATIONAL MEMORANDUM\n                                                  OIR-16-05M\n                                                   ISSUED\n                                                 August 8, 2016\n                                               Florida Office of Insurance Regulation\n                                                  David Altmaier, Commissioner\n\n    TO ALL LIFE AND HEALTH INSURERS AUTHORIZED TO DO BUSINESS IN\n                              FLORIDA\n\n                      Implementation of Principle Based Reserving in Florida\n\nSection 625.1212, Florida Statutes, provides that changes to the valuation of policies and\ncontracts for life insurance, accident and health insurance and deposit-type contracts will be\neffective in Florida the later of January 1, 2017 or the January 1 immediately following the July\n1 that Florida’s Insurance Commissioner certifies to the Financial Service Commission that the\nstatutory conditions prescribed in Section 625.1212(2)(f) have been met. That certification was\nmade on June 14, 2016; therefore, the operative date of the Valuation Manual in Florida is\nJanuary 1, 2017.\n\nInsurers are advised to review the Valuation Manual and plan how best to implement its\nrequirements. To provide a smooth transition to a principle-based valuation approach, the\nValuation Manual permits a deferral of up to three years. If a company defers principle-based\nvaluation, it may use the current formulaic approach in the Valuation Manual for policies issued\nduring the deferral period.\n\nEach Florida domestic Life and Health Insurer subject to 625.1212, Florida Statutes, must notify\nthe Office by September 1, 2016, whether it will:\n\n   1. Request a Companywide Exemption for 2017 per Section 6.A of Chapter 20 of the\n      Valuation Manual (VM-20); or\n   2. Use Appendix A and C of the Valuation Manual and if so, provide the anticipated\n      mortality basis (i.e. company experience, 2017 CSO, etc.); or\n   3. Calculate reserves per the requirement of VM-20.\n\nNotifications should be directed to PBR@floir.com.\n\nIf you have any questions regarding the contents of this Memorandum, please contact Eric\nJohnson, PhD, ASA, Chief Actuary & Director, Life & Health Product Review, Florida Office of\nInsurance Regulation at Eric.Johnson@floir.com or (850) 413-5059.\n\n                                           Page 1 of 1","text_length":2369}
{"slug":"fl-oir-17-01m","jurisdiction":"FL","agency":"FLOIR","doc_type":"bulletin","citation":"OIR-17-01M","title":"OIR-17-01M","official_source_url":"https://floir.gov/docs-sf/default-source/informational-memoranda/oir-17-01m.pdf","access_class":"statutory-public","access_notes":"floir.gov self-hosted-gov; gate-zero FL-a","first_seen_at":"2026-07-19T16:15:49.214513+00:00","last_checked_at":"2026-07-20T06:19:37.597463+00:00","versions":[{"fetched_at":"2026-07-19T16:15:49.214513+00:00","version_no":1,"text_length":7660,"effective_date":null,"content_sha256_short":"ef4ef833f3c9"}],"text":"INFORMATIONAL MEMORANDUM\n                                                   OIR-17-01M\n                                                     ISSUED\n                                                 February 7, 2017\n                                                Florida Office of Insurance Regulation\n                                                   David Altmaier, Commissioner\n\n    NOTIFICATION TO ALL INSURERS AND HEALTH MAINTENANCE ORGANIZATIONS\n                ENGAGING A THIRD PARTY TO PROVIDE SERVICES\n\nThe purpose of this informational memorandum is to notify all insurers and health maintenance\norganizations (HMO)s, if the insurer or HMO engages a third party to provide services, of certain\nprovisions of the Insurance Code.\n\nPursuant to Section 626.8817, Florida Statutes, it is the sole responsibility of the insurer or HMO to\nprovide for competent administration of its programs. If the insurer or HMO engages the services of an\nadministrator, the insurer or HMO is responsible for determining benefits, premium increases,\nunderwriting criteria, and claims payment procedures, and is also responsible for conducting a semi-\nannual review of the administrator’s operations when the administrator administers benefits for more than\none hundred (100) certificateholders.\n\nPursuant to Section 626.883(1), Florida Statutes, an insured’s payment of premiums or charges for\ninsurance to the administrator shall be deemed to have been received by the insurer. Payments forwarded\nby the insurer to the administrator, for purposes of a return of premiums or payment of claims, are not\ndeemed to have been paid to the insured or claimant until such payments are received by the insured or\nclaimant.\n\nPursuant to Section 641.35(3)(a), Florida Statutes, if an HMO, through a health risk contract, transfers to\nany entity the obligation to pay providers for subscriber claims, the liability for any such payment remains\nwith the HMO until the payment is received by the provider and should be reflected in loss reserves.\n\nPursuant to Section 641.234(4), Florida Statutes, if an HMO, through a health risk contract, transfers to\nany entity the obligations to pay a provider for any claims on behalf of a subscriber, the HMO shall remain\nresponsible for any violations of Sections 641.3155 (prompt payment), 641.3156 (treatment\nauthorization), and 641.51(4) (balance billing), Florida Statutes.\n\nIf you have any questions regarding the contents of this Memorandum, please contact Eric Johnson,\nFlorida Office of Insurance Regulation at Eric.Johnson@floir.com or (850) 413-5059.\n\n                                                Page 1 of 3\n626.8817    Responsibilities of insurance company with respect to administration of coverage insured.—\n\n(1) If an insurer uses the services of an administrator, the insurer is responsible for determining the\nbenefits, premium rates, underwriting criteria, and claims payment procedures applicable to the\ncoverage and for securing reinsurance, if any. The rules pertaining to these matters shall be provided, in\nwriting, by the insurer or its designee to the administrator. The responsibilities of the administrator as to\nany of these matters shall be set forth in a written agreement binding upon the administrator and the\ninsurer.\n(2) It is the sole responsibility of the insurer to provide for competent administration of its programs.\n(3) If an administrator administers benefits for more than 100 certificateholders on behalf of an\ninsurer, the insurer shall, at least semiannually, conduct a review of the operations of the administrator.\nAt least one such review must be an onsite audit of the operations of the administrator. The insurer may\ncontract with a qualified third party to conduct such review.\n(4) For purposes of this section, the term “insurer” means a licensed insurance company, health\nmaintenance organization, prepaid limited health service organization, or prepaid health clinic.\n\n626.883 Administrator as intermediary; collections held in fiduciary capacity; establishment of\naccount; disbursement; payments on behalf of insurer.—\n\n(1) If an insurer utilizes the services of an administrator under the terms of a written agreement, the\npayment to the administrator of any premiums or charges for insurance by or on behalf of the insured\nshall be deemed to have been received by the insurer, and return premiums or claim payments forwarded\nby the insurer to the administrator shall not be deemed to have been paid to the insured or claimant until\nsuch payments are received by the insured or claimant. Nothing in this part limits any right of the insurer\nagainst the administrator resulting from the failure of the administrator to make payments to the insurer,\ninsureds, or claimants.\n\n641.35   Assets, liabilities, and investments.—\n\n(3) LIABILITIES.—In any determination of the financial condition of a health maintenance\norganization, liabilities to be charged against its assets shall include:\n(a) The amount, estimated consistently with the provisions of this part, necessary to pay all of its\nunpaid losses and claims incurred for or on behalf of a subscriber, on or prior to the end of the reporting\nperiod, whether reported or unreported, including contract and premium deficiency reserves. If a health\nmaintenance organization, through a health care risk contract, transfers to any entity the obligation to\npay any provider for any claim arising from services provided to or for the benefit of any subscriber, the\nliabilities of the health maintenance organization under this section shall include the amount of those\nlosses and claims to the extent that the provider has not received payment. No liability need be\nestablished if the entity has provided to the health maintenance organization a financial instrument\nacceptable to the office securing the obligations under the contract or if the health maintenance\norganization has in place an escrow or withhold agreement approved by the office which assures full\npayment of those claims. Financial instruments may include irrevocable, clean, and evergreen letters of\ncredit. As used in this paragraph, the term “entity” does not include this state, the United States, or an\nagency thereof or an insurer or health maintenance organization authorized in this state.\n\n                                                 Page 2 of 3\n641.234   Administrative, provider, and management contracts.—\n\n(4)(a) If a health maintenance organization, through a health care risk contract, transfers to any entity\nthe obligations to pay any provider for any claims arising from services provided to or for the benefit of\nany subscriber of the organization, the health maintenance organization shall remain responsible for any\nviolations of ss. 641.3155, 641.3156, and 641.51(4). The provisions of ss. 624.418-624.4211 and 641.52\nshall apply to any such violations.\n(b) As used in this subsection:\n1. The term “health care risk contract” means a contract under which an entity receives compensation\nin exchange for providing to the health maintenance organization a provider network or other services,\nwhich may include administrative services.\n2. The term “entity” means a person licensed as an administrator under s. 626.88 and does not include\nany provider or group practice, as defined in s. 456.053, providing services under the scope of the\nlicense of the provider or the members of the group practice. The term does not include a hospital\nproviding billing, claims, and collection services solely on its own and its physicians’ behalf and\nproviding services under the scope of its license.\n\n                                               Page 3 of 3","text_length":7660}
{"slug":"fl-oir-15-08m","jurisdiction":"FL","agency":"FLOIR","doc_type":"bulletin","citation":"OIR-15-08M","title":"OIR-15-08M","official_source_url":"https://floir.gov/docs-sf/default-source/informational-memoranda/oir-15-08m.pdf","access_class":"statutory-public","access_notes":"floir.gov self-hosted-gov; gate-zero FL-a","first_seen_at":"2026-07-19T16:15:49.214513+00:00","last_checked_at":"2026-07-20T06:19:37.597463+00:00","versions":[{"fetched_at":"2026-07-19T16:15:49.214513+00:00","version_no":1,"text_length":1973,"effective_date":null,"content_sha256_short":"63b43d518498"}],"text":"INFORMATIONAL MEMORANDUM\n                                          OIR-15-08M\n                                            ISSUED\n                                        December 15, 2015\n                                        Florida Office of Insurance Regulation\n                                         Kevin M. McCarty, Commissioner\n\n                        INFORMATIONAL MEMORANDUM\n\nTO ALL VARIABLE ANNUITY WRITERS AUTHORIZED TO DO BUSINESS IN\n                          FLORIDA\n        MATURITY DATES, EXTENSION AND ANNUITIZATION\n\nThe purpose of this memorandum is to clarify some apparent misconceptions regarding\nthe ability to extend annuity contracts beyond their original maturity date following recent\nregulatory settlement agreements (RSAs).\n\nThe Office has been made aware of instances where an annuity contract owner has\nreceived communication from an insurer as the maturity date of a contract is approaching\nthat their only options were to either surrender the contract or annuitize the contract.\n\nUnder the provisions of the RSAs, insurers agreed to specific revisions to policies and\nprocedures regarding the identification and disposal of annuity contracts. Nothing in the\nRSAs limits an insurer or annuity contract owner’s options to only surrender the contract\nor annuitize the contract at the maturity date. Rather, an explicit requirement of the RSAs\nrevised business practices allows for the extension of a maturity date upon affirmative\nrequest of the annuity contract owner.\n\nThe Office remains committed to ensuring the freedom of choice policy holders have long\nhad with regard to planning their financial security, and does not believe that any\ncomponent of the recent RSAs inhibits continuation of those choices.\n\nShould you have any questions regarding the content of this memorandum, please contact\nAnoush Brangaccio, General Counsel at Anoush.Brangaccio@floir.com or at (850) 413-\n4116.\n\n                                        Page 1 of 1","text_length":1973}
{"slug":"fl-oir-23-04m","jurisdiction":"FL","agency":"FLOIR","doc_type":"bulletin","citation":"OIR-23-04M","title":"OIR-23-04M","official_source_url":"https://floir.gov/docs-sf/default-source/informational-memoranda/oir-23-04m.pdf","access_class":"statutory-public","access_notes":"floir.gov self-hosted-gov; gate-zero FL-a","first_seen_at":"2026-07-19T16:15:49.214513+00:00","last_checked_at":"2026-07-20T06:19:37.597463+00:00","versions":[{"fetched_at":"2026-07-19T16:15:49.214513+00:00","version_no":1,"text_length":11807,"effective_date":null,"content_sha256_short":"42c68ba20f56"}],"text":"INFORMATIONAL MEMORANDUM\n                                                   OIR-23-04M\n                                                     ISSUED\n                                                   July 19, 2023\n                                                Florida Office of Insurance Regulation\n                                                 Michael Yaworsky, Commissioner\n\nNOTIFICATION TO ALL PHARMACY BENEFIT MANAGERS TO BE REGULATED AS INSURANCE\n                              ADMINISTRATORS\n\n                            ~ Implementing Florida’s Prescription Drug Reform Act ~\n\nThe purpose of this informational memorandum is to notify all Pharmacy Benefit Managers (PBMs) and\nPharmacy Benefits Plans or Programs of recent changes to Florida Law included within the Prescription Drug\nReform Act (SB 1550). As signed by Governor DeSantis in May, the Prescription Drug Reform Act institutes\nnew regulatory requirements for all PBMs, including a requirement to become fully regulated as Insurance\nAdministrators. As the 2023 Florida Statutes have not yet been published, all citations included in this\nmemorandum and attachments are to the Florida Statutes reflected in Chapter 2023-029, Laws of Florida, a\ncopy can be found here.\n\nIn addition to noticing the formal commencement of rulemaking in the Florida Administrative Register, the\nFlorida Office of Insurance Regulation (OIR) is providing this informational memorandum to educate\nstakeholders on the implementation related activities.\n\n                                   Application for Certificate of Authority\n\nAs stated above, the OIR has formally initiated the rulemaking process to promulgate application forms for\nPBMs seeking to operate in Florida. Pursuant to the legislation, beginning on January 1, 2024, PBMs operating\nin Florida must continue to be registered with the OIR, using the form linked here (s. 624.490, Florida Statutes),\nand hold a valid certificate of authority (COA) as an administrator (ss. 626.88 and 626.8805, Florida Statutes).\n\nGiven that the new requirements for PBMs exceed both the current registration requirement and the application\nrequirements of administrators not considered PBMs, all PBMs currently registered with the OIR, including\nthose that currently hold a COA as an administrator, and any new PBM seeking to operate in Florida, will be\nrequired to complete an application to obtain a COA. The application form is available here. Upon receipt and\nreview of a complete application by a PBM that meets the requirements of Florida Law, the OIR will issue a\nCOA.\n\nAny PBM operating in Florida without a valid COA beginning on January 1, 2024, will be subject to a fine of\n$10,000 per violation per day. The OIR urges all PBMs to make their application filing as soon as possible to\navoid delays, including obtaining background reports required in the Florida Insurance Code.\n\n                                   Transparent Reporting Requirements\n\nIn addition to the referenced application requirements, PBMs will also be subject to a series of transparent\nreporting requirements including disclosures related to relationships with affiliated entities and ownership\n\n                                                   Page 1 of 4\naffiliations, contracts with affiliates, pharmacies, and pharmacy benefits plans or programs, and several\nrequirements for specified contractual terms and conditions.\n\nThe method in which PBMs and Pharmacy Benefit Plans or Programs shall report the requirements is provided\nbelow:\n\nFinancial Condition and Audited Financial Statements: The PBM’s financial condition (subsection\n626.89(1), Florida Statutes) and the PBM’s audited annual financial statements (subsection 626.89(2), Florida\nStatutes) should be submitted electronically within three months after the end of the administrator’s fiscal year,\nthrough http://www.floir.com/iportal. Form OIR-A3-975 should be used to submit financial information.\n\nNotification of Violations: The notification of any administrative, civil, or criminal complaints, settlements,\nor discipline of the pharmacy benefit manager or any of its affiliates which relate to a violation of the insurance\nlaws, including pharmacy benefit laws in any state should be submitted electronically to\nhttp://www.floir.com/iportal, as a periodic filing, within 30 days of the complaint, settlement, or discipline\n(subsection 626.89(5), Florida Statutes).\n\nNetwork Adequacy Attestation: Beginning January 1, 2024, the requirement for an annual attestation of\ncompliance with network requirements (subsection 626.89(6), Florida Statutes) should be submitted\nelectronically to http://www.floir.com/iportal, and included in the annual filings thereafter. PBMs are\nencouraged to provide additional documentation (i.e. Network Files, Analyses, etc.) to support this attestation\nannually, as it will also be requested during the biennial examination cycle.\n\nOwnership Changes: Material changes of ownership (subsection 626.89(4), Florida Statutes) should\nimmediately be submitted electronically to http://www.floir.com/iportal, as a periodic filing. A change of\nownership affiliation of any kind with any pharmacy, which meets the requirements of section 626.8814(2)\nFlorida Statutes, must be reported to the OIR in writing, and may be submitted electronically to\nhttp://www.floir.com/iportal, within 60 days of the change in ownership interest.\n\nAppeals and Denials of Pharmacies and Pharmacists: A report of the total number of appeals and denials\nby pharmacies or pharmacists of the PBM’s decisions regarding a drug’s maximum allowable cost and\nreimbursement (section 626.8825, Florida Statutes) is required to be filed with the OIR every 90 days. This\nreport may be filed at the following email address: PBMreporting@floir.com. OIR is creating a suggested\ntemplate to use for reporting. Once completed, the suggested template will be posted on OIR's website here.\nUse of this template will ensure that the information submitted is complete and the filing can be timely\nprocessed.\nAgreements with Pharmacy Benefit Plans or Programs: PBMs are also directed to notify any pharmacy\nbenefits plans or programs they are contracted with of the requirement (subsection 626.8825(2)(h)2., Florida\nStatutes) to annually submit a statement of attestation of compliance with the requirements of subsection\n626.8825(2), Florida Statutes, governing contracts between the PBM and the pharmacy benefits plans or\nprograms. This requirement applies to all pharmacy benefits plans or programs as defined in subsection\n626.8825(1)(u), Florida Statutes. The attestations may be submitted to: PBMreporting@floir.com. If the plan\nor program is directed by a licensed insurer or HMO, the attestation may be submitted electronically as a\nperiodic filing to http://www.floir.com/iportal.\n\n                        Contract Provisions to Protect Consumers and Pharmacies\n\nContracts between a PBM and a Pharmacy Benefit Plan or Program: The bill institutes a series of\nprotections for both consumers and pharmacies through contracting provisions between PBMs and Pharmacy\n                                                   Page 2 of 4\nBenefit Plans or Programs. Of note, the bill requires that in addition to any other requirements of the Florida\nInsurance Code, all contractual arrangements executed, amended, adjusted, or renewed on or after July 1, 2023,\nwhich are applicable to pharmacy benefits covered on or after January 1, 2024, between a PBM and a Pharmacy\nBenefits Plan or Program must include, in substantial form, standard terms, except to the extent not allowed\nby law, shall supersede any contractual terms to the contrary. A complete listing of terms can be found in the\nbill (s. 626.8825(2), Florida Statutes).\n\nContracts between a PBM and a Participating Pharmacy: In addition to the above referenced requirements,\nthe bill institutes a series of protections for both consumers and pharmacies through contracting provisions\nbetween PBMs and Participating Pharmacies. Of note, the bill requires that in addition to any other\nrequirements of the Florida Insurance Code, a participation contract executed, amended, adjusted, or renewed\non or after July 1, 2023, which are applicable to pharmacy services on or after January 1, 2024, between a\nPBM and one or more pharmacies or pharmacists must include, in substantial form, standard terms, except to\nthe extent not allowed by law, shall supersede any contractual terms to the contrary. A complete listing of\nterms can be found in the bill (s. 626.8825(3), Florida Statutes).\n\nAdditionally, as published in the Florida Administrative Register, draft rules have been published detailing the\nmethod in which PBMs provide remittance to participating pharmacies.\n\n                                             Patient Data Privacy\n\nThe bill also prohibits PBMs from transferring or sharing records relative to prescription information\ncontaining patient-identifiable or prescriber-identifiable data to an affiliated pharmacy for any commercial\npurpose other than the limited purposes of facilitating pharmacy reimbursement, formulary compliance, or\nutilization review on behalf of the applicable pharmacy benefits plan or program.\n\n                                    Additional Prohibited PBM Practices\n\nIn addition to the requirements set forth in the bill, the legislation includes additional prohibitions against PBM\npractices including: restricting or penalizing a pharmacy or pharmacist from disclosing relevant information\nto a patient, government officials, or law enforcement; communicating at the point-of-sale, or otherwise\nrequiring, a cost-sharing obligation for a covered person that exceeds the lesser of the applicable amount in\nthe covered person’s plan or the usual and customary price. Additionally, the bill clarifies that Florida’s\nprohibition against “fail twice” step therapy protocols apply to both plans and PBMs.\n\nThe bill also provides additional protections against PBMs exerting retaliatory action against pharmacists or\npharmacies that provide information to the OIR pursuant to a compliant or a query regarding compliance with\nthis act. A complete listing of prohibitions can be found in the bill.\n\n                                        Investigations & Examinations\n\nThe bill subjects PBMs to biennial exams beginning on January 1, 2025, to ensure compliance with Florida\nlaw. This requirement is in addition to any investigation or examination conducted because of a referral or\ncomplaint driven investigation or examination conducted at any time.\n\nAny PBM found to exhibit a pattern or practice of knowing and willful violations with section 626.8825\n(Pharmacy Benefit Manager Transparency & Accountability), or 626.8827 (Pharmacy Benefit Manager\nProhibited Practices), may be subject to additional penalties per section 626.8828, Florida Statutes.\n\n                                                   Page 3 of 4\nAdditionally, as published in the Florida Administrative Register, draft rules have been published detailing\nthe method in which PBMs provide remittance to participating pharmacies and the types of independent\nprofessional examiners who may conduct examinations.\n\nThe OIR is also directed to regularly report violations of this act to the Governor, President of the Senate,\nand Speaker of the House of Representatives.\n\nThis memorandum contains a significant portion of changes in Florida Law but is not intended, nor shall be\nconsidered as, an exhaustive list of all changes in Florida law. The OIR directs PBMs to review the law in its\nentirety and to make regulatory changes as necessary to ensure compliance with the law.\n\nFor questions regarding this memorandum, please contact InformationalMemoranda@floir.com.\n\n                                                  Page 4 of 4","text_length":11807}
{"slug":"ga-bulletin-26-ex-1","jurisdiction":"GA","agency":"OCI","doc_type":"bulletin","citation":"GA OCI Bulletin 26-EX-1","title":"BULLETIN 26-EX-1: 1332 WAIVER REINSURANCE PROGRAM EXTENSION APPLICATION PUBLIC NOTICE","official_source_url":"https://oci.georgia.gov/document/bulletin/bulletin-26-ex-1-1332-waiver-reinsurance-program-extension-application-public/download","access_class":"source-wants-visibility","access_notes":"oci.georgia.gov; gate-zero TOP-20 GA bulletins row. pre-2019 archive sits on a commercial platform; excluded.","first_seen_at":"2026-07-20T01:59:05.806098+00:00","last_checked_at":"2026-07-20T06:40:21.566212+00:00","versions":[{"fetched_at":"2026-07-20T01:59:05.806098+00:00","version_no":1,"text_length":0,"effective_date":null,"content_sha256_short":"0844962c4f1c"}],"text":"","text_length":0}
{"slug":"ga-bulletin-25-ex-4","jurisdiction":"GA","agency":"OCI","doc_type":"bulletin","citation":"GA OCI Bulletin 25-EX-4","title":"BULLETIN 25-EX-4: FOSTERING SUCCESS ACT TAX CREDIT PROGRAM","official_source_url":"https://oci.georgia.gov/document/bulletin/bulletin-25-ex-4-fostering-success-act-tax-credit-program/download","access_class":"source-wants-visibility","access_notes":"oci.georgia.gov; gate-zero TOP-20 GA bulletins row. pre-2019 archive sits on a commercial platform; excluded.","first_seen_at":"2026-07-20T01:59:05.806098+00:00","last_checked_at":"2026-07-20T06:40:21.566212+00:00","versions":[{"fetched_at":"2026-07-20T01:59:05.806098+00:00","version_no":1,"text_length":2804,"effective_date":null,"content_sha256_short":"0a91bfc5135d"}],"text":"BULLETIN 25-EX-4\n\nTO:            ALL GEORGIA INSURANCE COMPANIES\n\nFROM:          JOHN F. KING\n               INSURANCE AND SAFETY FIRE COMMISSIONER\n\nDATE:          December 31, 2025\n\nRE:          FOSTERING SUCCESS ACT TAX CREDIT PROGRAM\n______________________________________________________________________________\n\nThe Fostering Success Act, signed into law by Governor Brian Kemp, creates a powerful new\nway for your company to make a lasting impact. Insurance companies can now redirect a portion\nof their state premium tax liability to help youth aging out of foster care.\n\nEach year, about 600 young Georgians exit the foster care system, often without a stable support\nnetwork, leaving them vulnerable to homelessness, unemployment, and poor health outcomes.\nThis program offers a cost-neutral way for you to contribute to reversing that trend.\n\nParticipation is straightforward and provides a 100% dollar-for-dollar premium tax credit.\n\n ● Preapproval: Insurance companies can seek preapproval from the Department of Revenue.\n   For more information visit: https://dor.georgia.gov/qualified-foster-child-donation-credit.\n ● Contribute: Make a donation directly to a qualified foster child support organization.\n ● Receive Credit: The full donation amount is applied as a direct credit against your\n   company's state premium tax liability.\n ● Create Impact: Your investment funds will support proven, high-impact programs that\n   provide access to higher education, safe housing, counseling, and financial literacy training\n   for these deserving young adults.\nRedirecting your tax liability is a direct investment in Georgia's future workforce and community\nleaders. This initiative empowers youth to achieve self-sufficiency, build healthier lives, and gain\neconomic mobility. The introduction of these evidence-based programs leads to significant\npositive changes. By participating, your company helps reduce dependency on public systems\nand directly fuels a homegrown talent pipeline of resilient and motivated individuals for our\nstate's industries.\n\nI strongly encourage all insurance companies to consider this transformative initiative. By\nredirecting your tax liability, you can rewrite the story for these young adults from one of\ninstability into one of hope and opportunity.\nTo learn more or begin the process, please contact the Georgia Premium Tax Division at\nPremiumTax@oci.ga.gov.\n\nThank you for your commitment to our communities. Together, we can ensure every young adult\nleaving foster care has the chance to succeed.\n\n                                    _____________________________________________\n                                    JOHN F. KING\n                                    INSURANCE AND SAFETY FIRE COMMISSIONER\n                                    STATE OF GEORGIA","text_length":2804}
{"slug":"ga-bulletin-25-ex-5","jurisdiction":"GA","agency":"OCI","doc_type":"bulletin","citation":"GA OCI Bulletin 25-EX-5","title":"BULLETIN 25-EX-5: DOCUMENTATION REQUIREMENTS FOR CLAIMING GEORGIA HOUSING TAX CREDITS WITH ANNUAL PREMIUM TAX RETURNS","official_source_url":"https://oci.georgia.gov/document/bulletin/bulletin-25-ex-5-documentation-requirements-claiming-georgia-housing-tax-credits/download","access_class":"source-wants-visibility","access_notes":"oci.georgia.gov; gate-zero TOP-20 GA bulletins row. pre-2019 archive sits on a commercial platform; excluded.","first_seen_at":"2026-07-20T01:59:05.806098+00:00","last_checked_at":"2026-07-20T06:40:21.566212+00:00","versions":[{"fetched_at":"2026-07-20T01:59:05.806098+00:00","version_no":1,"text_length":1520,"effective_date":null,"content_sha256_short":"521208287792"}],"text":"BULLETIN 25-EX-5\n\nTO:            ALL INSURERS SUBJECT TO O.C.G.A. §§ 33-5-17, 33-8-4, & 33-40-5\n\nFROM:          OCI PREMIUM TAX DIVISION\n\nDATE:          DECEMBER 31, 2025\n\nRE:            DOCUMENTATION REQUIREMENTS FOR CLAIMING GEORGIA\n               HOUSING TAX CREDITS WITH ANNUAL PREMIUM TAX RETURNS\n\nThe Georgia Housing Tax Credit, as set forth in O.C.G.A. § 33-1-18, is available to certain\nentities subject to insurance premium tax in Georgia.\n\nThis Directive provides notice that complete documentation is required to be submitted with the\nAnnual Premium Tax return in order to obtain credit. Due to recent system changes, OCI is\nauditing current-year returns. If documentation is not available at the time of filing, an amended\nreturn should be filed when documentation is available and complete. ESTIMATES WILL NOT\nBE ACCEPTED.\n\nComplete documentation includes:\n\n(1)     A properly executed Form IT-HC, with page 3 reflecting the TOTAL amount of credit\n        claimed;\n\n(2)     A Georgia K-1 equivalent for each partnership indicating the amount of State credit\n        allocated; and\n\n(3)     A schedule that includes each property for which a credit is claimed with a building-by-\n        building allocation.\n\nPlease contact the Georgia Premium Tax Division at 404-656-7553 or email\npremiumtax@oci.ga.gov with any questions.\n\n                                      JOHN F. KING\n                                      INSURANCE AND SAFETY FIRE COMMISSIONER\n                                      STATE OF GEORGIA","text_length":1520}
{"slug":"ga-bulletin-25-ex-6","jurisdiction":"GA","agency":"OCI","doc_type":"bulletin","citation":"GA OCI Bulletin 25-EX-6","title":"BULLETIN 25-EX-6: STEP THERAPY PROHIBITED FOR STAGE-FOUR METASTATIC CANCER","official_source_url":"https://oci.georgia.gov/document/bulletin/bulletin-25-ex-6-step-therapy-prohibited-stage-four-metastatic-cancer/download","access_class":"source-wants-visibility","access_notes":"oci.georgia.gov; gate-zero TOP-20 GA bulletins row. pre-2019 archive sits on a commercial platform; excluded.","first_seen_at":"2026-07-20T01:59:05.806098+00:00","last_checked_at":"2026-07-20T06:40:21.566212+00:00","versions":[{"fetched_at":"2026-07-20T01:59:05.806098+00:00","version_no":1,"text_length":3145,"effective_date":null,"content_sha256_short":"15d29f5ca628"}],"text":"BULLETIN 25-EX-6\n\nTO:                   ALL HEALTH PLANS IN THE STATE OF GEORGIA\n\nFROM:                 JOHN F. KING\n                      INSURANCE AND SAFETY FIRE COMMISSIONER\n\nDATE:                 DECEMBER 31, 2025\n\nRE:                   STEP THERAPY PROHIBITED FOR STAGE-FOUR METASTATIC CANCER\n\nThis Bulletin is intended for all health benefit plans1 issued for delivery in Georgia, including any\nplans established under Article 1 of Chapter 18 of Title 45 (Georgia state employee plans) and\nplans under Article 7 of Chapter 4 of Title 49 (Georgia Medicaid managed care plans).\n\nO.C.G.A § 33-24-59.20 prohibits any health benefit plan from utilizing step therapy (also known\nas a “fail first” protocol) for the treatment of stage four advanced, metastatic cancer.2\n\nWhile plans may ensure that the use of a drug is consistent with best practices for the treatment of\nstage four advanced, metastatic cancer and is supported by peer reviewed medical literature, a\nhealth benefit plan which directly or indirectly covers the treatment of stage four advanced,\nmetastatic cancer may not limit or exclude coverage for an FDA approved drug and may not require\nthat a patient fails to successfully respond to a different drug or prove a history of failure of such\ndrug or drugs prior to authorizing treatment or covering such drug.\nA health benefit plan shall not require a patient with stage four, advanced metastatic cancer to try\nanother prescription drug or demonstrate past failure with another prescription drug either\nexplicitly through the terms of its coverage criteria or indirectly through the use of prior\nauthorization before having coverage approved for a prescription drug approved for this condition\nor where use of the drug for the condition is supported by best practices and peer reviewed medical\nliterature.\n\n1\n  “Health benefit plan” means any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare\nbenefit plan, contract or agreement with a health maintenance organization, subscriber contract or agreement, preferred provider organization,\naccident and sickness insurance benefit plan, or other insurance contract under any other name. The term shall include any health insurance plan\nestablished under Article 1 of Chapter 18 of Title 45 and under Article 7 of Chapter 4 of Title 49, the “Georgia Medical Assistance Act of 1977.”\nO.C.G.A. § 33-24-59.20(a)(1).\n2\n  “Stage four advanced, metastatic cancer” means cancer that has spread from the primary or original site of the cancer to nearby tissues, lymph\nnodes, or other areas or parts of the body. O.C.G.A. § 33-24-59.20(a)(2).\nThis Bulletin is intended to remind health plans of their obligation to comply with O.C.G.A. § 33-\n24-59.20 and the Department of Insurance will take regulatory action as necessary to enforce\ncompliance with such obligation.\n\n                                     _____________________________________________\n                                     JOHN F. KING\n                                     INSURANCE AND SAFETY FIRE COMMISSIONER\n                                     STATE OF GEORGIA","text_length":3145}
{"slug":"ga-bulletin-25-ex-7","jurisdiction":"GA","agency":"OCI","doc_type":"bulletin","citation":"GA OCI Bulletin 25-EX-7","title":"BULLETIN 25-EX-7: MANDATED COVERAGE OF BIOMARKER TESTING","official_source_url":"https://oci.georgia.gov/document/bulletin/bulletin-25-ex-7-mandated-coverage-biomarker-testing-0/download","access_class":"source-wants-visibility","access_notes":"oci.georgia.gov; gate-zero TOP-20 GA bulletins row. pre-2019 archive sits on a commercial platform; excluded.","first_seen_at":"2026-07-20T01:59:05.806098+00:00","last_checked_at":"2026-07-20T06:40:21.566212+00:00","versions":[{"fetched_at":"2026-07-20T01:59:05.806098+00:00","version_no":1,"text_length":4742,"effective_date":null,"content_sha256_short":"102afde28879"}],"text":"BULLETIN 25-EX-7\n\nTO:                    ALL HEALTH PLANS IN THE STATE OF GEORGIA\n\nFROM:                  JOHN F. KING\n                       INSURANCE AND SAFETY FIRE COMMISSIONER\n\nDATE:                  DECEMBER 31, 2025\n\nRE:                    MANDATED COVERAGE OF BIOMARKER TESTING\n\nThis Bulletin is intended for all health benefit policies 1 issued for delivery in Georgia, including\nany plans established under Article 1 of Chapter 18 of Title 45 (Georgia state employee plans).\nO.C.G.A. § 33-24-59.33 requires that all health benefit policies include coverage for biomarker\ntesting for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring\nof an enrollee’s disease or condition when the testing is supported by any of the following five\ncriteria:\n     (1) FDA Approval: A labeled indication for a test that has been approved or cleared by the\n         United States Food and Drug Administration (FDA).\n\n     (2) Indicated Test: A test indicated for an FDA-approved drug or included in the\n         warnings/precautions of an FDA-approved drug label.\n\n     (3) CMS Determinations: A national coverage determination made by the federal Centers\n         for Medicare and Medicaid Services or a local coverage determination made by a\n         medicare administrative contractor.\n\n     (4) Clinical Practice Guidelines: Nationally recognized clinical practice guidelines and\n         consensus statements.\n\n     (5) Warnings and precautions on FDA approved drugs.\n\nFurther all health benefit policies shall ensure biomarker testing coverage is provided in a\nmanner that limits disruptions in care, including the need for multiple biopsies or biospecimen\nsamples. The process for requesting an exception to a coverage policy or appealing an adverse\n\n1\n  “Health benefit policy” means any individual or group plan, policy, or contract for healthcare services issued, delivered, issued for delivery, or\nrenewed in this state which provides major medical benefits, including those contracts executed by the State of Georgia on behalf of state\nemployees under Article 1 of Chapter 18 of Title 45, by a health care corporation, health maintenance organization, preferred provider\norganization, accident and sickness insurer, fraternal benefit society, hospital service corporation, medical service corporation, or other insurer or\nsimilar entity. O.C.G.A. § 33-24-59.33(a)(4).\ndetermination must be readily accessible on the plan’s website. Further, plans are expected to\nadhere to the expedited timelines required for urgent medical necessity.\n\nRequired Coverage: Examples and Medicare LCDs\n\nTo assist in compliance, the Commissioner has identified the following non-exhaustive list of\ntests and categories that have met the threshold for coverage based on the criteria above,\nspecifically referencing Palmetto GBA (MolDX) determinations for the Georgia jurisdiction:\n\nTest Category                   Relevant Evidence / LCD         Application\n\nComprehensive Genomic           NCD 90.2 / NCCN                 Advanced/Metastatic solid\nProfiling (CGP)                 Guidelines                      tumors (Stage III/IV).\n\nLiquid Biopsy                   LCD L37870 (InVisionFirst)      Lung cancer patients\n                                                                (NSCLC) where tissue is\n                                                                insufficient.\n\nPharmacogenomics                FDA Labeled Indications         DPYD/TPMT for chemo\n                                                                toxicity; CYP2C19 for\n                                                                Clopidogrel.\n\nMinimal Residual Disease        LCD L38290                      Monitoring recurrence in\n(MRD)                           (Signatera/Guardant)            colorectal and other cancers.\n\nHereditary Cancer Testing       NCCN Guidelines / LCD           BRCA1/2, Lynch Syndrome,\n                                L38966                          and high-risk panel testing.\n\nNeurological/Oncology           LCD L35974                      MGMT Promoter\n                                                                Methylation for\n                                                                Glioblastoma.\n\nThis Bulletin is intended to remind health plans of their obligation to comply with O.C.G.A. §\n33-24-59.33 and the Department of Insurance will take regulatory action as necessary to enforce\ncompliance with such obligation.\n\n                                     _____________________________________________\n                                     JOHN F. KING\n                                     INSURANCE AND SAFETY FIRE COMMISSIONER\n                                     STATE OF GEORGIA","text_length":4742}
{"slug":"ga-bulletin-25-ex-3","jurisdiction":"GA","agency":"OCI","doc_type":"bulletin","citation":"GA OCI Bulletin 25-EX-3","title":"BULLETIN 25-EX-3: IMPLEMENTATION OF NEW COMPLIANCE REVIEW PROGRAM","official_source_url":"https://oci.georgia.gov/document/bulletin/bulletin-25-ex-3-implementation-new-compliance-review-program/download","access_class":"source-wants-visibility","access_notes":"oci.georgia.gov; gate-zero TOP-20 GA bulletins row. pre-2019 archive sits on a commercial platform; excluded.","first_seen_at":"2026-07-20T01:59:05.806098+00:00","last_checked_at":"2026-07-20T06:40:21.566212+00:00","versions":[{"fetched_at":"2026-07-20T01:59:05.806098+00:00","version_no":1,"text_length":5146,"effective_date":null,"content_sha256_short":"fff31a87bb90"}],"text":"BULLETIN 25-EX-3\n\nTO:            ALL SURPLUS LINES AGENTS WRITING IN THE STATE OF GEORGIA\n\nFROM:          JOHN F. KING\n               INSURANCE AND SAFETY FIRE COMMISSIONER\n\nDATE:          OCTOBER 2, 2025\n\nRE:            IMPLEMENTATION OF NEW COMPLIANCE REVIEW PROGRAM\n\nBeginning in October 2025, the Florida Surplus Lines Service Office (FSLSO) SLIP+ team will\nbegin conducting compliance reviews of Georgia-licensed surplus lines brokers on behalf of the\nGeorgia Department of Insurance, Office of Insurance and Safety Fire Commissioner (GA OCI).\n\nThe purpose of this program is to ensure brokers are meeting statutory requirements for policy\nfiling and tax remittance, while also providing educational assistance to strengthen compliance\npractices across the Georgia surplus lines market.\n\nCompliance reviews will verify that:\n\n   •    All policies, endorsements, and cancellations are properly filed.\n   •    Premium taxes are accurately calculated, reported, and paid.\n   •    Broker records align with Georgia surplus lines laws and regulations.\nReviews may be conducted on-site at the broker’s office or as a remote (desk) audit, depending on\ncircumstances and mutual agreement. Brokers selected for review will receive advance notice and\ndetailed instructions to prepare the required records.\n\nCompliance reviews may be scheduled on a routine basis, at random, or as a result of identified\nreporting discrepancies. In many cases, reviews result in either no findings or minor corrections.\nHowever, significant non-compliance may be referred to GA OCI for further action.\n\nAdditional details regarding the process, requirements, and expectations of the Compliance\nReview Program are provided in Attachment A.\nFor questions, please contact compliancereview@slipplus.com or premiumtax@oci.ga.gov.\n\n                                  __________________________________\n                                  JOHN F. KING\n                                  INSURANCE AND SAFETY FIRE COMMISSIONER\n                                  STATE OF GEORGIA\n\n                                                                                        2\nAttachment A: Compliance Review Program – Additional Details\n\nPurpose and Educational Role\nCompliance reviews are designed not only to verify accuracy and compliance but also to serve as\nan educational tool. They provide brokers and their staff with feedback, clarification, and resources\nto ensure filings are completed efficiently and in alignment with Georgia law.\n\nPROCESS\n\nNotice of Intent & Scheduling\nA Notice of Intent will be sent to the broker via email as advance notification of an upcoming\nreview. Within 5–7 days, a SLIP+ analyst will contact the broker to schedule the review date.\nReviews may take place on-site at the broker’s office or remotely. If multiple licensed brokers\nwork in the same office, GA OCI may coordinate reviews simultaneously to reduce business\ninterruptions.\n\nPreparation & Checklist\nOnce a review date is established, the assigned analyst will provide a detailed list of policies and\ntransactions selected for review and a Compliance Review Preparation Checklist to assist the\nbroker             with             preparation             for            the               review.\n\nRecords Requested\n\nRecords may include, but are not limited to:\n\n   •   Policy records from the past three (3) years, including:\n           o Policy declarations (with coverage details and insured property locations).\n           o Policy face or front page (if surplus lines stamp is not displayed on the declarations\n               page).\n           o Endorsements included on the sampling list.\n           o Agency invoices issued to policyholders for sampled policies.\n           o Proof of premium paid date.\n           o Proof of inspections, surveys, or membership agreements related to agency fees.\n\nOn-Site Requirements\n\nIf the review is conducted at the broker’s office, brokers must provide:\n\n   •   A desk/table and chair.\n   •   A telephone and power outlet.\n   •   Courtesy space for the analyst to perform their duties.\n\n                                                                                                   3\nTimeline & Findings Report\nBrokers will receive a written report of findings within 14 days of the date the review is completed.\nBrokers are expected to respond to any variances noted. Findings serve both as corrective direction\nand as an educational resource for brokers and agency staff.\n\nFrequency of Reviews\n\nCompliance reviews will take place on a routine cycle, every three (3) years, as part of the normal\noversight process, at random to ensure broad participation across the market, or when reporting\ndiscrepancies or other red flags are identified.\n\nSummary\nBy preparing ahead of the October program launch, brokers can ensure their reporting and records\nare accurate, complete, and in full alignment with state law. Compliance reviews are intended to\nsupport brokers, reduce errors, and strengthen the integrity of Georgia’s surplus lines market.\n\n                                                                                                   4","text_length":5146}
{"slug":"ga-bulletin-25-ex-2","jurisdiction":"GA","agency":"OCI","doc_type":"bulletin","citation":"GA OCI Bulletin 25-EX-2","title":"BULLETIN 25-EX-2: CITY OF COLUMBUS V. KENNEDY AND RE-FILING OF 2026 RATES","official_source_url":"https://oci.georgia.gov/document/bulletin/bulletin-25-ex-2-city-columbus-v-kennedy-and-re-filing-2026-rates/download","access_class":"source-wants-visibility","access_notes":"oci.georgia.gov; gate-zero TOP-20 GA bulletins row. pre-2019 archive sits on a commercial platform; excluded.","first_seen_at":"2026-07-20T01:59:05.806098+00:00","last_checked_at":"2026-07-20T06:40:21.566212+00:00","versions":[{"fetched_at":"2026-07-20T01:59:05.806098+00:00","version_no":1,"text_length":2843,"effective_date":null,"content_sha256_short":"9d75e1b91da3"}],"text":"BULLETIN 25-EX-02\n\nTO:             ALL HEALTH INSURERS OFFERING PLANS ON GEORGIA ACCESS\n\nFROM:           JOHN F. KING\n                INSURANCE AND SAFETY FIRE COMMISSIONER\n\nDATE:           SEPTEMBER 5, 2025\n\nRE:             CITY OF COLUMBUS V. KENNEDY AND RE-FILING OF 2026 RATES\n\nThe Georgia Office of the Commissioner of Insurance and Safety Fire (OCI) is issuing this bulletin\nto provide updated guidance regarding the federal court litigation in City of Columbus v. Kennedy.\n\nOn September 4, 2025, the Maryland District Court extended the time for the federal government\nto respond to its motion for a stay of the preliminary injunction originally issued on August 22,\n2025. This extension means the injunction is still in effect, and the provisions of the federal rule\nat issue in the case, particularly those concerning Actuarial Value (AV) policies, will not be\nimplemented for Plan Year 2026 at this time.\n\nAs a result, some previously filed health plans for Plan Year 2026 may be out of compliance with\nthe AV policy as it stands following the injunction. OCI is providing the following guidelines for\nre-filing rates to ensure continued compliance.\n\nRe-Filing Guidelines for Qualified Health Plans:\nTo address the impact of the injunction, OCI will allow a limited re-filing period for certain\nQualified Health Plans (QHPs).\n •    Allowed Re-filings: Only plans that OCI identifies as being out of compliance with the AV\n      policy due to the court order will be allowed to re-file. OCI will provide issuers with a specific\n      list of these plans.\n\n •    Permissible Changes: Allowable data changes are only those required to bring the specified\n      plans into compliance with the AV policy. Issuers must provide a clear summary of all\n      changes made with their re-filing.\n\n •    Plan Withdrawal Option: Issuers have the option to withdraw non-compliant plans instead of\n      re-filing, provided that they will still meet the required metal level offerings in each county\n      within their service area after the withdrawal. This option ensures that consumers will still\n      have a choice of plans while allowing issuers flexibility.\n •   Re-filing Deadline: OCI requests that carriers submit their re-filings as soon as possible, but\n     all re-filings must be received by OCI no later than Friday, September 12, 2025.\n\nOCI will continue to monitor the ongoing litigation and will provide further guidance as necessary.\nSmall Group plans and off-exchange plans will receive additional information regarding re-filing\nin the coming weeks. For any questions regarding this bulletin, please contact OCI at (404) 656-\n2070.\n\n                                          JOHN F. KING\n                                          INSURANCE AND SAFETY FIRE COMMISSIONER\n                                          STATE OF GEORGIA","text_length":2843}
{"slug":"ga-bulletin-25-ex-1","jurisdiction":"GA","agency":"OCI","doc_type":"bulletin","citation":"GA OCI Bulletin 25-EX-1","title":"BULLETIN 25-EX-1: ARBITRATION PANEL EXECUTIVE ORDER","official_source_url":"https://oci.georgia.gov/document/bulletin/bulletin-25-ex-1-arbitration-panel-executive-order/download","access_class":"source-wants-visibility","access_notes":"oci.georgia.gov; gate-zero TOP-20 GA bulletins row. pre-2019 archive sits on a commercial platform; excluded.","first_seen_at":"2026-07-20T01:59:05.806098+00:00","last_checked_at":"2026-07-20T06:40:21.566212+00:00","versions":[{"fetched_at":"2026-07-20T01:59:05.806098+00:00","version_no":1,"text_length":3209,"effective_date":null,"content_sha256_short":"fe67626d4920"}],"text":"BULLETIN 25-EX-1\n\nTO:          LICENSED ATTORNEYS AND INSURANCE ADJUSTERS IN GEORGIA\n\nFROM:        JOHN F. KING\n             INSURANCE AND SAFETY FIRE COMMISSIONER\n\nDATE:        FEBRUARY 19, 2025\n\nRE:          OPEN APPLICATION FOR ARBITRATION PANEL\n\n______________________________________________________________________________\n\nThe Commissioner of Insurance is accepting applications from Attorneys and Insurance Adjusters,\nlicensed in the State of Georiga to be arbitrators for the arbitration panel described below.\n\nTo provide procedures for the expeditious and efficient settlement of first-party property damage\nclaims under peronsal private passenger motor vehicle policies the Commissioner of Insurance\nand Safety Fire can establish a panel for arbitration of disputed property damage claims, where\nsuch claims involve total losses. O.C.G.A. § 33-34-8(6); Ga. Comp. R. & Regs. r. 120-2-52-.03(6).\nThe panel of arbitrators shall consist of attorneys authorized to practice law in this State and\ninsurance adjusters licensed to act as such in this State. Any panelists selected under this rule will\nbe chosen from the applications received by the Department.\n\nApplicants need to complete the attached application and provide:\n\n   -    Applicant’s Legal Name\n   -    Applicant’s Email Address\n   -    Applicant’s Phone Number\n   -    Applicant’s Mailing Address\n   -    GA Letter of Good Standing (Attorneys)\n   -    GA Disciplinary History (Attorneys)\n   -    GA License Number and National Producer Number (Adjusters)\n   -    Citizenship Affidavit (Form GID-276-GN)\n\n                                       _____________________________________________\n                                       JOHN F. KING\n                                       INSURANCE AND SAFETY FIRE COMMISSIONER\n                             Application for Arbitration Panel\nThe Commissioner of Insurance is accepting applications from licensed Attorneys and Insurance Adjusters\nlicensed in the State of Georgia to establish an arbitration panel for disputes related to disputed property claims,\nwhere such claims involve total losses. O.C.G.A.§ 33-34-8(6); Ga. Comp. R & Regs. r. 120-2-52-.03(6).\n\nThe panel of arbitrators shall consist of attorneys authorized to practice law in this State and insurance adjusters\nlicensed to act as such in this State. Attorneys and Adjusters must complete this form and provide the respective\ndocuments requested below to be considered under this rule.\n\n Applicant Type:                            ☐ Attorney\n (check one)                                ☐ Adjuster\n Legal Name:\n\n Email Address:\n\n Phone Number:\n\n Mailing Address:\n\n GA License Number:\n (Adjusters only)\n National Producer Number:\n (Adjusters only)\n\n Enclose Required Documents:                ☐ GA Letter of Good Standing (Attorneys)\n (check all that apply)                     ☐ GA Disciplinary History (Attorneys)\n                                            ☐ Citizenship Affidavit - Form GID-276-GN (All Applicants)\n\nEmail completed applications and the required supporting document(s) to the Administrative Procedure Division\nat ArbitrationPanel@oci.ga.gov. Please include “Arbitration Panel Application” in the subject line.","text_length":3209}
{"slug":"ga-bulletin-24-ex-11","jurisdiction":"GA","agency":"OCI","doc_type":"bulletin","citation":"GA OCI Bulletin 24-EX-11","title":"BULLETIN 24-EX-11: SPECIAL ENROLLMENT PERIOD DECEMBER 21 - DECEMBER 31","official_source_url":"https://oci.georgia.gov/document/bulletin/bulletin-24-ex-11-special-enrollment-period-december-21-december-31/download","access_class":"source-wants-visibility","access_notes":"oci.georgia.gov; gate-zero TOP-20 GA bulletins row. pre-2019 archive sits on a commercial platform; excluded.","first_seen_at":"2026-07-20T01:59:05.806098+00:00","last_checked_at":"2026-07-20T06:40:21.566212+00:00","versions":[{"fetched_at":"2026-07-20T01:59:05.806098+00:00","version_no":1,"text_length":835,"effective_date":null,"content_sha256_short":"3c90a47703c2"}],"text":"BULLETIN 24-EX-11\n\nTO:            ALL INSURERS OFFERING PLANS ON GEORGIA ACCESS\n\nFROM:          JOHN F. KING\n               INSURANCE AND SAFETY FIRE COMMISSIONER\n\nDATE:          DECEMBER 20, 2024\n\nRE:            SPECIAL ENROLLMENT PERIOD DECEMBER 21 – DECEMBER 31\n\nThe Commissioner of Insurance announces a Temporary Special Enrollment Period (the “SEP”)\n\nfor qualified Georgia Access enrollees whose coverage was automatically renewed for Plan Year\n\n2025 after December 1, 2024. This SEP will begin on December 21, 2024, and end on December\n\n31, 2024. Any coverage effectuated during this SEP will have an effective date of January 1, 2025.\n\n                                         JOHN F. KING\n                                         INSURANCE AND SAFETY FIRE COMMISSIONER\n                                         STATE OF GEORGIA","text_length":835}
{"slug":"ga-bulletin-24-ex-9","jurisdiction":"GA","agency":"OCI","doc_type":"bulletin","citation":"GA OCI Bulletin 24-EX-9","title":"BULLETIN 24-EX-9: ANNUAL SUBMISSION OF MENTAL HEALTH PARITY COMPARATIVE ANALYSES REPORT","official_source_url":"https://oci.georgia.gov/document/bulletin/bulletin-24-ex-9-annual-submission-mental-health-parity-comparative-analyses/download","access_class":"source-wants-visibility","access_notes":"oci.georgia.gov; gate-zero TOP-20 GA bulletins row. pre-2019 archive sits on a commercial platform; excluded.","first_seen_at":"2026-07-20T01:59:05.806098+00:00","last_checked_at":"2026-07-20T06:40:21.566212+00:00","versions":[{"fetched_at":"2026-07-20T01:59:05.806098+00:00","version_no":1,"text_length":4283,"effective_date":null,"content_sha256_short":"c3c6989dbbfa"}],"text":"BULLETIN 24-EX-9\nTO:       ALL ENTITIES OFFERING HEALTH BENEFIT PLANS IN GEORGIA\n\nFROM: JOHN F. KING\n      INSURANCE AND SAFETY FIRE COMMISSIONER\n\nDATE: NOVEMBER 27, 2024\n\nRE:      ANNUAL SUBMISSION OF MENTAL HEALTH PARITY COMPARATIVE\n         ANALYSES REPORT\n\nThe Official Code of Georgia (O.C.G.A.) § 33-1-27(b)(4) requires health insurers offering\ncoverage for mental health or substance use disorders as part of a health care plan to comply with\nGeorgia’s Mental Health Parity Act. Insurers subject to the preceding Code section are required to\nsubmit data on mental health parity and other information designated by the Commissioner on an\nannual basis to the Office of the Commissioner of Insurance (OCI).\nInsurers that offered coverage for mental health or substance use disorders as part of a health plan\nissued in or delivered in the State of Georgia are required to submit a Comparative Analysis Report\n(CAR) to the OCI on or before January 1st. Insurer groups wishing to submit a single CAR for\nmultiple insurance companies may do so as long as each document identifies the applicable\ncompany name and NAIC code.\nCompanies that filed an Attestation for Annual Reporting MHPAEA Analyses for the prior\nreporting year and received approval from the OCI are not required to submit a CAR, unless\ncoverage issued by the insurer in the State during the current reporting year is now subject to § 33-\n1-27.\nThe OCI has contracted with Regulatory Insurance Advisors, LLC (RIA) to facilitate the collection\nand analysis of mental health parity data.\n\nFILING INSTRUCTIONS\nTo facilitate the collection and analysis of mental health parity data, any questions regarding data\ncollection     and     mental     health     parity   analysis     should     be    addressed     to\nGA_MHPA_DataCall@riaconsulting.net.\nWhen submitting the CAR, please include the following in the email Subject line: “Comparative\nAnalyses Report,” data year, Company NAIC Code, and Company Name. For example, the\nSubject line would be: Comparative Analyses Report, YYYY, NAIC Code 12345 – ABC\nCompany. This analysis is based on current plan year information.\n  Submission          Georgia Code\n                                                  Due Date              Where to send\n   Required            Reference\n                                                              GA Office of Commissioner of\n Comparative    O.C.G.A. § 33-1- 27(b)(4) January 1st or\n                                         last business day             Insurance\nAnalyses Report                                             GA_MHPA_DataCall@riaconsulting.net\n                                          prior to deadline\n\n The following are required for inclusion in the Comparative Analyses Report and resources\n available:\n\n     •   Results of Department of Labor (DOL) Self-Compliance Tool (Refer to resources at:\n         https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/mental-health-and-\n         substance-use-disorder-parity);\n     •   Identified Non-Quantitative Treatment Limitations (NQTL’s) (i.e., prior authorizations,\n         reimbursement rates, and exceptions to access to non-network providers).\n     •   Factors considered in developing NQTL’s;\n     •   Experience/expertise of people developing NQTL’s;\n     •   Sources and evidentiary standards utilized to identify NQTL’s. A best practice is to provide\n         the entire PDF of the sources and evidentiary standards, including page numbers and sections.\n     •   Proof of processes and evidentiary standards used in applying the NQTL’s are comparable\n         and no more stringently applied to Mental Health and Substance Use Disorder (MH/SUD)\n         and Medical/Surgical benefits as written, and in operation.\n     •   Complete, clear and unredacted documentation.\n     •   It is unnecessary and inappropriate to put confidential and proprietary information\n         protections or statements on any documentation submitted.\n\n If you have any questions, please contact the Office of the Commissioner of Insurance by email at\n GA_MHPA_DataCall@riaconsulting.net.\n\n                                      JOHN F. KING\n                                      INSURANCE AND SAFETY FIRE COMMISSIONER\n                                      STATE OF GEORGIA","text_length":4283}
{"slug":"ga-bulletin-24-ex-8","jurisdiction":"GA","agency":"OCI","doc_type":"bulletin","citation":"GA OCI Bulletin 24-EX-8","title":"BULLETIN 24-EX-8: EMERGENCY DISASTER ADJUSTER REQUEST","official_source_url":"https://oci.georgia.gov/document/bulletin/bulletin-24-ex-8-emergency-disaster-adjuster-request/download","access_class":"source-wants-visibility","access_notes":"oci.georgia.gov; gate-zero TOP-20 GA bulletins row. pre-2019 archive sits on a commercial platform; excluded.","first_seen_at":"2026-07-20T01:59:05.806098+00:00","last_checked_at":"2026-07-20T06:40:21.566212+00:00","versions":[{"fetched_at":"2026-07-20T01:59:05.806098+00:00","version_no":1,"text_length":0,"effective_date":null,"content_sha256_short":"3eb35793a1ff"}],"text":"","text_length":0}
{"slug":"ga-bulletin-26-ex-2","jurisdiction":"GA","agency":"OCI","doc_type":"bulletin","citation":"GA OCI Bulletin 26-EX-2","title":"BULLETIN 26-EX-2: TAX CREDITS FOR CONTRIBUTIONS TO FOSTER CHILD SUPPORT ORGANIZATIONS","official_source_url":"https://oci.georgia.gov/document/bulletin/bulletin-26-ex-2-tax-credits-contributions-foster-child-support-organizations/download","access_class":"source-wants-visibility","access_notes":"oci.georgia.gov; gate-zero TOP-20 GA bulletins row. pre-2019 archive sits on a commercial platform; excluded.","first_seen_at":"2026-07-20T01:59:05.806098+00:00","last_checked_at":"2026-07-20T06:40:21.566212+00:00","versions":[{"fetched_at":"2026-07-20T01:59:05.806098+00:00","version_no":1,"text_length":2087,"effective_date":null,"content_sha256_short":"d49ecfc7da74"}],"text":"BULLETIN 26-EX-2\n\nTO:          ALL ADMITTED INSURERS CONDUCTING BUSINESS IN\n             THE STATE OF GEORGIA\n\nFROM:        JOHN F. KING\n             INSURANCE AND SAFETY FIRE COMMISSIONER\n\nDATE:        May 29, 2026\n\nRE:         TAX CREDITS FOR CONTRIBUTIONS TO FOSTER CHILD\n            SUPPORT ORGANIZATIONS\n\nThe purpose of this Bulletin is to inform all insurers conducting business in the state of Georgia\nabout a provision of House Bill 136 which goes into effect for tax years beginning on or after\nJanuary 1, 2026.\n\nThe legislation provides for tax credits of up to 30 percent of an insurer’s state insurance premium\ntax liability participating in the Qualified Foster Child Support (“QFCS”) Donation Credit, when\napplied for between January 1 and June 30 of the year in which the credit will be taken. If there are\naggregate amounts remaining after June 30, a company can apply between July 1 and December 31,\nand if approved, 100% of the tax liability can be taken. The state has designated up to $10 million of\nthe $30 million in annual QFCS tax credits specifically for insurers.\n\nThe QFCS Tax Credit Program allows any eligible company to redirect up to 30 percent of their\nstate tax liability to an approved Qualified Organizations (QO) in order to support foster children\nand justice involved youth.\n\n   1. Visit the Department of Revenue’s Georgia Tax Center (GTC) for instruction on\n      applying for the QFCS. If you have never filed an income tax return, contact the\n      Taxpayer Services Call Center at 877-423-6711.\n\n   2. Claim your Credits\n         a. List the earned credits on Section 4 of Form GID-205-PT. The total of section 1-4\n             of Form GID-205-PT should be claimed on line 12 of Form GID-012-PT, the\n             Georgia Insurance Premium Tax Return. Attach a copy of both the GA DOR\n             approval letter and QO acknowledgment to the Return.\n         b. Unused credits may be carried forward for up to three years.\n____________________________________________________\nJOHN F. KING\nINSURANCE AND SAFETY FIRE COMMISSIONER\nSTATE OF GEORGIA","text_length":2087}
{"slug":"il-cb-2018-10","jurisdiction":"IL","agency":"IDOI","doc_type":"bulletin","citation":"IDOI CB 2018-10","title":"Company Bulletin 2018-10","official_source_url":"https://idoi.illinois.gov/content/dam/soi/en/web/insurance/companies/companybulletins/cb2018-10.pdf","access_class":"statutory-public","access_notes":"idoi.illinois.gov; gate-zero IL-a. PARTIAL SET: page-1-per-year harvest; pagination completion pending.","first_seen_at":"2026-07-19T16:34:41.510376+00:00","last_checked_at":"2026-07-20T06:28:38.037958+00:00","versions":[{"fetched_at":"2026-07-19T16:34:41.510376+00:00","version_no":1,"text_length":0,"effective_date":"2018-11-09","content_sha256_short":"a3d4490d4e8b"}],"text":"","text_length":0}
{"slug":"il-cb-2018-09","jurisdiction":"IL","agency":"IDOI","doc_type":"bulletin","citation":"IDOI CB 2018-09","title":"Company Bulletin 2018-09","official_source_url":"https://idoi.illinois.gov/content/dam/soi/en/web/insurance/companies/companybulletins/cb2018-09.pdf","access_class":"statutory-public","access_notes":"idoi.illinois.gov; gate-zero IL-a. PARTIAL SET: page-1-per-year harvest; pagination completion pending.","first_seen_at":"2026-07-19T16:34:41.510376+00:00","last_checked_at":"2026-07-20T06:28:38.037958+00:00","versions":[{"fetched_at":"2026-07-19T16:34:41.510376+00:00","version_no":1,"text_length":3451,"effective_date":"2018-10-18","content_sha256_short":"46c71080e92e"}],"text":"Illinois Department of Insurance\n\nBRUCE RAUNER                                                                                     JENNIFER HAMMER\n      dovernor                                                                                        Director\n\nTO:               ALL INSURANCE COMPANIES APPROVED TO PROVIDE WORKERS'\n                  COMPENSATION INSURANCE CO RAGE     THE STATE OF ILLINOIS\n\nFROM:             Jennifer Hammer, Director of Insuran\n\nDATE:             October 18, 2018\n\nRE:               Company Bulletin #2018-09 Workers' Compensation Rating\n\nThe purpose of this Bulletin is to provide guidance for all insurance companies who write workers'\ncompensation coverage in Illinois if they choose to use rate tiering.\n\nInsurance companies authorized to write workers' compensation insurance in Illinois may establish\nmultiple rating tiers to price workers' compensation insurance policies. Companies must file all workers'\ncompensation rates, including multiple rating tiers, with the Illinois Department oflnsurance in accordance\nwith 215 ILCS 5/456-457 and 50 Ill. Adm. Code Section 2902.\n\n      1. Workers' Compensation Classification Rate Tiering will require:\n             a. a filed program used to dete1mine tier placement;\n                       1. Tiering should use objective criteria (not subjective).\n                      11. Tiering should be applied uniformly across all policyholders.\n                     111. When determining rates, the Experience Modification should be considered in\n                          the Generalized Linear Model (GLM) and other calculations.\n                     1v. Companies filing Tiers should provide a distribution of insureds by Tier.\n                      v. Tiering definitions should be fully disclosed to show all factors contributing to\n                          the Tiering mechanism.\n             b. all rate pages to be filed; and\n                       i. completion of the Company Rate Information within the filing.\n                      ii. percentage deviation from the licensed rating organizations recommend rate\n                          filing for the overall rate adjustment.\n             c. all rates are not to be excessive, inadequate or unfairly discriminatory.\n                       1. In determining compliance with 456(l)(d): \"unfair discrimination exists if, after\n                          allowingfor practical limitations, price differentials fail to reflect equitably the\n                          difference in expected losses and expenses. A rate is not unfairly discriminatory\n                          because different premiums result for policyholders with like exposures but\n                          different expenses, or like expenses but different loss exposures, so long as the\n                          rate reflects the differences with reasonable accuracy\", data collection\n                          resource(s) should be provided within the filing.\n      2. Proper compliance with all adopted licensed rating organization filings, i.e. statistical data\n         reporting in accordance with 50 Ill. Adm. Code Section 2903.\n\nQuestions regarding this bulletin may be directed to DOI.InfoDesk@illinois.gov\n\n                                                  320 West Washington St.\n                                                Springfield, Illinois 62767-0001\n                                                        (217) 782-4515","text_length":3451}
{"slug":"il-cb-2017-05","jurisdiction":"IL","agency":"IDOI","doc_type":"bulletin","citation":"IDOI CB 2017-05","title":"Company Bulletin 2017-05","official_source_url":"https://idoi.illinois.gov/content/dam/soi/en/web/insurance/companies/companybulletins/cb2017-05.pdf","access_class":"statutory-public","access_notes":"idoi.illinois.gov; gate-zero IL-a. PARTIAL SET: page-1-per-year harvest; pagination completion pending.","first_seen_at":"2026-07-19T16:34:41.510376+00:00","last_checked_at":"2026-07-20T06:28:38.037958+00:00","versions":[{"fetched_at":"2026-07-19T16:34:41.510376+00:00","version_no":1,"text_length":0,"effective_date":"2017-12-21","content_sha256_short":"fc83ee62a1ce"}],"text":"","text_length":0}
{"slug":"il-cb-2017-04","jurisdiction":"IL","agency":"IDOI","doc_type":"bulletin","citation":"IDOI CB 2017-04","title":"Company Bulletin 2017-04","official_source_url":"https://idoi.illinois.gov/content/dam/soi/en/web/insurance/companies/companybulletins/cb2017-04.pdf","access_class":"statutory-public","access_notes":"idoi.illinois.gov; gate-zero IL-a. PARTIAL SET: page-1-per-year harvest; pagination completion pending.","first_seen_at":"2026-07-19T16:34:41.510376+00:00","last_checked_at":"2026-07-20T06:28:38.037958+00:00","versions":[{"fetched_at":"2026-07-19T16:34:41.510376+00:00","version_no":1,"text_length":0,"effective_date":"2017-12-20","content_sha256_short":"619474d0fb75"}],"text":"","text_length":0}
{"slug":"il-cb-2017-01","jurisdiction":"IL","agency":"IDOI","doc_type":"bulletin","citation":"IDOI CB 2017-01","title":"Company Bulletin 2017-01","official_source_url":"https://idoi.illinois.gov/content/dam/soi/en/web/insurance/companies/companybulletins/cb2017-01.pdf","access_class":"statutory-public","access_notes":"idoi.illinois.gov; gate-zero IL-a. PARTIAL SET: page-1-per-year harvest; pagination completion pending.","first_seen_at":"2026-07-19T16:34:41.510376+00:00","last_checked_at":"2026-07-20T06:28:38.037958+00:00","versions":[{"fetched_at":"2026-07-19T16:34:41.510376+00:00","version_no":1,"text_length":0,"effective_date":"2017-03-10","content_sha256_short":"e3073b1b2c58"}],"text":"","text_length":0}
{"slug":"il-cb-2016-08","jurisdiction":"IL","agency":"IDOI","doc_type":"bulletin","citation":"IDOI CB 2016-08","title":"Company Bulletin 2016-08","official_source_url":"https://idoi.illinois.gov/content/dam/soi/en/web/insurance/companies/companybulletins/cb2016-08.pdf","access_class":"statutory-public","access_notes":"idoi.illinois.gov; gate-zero IL-a. PARTIAL SET: page-1-per-year harvest; pagination completion pending.","first_seen_at":"2026-07-19T16:34:41.510376+00:00","last_checked_at":"2026-07-20T06:28:38.037958+00:00","versions":[{"fetched_at":"2026-07-19T16:34:41.510376+00:00","version_no":1,"text_length":0,"effective_date":"2016-10-11","content_sha256_short":"2455b516c2b5"}],"text":"","text_length":0}
{"slug":"il-cb-2016-02","jurisdiction":"IL","agency":"IDOI","doc_type":"bulletin","citation":"IDOI CB 2016-02","title":"Company Bulletin 2016-02","official_source_url":"https://idoi.illinois.gov/content/dam/soi/en/web/insurance/companies/companybulletins/cb2016-02.pdf","access_class":"statutory-public","access_notes":"idoi.illinois.gov; gate-zero IL-a. PARTIAL SET: page-1-per-year harvest; pagination completion pending.","first_seen_at":"2026-07-19T16:34:41.510376+00:00","last_checked_at":"2026-07-20T06:28:38.037958+00:00","versions":[{"fetched_at":"2026-07-19T16:34:41.510376+00:00","version_no":1,"text_length":9600,"effective_date":"2016-02-08","content_sha256_short":"e89224efbcfe"}],"text":"Illinois Department of Insurance\n\nBRUCE RAUNER                                                                ANNE MELISSA DOWLING\n   Governor                                                                     Acting Director\n\nTO:           All Insurers\n\nFROM:         Anne Melissa Dowling, Acting Director of Insurance\n\nDATE:         February 5, 2016\n\nRE:           COMPANY BULLETIN CB #2016-02\n              ILLINOIS-SPECIFIC SMALL GROUP COMPOSITE PREMIUM METHOD\n\nFamily Composite Premiums in the Illinois Small Group Market for Health Benefit Plans\n                  Issued or Renewed on or after January 1, 2016\n\nIllinois has allowed the use of family tiered composite premiums in the small group market, and\nits use has been well established in the marketplace. Under a tiered composite approach, the\npremium levels for all small group employees are derived from the combined rating\ncharacteristics of the entire group, adjusted to allow for the inclusion of an employee’s covered\ndependents. The Illinois Department believes that the use of a composite premium\nmethodology may reduce administrative burdens on issuers and small group employers, will\nreduce premium instability for employers and employees, will simplify employee decisions, and\nmay facilitate defined employer contributions. As the use of composite premiums is also\nwidespread in the large group market, providing the use of composite premiums for smaller\nemployers also ensures consistent practices across the entire group market.\n\nThe following sections outline the requirements for issuers looking to implement composite\nrating methodology in the small group market outside the Federal Marketplace – both for\ndeveloping aggregate composite premiums and allocating these premiums to covered\nemployees and their dependents.\n\nA. Development of Composite Premiums\n\nAs required by 45 CFR §147.102(c)(1) and (3), a composite premium must be developed using\na per-member rating methodology. For each covered employee and his/her covered\ndependents, the premium must be determined as follows:\n   - For each covered child age 0 to 20: Calculate the rate for each of the oldest three\n      children by multiplying the base rate by the applicable age and geographic area factors.\n      Tobacco use factors must not be applied at this time.\n   - For all other individuals: Calculate the rate for each person by multiplying the base rate\n      by the applicable age and geographic area factors. Tobacco use factors must not be\n      applied at this time.\n\n                                        320 West Washington St.\n                                      Springfield, Illinois 62767-0001\n                                               (217) 782-4515\n                                        http://insurance.illinois.gov\nIllinois Department of Insurance\nCompany Bulletin 2016-02\nPage 2 of 4\n\nAge and geographic area are determined at the time that coverage is issued to or renewed\nwith the group. The composite premium prior to tobacco use surcharges is equal to the sum of\nthe premiums determined for each covered employee and his/her covered dependents.\n\nB. Allocation of Composite Premiums\n\nOnce a composite premium has been calculated, it must be allocated back to covered\nemployees based on the tier factor applicable to each employee’s family composition. Illinois\nrequires standard tier definitions and factors for all issuers where tiered composite rating is\nused, as follows:\n       - Employee only = 1.00\n       - Employee + spouse = 2.00\n       - Employee + children (including all covered children up to age 26) = 1.85\n       - Employee + family (including spouse and all covered children up to age 26) = 2.85\nNote that all children under age 26 are considered to meet the definition of “children” for\nemployee + family and employee + children tiers.\n\nThe Weighted Employee Count is equal to the sum of the tier factors determined across all\ncovered employees. From this the Final Tier Premium prior to tobacco use surcharges can be\ncalculated as:\n\n      Final Tier Premium = [Group aggregate premium] / [Weighted Employee count]\n                               x [Tier factor]\n\nFor any employee, the premium applicable can then simply be derived per the formula below:\n\n      Final Employee Premium = Final tier Premium +\n                            [Applicable Tobacco Surcharge, if any]\n\nC. Example\n\nAs an example of the above approach, consider the following group of employees:\n   - Employee A: Employee + spouse + 2 children = Employee + family\n   - Employee B: Employee + spouse\n   - Employee C: Employee + spouse + 3 children = Employee + family\n   - Employee D: Employee + 4 children = Employee + children\n   - Employee E: Employee only\n\nFor each of the employees, the applicable tier factor is then assigned.\n   - Employee A: Employee + family = 2.85\n   - Employee B: Employee + spouse = 2.00\n   - Employee C: Employee + family = 2.85\n   - Employee D: Employee + children = 1.85\n   - Employee E: Employee only = 1.00\n\n                                        320 West Washington St.\n                                      Springfield, Illinois 62767-0001\n                                               (217) 782-4515\n                                        http://insurance.illinois.gov\nIllinois Department of Insurance\nCompany Bulletin 2016-02\nPage 3 of 4\n\nThe Weighted Employee Count can then be derived as follows:\n\n      Weighted employee count = 2.85 + 2.00 + 2.85 + 1.85 + 1.00 = 10.55\n\nAssuming the total monthly premium for the group is $5,275 (prior to any tobacco surcharge),\nthe Final Tier Premium for each tier can be derived consistent with the formula above.\n   - Employee only = 5,275/10.55 x 1.00 = 500\n   - Employee + spouse = 5,275/10.55 x 2.00 = 1,000\n   - Employee + children = 5,275/10.55 x 1.85 = 925\n   - Employee + family = 5,275/10.55 x 2.85 = 1,425\n\nEach employee is then assigned the premium applicable to their tier.\n   - Employee A: Employee + family = 1,425\n   - Employee B: Employee + spouse = 1,000\n   - Employee C: Employee + family = 1,425\n   - Employee D: Employee + children = 925\n   - Employee E: Employee only = 500\n      TOTAL = 1,425 + 1,000 + 1,425 + 925 + 500 = $5,275\n\nThe final premium for any employee would be the amount shown above plus any tobacco\nsurcharges applicable to the employee and his/her covered dependents.\n\nD. Recalculation of Average Monthly Premiums\n\nThroughout a small group’s policy period, employees may come and go and employees may\nqualify for special enrollment periods due to various life events. The methodology described\nabove determines premiums for each tier based on a census of employees and their covered\ndependents at the time the group’s policy is issued or renewed. The average monthly premium\nfor each of the tiers (“Final Tier Premium” above) must remain in effect throughout the entire\npolicy period and may not increase or decrease to reflect changes in the small group census.\nThe Final Tier Premium must be recalculated annually, based on the census at the time the\npolicy is rated.\n\nE. Application of Tobacco Use Factors\n\nThe family composite premiums do not include a tobacco use factor. If a tobacco use factor is\nused, it must be applied to the specific individual, and is applied to premium applicable to that\nindividual if per-member rating were applicable (the same amount the member would\ncontribute to the Development of Composite Premiums as outlined in Section A above). This\nadditional surcharge is then added to the monthly premium for that individual previously\ndetermined based upon the tier allocation.\n\n                                        320 West Washington St.\n                                      Springfield, Illinois 62767-0001\n                                               (217) 782-4515\n                                        http://insurance.illinois.gov\nIllinois Department of Insurance\nCompany Bulletin 2016-02\nPage 4 of 4\n\nFor example, assume the spouse of employee C had premium of $600 contributing to the\naggregate $5,275, is a tobacco user, and the carrier has a tobacco use factor of 50%.\n   -   The total tobacco surcharge applicable to the spouse of employee C = 50% x $600 =\n       $300.\n   -   The total premium for employee C and family would be $1,425 + $300 = $1,725.\n\nF. Additional items\n\n   1) The method will be the only permitted composite premium method for new and\n      renewing non-grandfathered small group plans in Illinois offered outside the\n      marketplace, effective on or after January 1, 2016. Plans offered through the\n      marketplace are offered in partnership with the Federal SHOP, which does not currently\n      allow for composite premiums to be offered. When the Federal SHOP does implement\n      composite premiums, it will only utilize the federal two tiered approach and not the state\n      specific composite premium approach utilized outside of SHOP.\n\n   2) This bulletin does not intend to restrict per-member rating in the small group market.\n      Per-member premiums will also be permitted.\n\n   3) If an issuer elects to offer the tiered-composite premium methodology in Illinois, the\n      issuer is required to offer this option to all small employer groups without regard to size.\n\nPlease direct questions regarding this bulletin to Eric Anderson at eric.anderson@illinois.gov.\n\n                                        320 West Washington St.\n                                      Springfield, Illinois 62767-0001\n                                               (217) 782-4515\n                                        http://insurance.illinois.gov","text_length":9600}
{"slug":"il-cb-2026-08","jurisdiction":"IL","agency":"IDOI","doc_type":"bulletin","citation":"IDOI CB 2026-08","title":"Company Bulletin 2026-08","official_source_url":"https://idoi.illinois.gov/content/dam/soi/en/web/insurance/companies/companybulletins/cb-2026-08-climate-risk-disclosure-survey.pdf","access_class":"statutory-public","access_notes":"idoi.illinois.gov; gate-zero IL-a. PARTIAL SET: page-1-per-year harvest; pagination completion pending.","first_seen_at":"2026-07-19T16:34:41.510376+00:00","last_checked_at":"2026-07-20T06:28:38.037958+00:00","versions":[{"fetched_at":"2026-07-19T16:34:41.510376+00:00","version_no":1,"text_length":13661,"effective_date":"2026-06-29","content_sha256_short":"a9051f2a54f3"}],"text":"Illinois Department of Insurance\n\n JB PRITZKER                                                                             ANN GILLESPIE\n   Governor                                                                                 Director\n\nTO:               All Illinois Licensed Insurers\n\nFROM:             Ann Gillespie, Director\n\nDATE:             June 29, 2026\n\nRE:               Company Bulletin 2026-08 – Climate Risk Disclosure Survey\n\nIn cooperation with chief insurance regulators from American Samoa, California, Colorado,\nConnecticut, Delaware, District of Columbia, Guam, Hawaii, Maine, Maryland, Massachusetts,\nMichigan, Minnesota, Nevada, New Hampshire, New Jersey, New Mexico, New York, Northern\nMariana Islands, Oregon, Pennsylvania, Puerto Rico, Rhode Island, US Virgin Islands, Vermont,\nVirginia, Washington, and Wisconsin, the Illinois Department of Insurance is conducting the Climate\nRisk Disclosure Survey for Reporting Year 2025.\n\nFor the current survey, Reporting Year 2025, all participating insurers are required to report using the\nTask Force on Climate related Financial Disclosure (TCFD)-aligned NAIC Climate Disclosure Risk\nSurvey. For reporting year 2024, more than 1,800 companies responded to the Survey, capturing over\n86% of the entire U.S. insurance market. For guidance on the specific survey sections and questions,\nreference the NAIC Climate Risk Disclosure Survey document. Pursuant to P.A. 104-0534, all insurance\ncompanies who are licensed in the State of Illinois and who collected direct written premium amounts of\nmore than $100 million dollars nationwide during 2025 must respond to the survey.\n\nThe completed survey responses are due August 31, 2026. Please register and submit your survey\nresponses to the Department by going to the survey registration on the interactive web application and\nfollowing the registration and submission instructions. Insurance companies have to submit the TCFD-\naligned Climate Risk Disclosure Survey through a PDF document. Companies can use the Survey\nQuestions document attached to furnish their responses or upload their own TCFD-aligned report. All\nresponses should be self-contained within a single document, rather than a link to a public\nreport.\n\nCompanies within the same group whose policies and practices are the same and whose answers would\nnot be materially different from each other may submit uniform group\nresponses. When submitting group responses, please be certain to check the premium amounts for\neach individual company in the group that you are responsible for and submit a document for\neach company with more than $100 million in direct written premium nationwide.\n\nIn addition to the narrative Climate Risk Disclosure Survey, we invite companies to consider responding\nto the following voluntary closed-ended (Y/N) questions on this SurveyMonkey link. The voluntary\nclosed-ended questions align with the NAIC Climate Risk Disclosure Survey.\n\n           Springfield Office                                                       Chicago Office\n        320 W. Washington Street                                              115 S. LaSalle St., 13th Floor\n         Springfield, Illinois 62767                                             Chicago, Illinois 60603\n              (217) 782-4515                                                        (312) 814-2420\nConsistent with previous years, Climate Risk Disclosure Survey responses for the current and prior\nyears are available to the public and can be found on the California Department of Insurance’s\nwebsite. Additional information and guidance related to the survey can also be found on the California\nDepartment’s Climate Risk Disclosure website.\n\nWe have also provided a series of webinars on this Survey to build knowledge and capacity within the\ninsurance sector and insurance companies. You can find the webinars archived at the Climate Risk and\nResiliency Resource Center. We believe that these webinars will offer an excellent opportunity for\nparticipants to enhance their understanding of climate risk disclosure practices and gain practical\nknowledge on how to improve their own reporting.\n\nQuestions regarding this Company Bulletin should be directed to: DOI.InfoDesk@illinois.gov\n\nAttachment: NAIC Climate Risk Disclosure Survey TCFD-Aligned Questions\n\n           Springfield Office                                                     Chicago Office\n        320 W. Washington Street                                            115 S. LaSalle St., 13th Floor\n         Springfield, Illinois 62767                                           Chicago, Illinois 60603\n              (217) 782-4515                                                      (312) 814-2420\n     NAIC CLIMATE RISK DISCLOSURE SURVEY\n           TCFD-ALIGNED QUESTIONS\n                UPDATED 2022\nGOVERNANCE\n    1. Disclose the insurer’s governance around climate-related risks and opportunities.\nIn disclosing the insurer’s governance around climate-related risks and opportunities insurers should\nconsider including the following:\n         • Identify and include any publicly stated goals on climate-related risks and opportunities.\n         • Describe where climate-related disclosure is handled within the insurer’s structure, e.g., at a\n         group level, entity level, or a combination. If handled at the group level, describe what activities are\n         undertaken at the company level.\n         A. Describe the board and/or committee responsible for the oversight of climate-related risks and\n         opportunities.\nIn describing the position on the board and/or committee responsible for the oversight of managing the\nclimate-related financial risks, insurers should consider including the following:\n         • Describe the position on the board and/or committee responsible for the oversight of managing\n         the climate-related financial risks.\n         B. Describe management's role in assessing and managing climate-related risks and opportunities.\n\nSTRATEGY\n    2. Disclose the actual and potential impacts of climate-related risks and opportunities on the insurer’s\n         businesses, strategy, and financial planning where such information is material.\nIn disclosing the actual and potential impacts of climate-related risks and opportunities on the insurer’s\nbusinesses, strategy and financial planning, insurers should consider including the following:\n         • Describe the steps the insurer has taken to engage key constituencies on the topic of climate risk\n         and resiliency. *\n         • Describe the insurer's plan to assess, reduce, or mitigate its greenhouse gas emissions in its\n         operations or organizations. *\n         A. Describe the climate-related risks and opportunities the insurer has identified over the short,\n         medium, and long term.\nIn describing the climate-related risks and opportunities the insurer has identified over the short, medium,\nand longer term, insurers should consider including the following:\n                 • Define short, medium, and long-term, if different than 1-5 years as short term, 5-10 years\n                 as medium term, and 10-30 years as long term.\n         B. Describe the impact of climate-related risks and opportunities on the insurer’s business, strategy,\n         and financial planning.\nIn describing the impact of climate-related risks and opportunities on the insurer’s business, strategy, and\nfinancial planning, insurers should consider including the following:\n\n           Springfield Office                                                            Chicago Office\n        320 W. Washington Street                                                   115 S. LaSalle St., 13th Floor\n         Springfield, Illinois 62767                                                  Chicago, Illinois 60603\n              (217) 782-4515                                                             (312) 814-2420\n               • Discuss if and how the insurer provides products or services to support the transition to a\n               low carbon economy or helps customers adapt to climate-related risk.\n               • Discuss if and how the insurer makes investments to support the transition to a low\n               carbon economy.\n       C. Describe the resilience of the insurer’s strategy, taking into consideration different climate-related\n       scenarios, including a 2 degree Celsius or lower scenario.\n\nRISK MANAGEMENT\n    3. Disclose how the insurer identifies, assesses, and manages climate-related risks.\nIn disclosing how the insurer identifies, assesses, and manages climate-related risks, insurers\nshould consider including the following:\n         • Describe how the insurer considers the impact of climate related risks on its underwriting\n         portfolio, and how the company is managing its underwriting exposure with respect to physical,\n         transition and liability risk. *\n         • Describe any steps the insurer has taken to encourage policyholders to manage their potential\n         physical and transition climate related risks, if applicable. *\n         • Describe how the insurer has considered the impact of climate-related risks on its investment\n         portfolio, including what investment classes have been considered. *\n         A. Describe the insurers’ processes for identifying and assessing climate-related risks.\nIn describing the insurers’ processes for identifying and assessing climate-related risks, insurers should\nconsider including the following:\n                 • Discuss whether the process includes an assessment of financial implications and how\n                 frequently the process is completed. *\n         B. Describe the insurer’s processes for managing climate-related risks.\n         C. Describe how processes for identifying, assessing, and managing climate-related risks are\n         integrated into the insurer’s overall risk management.\nIn describing how processes for identifying, assessing, and managing climate-related risks are integrated\ninto the insurer’s overall risk management, insurers should consider including the following:\n                 • Discuss whether climate-related risks are addressed through the insurer’s general\n                 enterprise-risk management process or a separate process and how frequently the process\n                 is completed.\n                 • Discuss the climate scenarios utilized by the insurer to analyze its underwriting risks,\n                 including which risk factors the scenarios consider, what types of scenarios are used, and\n                 what timeframes are considered.\n                 • Discuss the climate scenarios utilized by the insurer to analyze risks on its investments,\n                 including which risk factors are utilized, what types of scenarios are used, and what\n                 timeframes are considered.\n\nMETRICS AND TARGETS\n   4. Disclose the metrics and targets used to assess and manage relevant collateralized risks and\n      opportunities where such information is material.\n\n           Springfield Office                                                           Chicago Office\n        320 W. Washington Street                                                  115 S. LaSalle St., 13th Floor\n         Springfield, Illinois 62767                                                 Chicago, Illinois 60603\n              (217) 782-4515                                                            (312) 814-2420\nIn disclosing the metrics and targets used to assess and manage relevant collateralized risks and\nopportunities where such information is material, insurers should consider including the following:\n         • Discuss how the insurer uses catastrophe modeling to manage the climate-related risks to your\n         business. Please specify for which climate-related risks the insurer uses catastrophe models to\n         assess, if any.\n         A. Disclose the metrics used by the insurer to assess climate-related risks and opportunities in line\n         with its strategy and risk management process.\nIn disclosing the metrics used by the insurer to assess climate-related risks and opportunities in line with its\nstrategy and risk management process, insurers should consider including the following:\n                  • In describing the metrics used by the insurer to assess and monitor climate risks, consider\n                  the amount of exposure to business lines, sectors, and geographies vulnerable to climate-\n                  related physical risks [answer in absolute amounts and percentages if possible], alignment\n                  with climate scenarios, [1 in 100 years probable maximum loss, Climate VaR, carbon\n                  intensity], and the amount of financed or underwritten carbon emissions.\n         B. Disclose Scope 1, Scope 2, and if appropriate, Scope 3 greenhouse gas (GHG) emissions, and the\n         related risks.\n         C. Describe the targets used by the insurer to manage climate-related risks and opportunities and\n         performance against targets.\n\n* Asterisks represent questions derived from the original Climate Risk Disclosure Survey.\n\n            Springfield Office                                                                    Chicago Office\n         320 W. Washington Street                                                           115 S. LaSalle St., 13th Floor\n          Springfield, Illinois 62767                                                          Chicago, Illinois 60603\n               (217) 782-4515                                                                     (312) 814-2420","text_length":13661}
{"slug":"il-cb-2026-07","jurisdiction":"IL","agency":"IDOI","doc_type":"bulletin","citation":"IDOI CB 2026-07","title":"Company Bulletin 2026-07","official_source_url":"https://idoi.illinois.gov/content/dam/soi/en/web/insurance/companies/companybulletins/cb-2026-07-pdaa-applicability-to-medicaid-managed-care-plans.pdf","access_class":"statutory-public","access_notes":"idoi.illinois.gov; gate-zero IL-a. PARTIAL SET: page-1-per-year harvest; pagination completion pending.","first_seen_at":"2026-07-19T16:34:41.510376+00:00","last_checked_at":"2026-07-20T06:28:38.037958+00:00","versions":[{"fetched_at":"2026-07-19T16:34:41.510376+00:00","version_no":1,"text_length":7240,"effective_date":"2026-05-15","content_sha256_short":"3060fc902561"}],"text":"Illinois Department of Insurance\n\n JB PRITZKER                                                                               ANN GILLESPIE\n   Governor                                                                                   Director\n\nTO:              All Pharmacy Benefit Managers Registered in Illinois and All Illinois Medicaid Managed\n                 Care Entities\n\nFROM:            Ann Gillespie, Director\n\nDATE:            May 15, 2026\n\nRE:              Company Bulletin 2026-07 – PDAA Applicability to Medicaid Managed Care Plans\n\nThe Illinois Department of Insurance (“Department”) is issuing this bulletin to address the Medicaid-\nrelated applicability of provisions within Section 513b1 of the Illinois Insurance Code (“Code”) (215\nILCS 5/513b1), especially provisions that fall after subsection (f) and before subsection (g).\n\nSince January 1, 2026, pharmacy benefit managers (“PBMs”) and their affiliates have been\nrequired to comply with subsections (f-5) through (f-25) of Section 513b1 of the Code in relation to\nMedicaid managed care plans. Additionally, as “insurers” or “health insurers” within the meaning of\nSection 513b1(a-5), Medicaid managed care entities and their affiliates directly have been\nrequired to comply with subsections (f-10), (f-20), and (f-25) of Section 513b1.\n\nAs added by the Prescription Drug and Affordability Act,1 these subsections establish the following\nrequirements for the administration of pharmacy benefits under health benefit plans:\n\n       (f-5): “A pharmacy benefit manager or an affiliate acting on its behalf shall not conduct spread\n       pricing.”\n\n       (f-10): “A pharmacy benefit manager or an affiliate acting on its behalf shall not steer a covered\n       individual. This prohibition also applies to an insurer and its affiliates. Existing agreements entered\n       into before the effective date of this amendatory Act of the 104th General Assembly shall\n       supersede this subsection until the termination of the current term of such agreement.”\n\n       (f-15): “A pharmacy benefit manager or affiliated rebate aggregator must remit no less than 100%\n       of any amounts paid by a pharmaceutical manufacturer, wholesaler, or other distributor of a drug,\n       including, but not limited to, rebates, group purchasing fees, and other fees, to the health benefit\n       plan      sponsor,      covered       individual,     or      employer.”       The       subsection\n       further establishes a PBM reporting requirement to the Department of Insurance and protects\n       confidential information received by the Department.\n\n       (f-20): “A pharmacy benefit manager or an affiliate acting on its behalf is prohibited from limiting\n       a covered individual's access to drugs from a pharmacy or pharmacist enrolled with the health\n       benefit plan under the terms offered to all pharmacies in the plan coverage area by designating the\n           Springfield Office                                                         Chicago Office\n        320 W. Washington Street                                               115 S. LaSalle Street, 13th Floor\n        Springfield, Illinois 62767                                                Chicago, Illinois 60603\n             (217) 782-4515                                                            (312) 814-2420\n       covered drug as a specialty drug contrary to the definition in this Section. This prohibition also\n       applies to an insurer and its affiliates.”\n\n       (f-25) “The contract between the pharmacy benefit manager and the insurer or health benefit plan\n       sponsor must allow and provide for the pharmacy benefit manager's compliance with an audit at\n       least once per calendar year of the rebate and fee records remitted from a pharmacy benefit\n       manager or its affiliated party to a health benefit plan. This audit may be incorporated into the\n       audit under paragraph (5) of subsection (b) of this Section. Contracts with rebate aggregators,\n       pharmacy services administrative organizations, pharmacies, or drug manufacturers must be\n       available for audit by health benefit plan sponsors, insurers, or their designees at least once per\n       plan year. Audits shall be performed by an auditor selected by the health benefit plan sponsor,\n       insurer, or its designee.” The subsection further requires copies of the report to be provided to the\n       PBM and to the Department, affirms the Department’s authority to access books and records\n       regardless of any plan sponsor-initiated audit, and protects confidential information received by\n       the Department.\n\nIn general, Section 513b1 of the Code applies with respect to Medicaid managed care plans: “This Section\napplies to contracts entered into or renewed on or after July 1, 2022. Unless provided otherwise in this\nSection or in the Illinois Public Aid Code, this Section applies to pharmacy benefit managers that are\ncontracted with a Medicaid managed care entity on or after January 1, 2026...” 215 ILCS 5/513b1(j).\n\nAdditionally, the Code states: “The changes made to this Section by Public Act 104-27 shall apply with\nrespect to any health benefit plan that provides coverage for drugs that is amended, delivered, issued, or\nrenewed on or after January 1, 2026.” 215 ILCS 5/513b1(k). The definition of “health benefit plan” refers\nto contracts with an “insurer” to pay for the costs of various health benefits, and the definition of “insurer”\nexpressly includes Medicaid managed care organizations and managed care community networks. 215\nILCS 5/513b1(a) and (a-5).\n\nSection 513b1 of the Code contains only one provision with a Medicaid-related exemption:\n\n       (f) “Unless required by law, a contract between a pharmacy benefit manager or third-party payer\n       and a 340B entity or 340B pharmacy shall not contain any provision that:\n              ...\n              [list of prohibited contractual provisions]\n              ...\n       As used in this subsection, \"pharmacy benefit manager\" and \"third-party payer\" do not include\n       pharmacy benefit managers and third-party payers acting on behalf of a Medicaid\n       program” (emphasis added).\n\nBecause the phrase “this subsection” occurs within subsection (f), the phrase refers to subsection\n(f). Subsections (f-5) through (f-25) are different from, and not part of, subsection (f). In fact, subsection\n(f) predates the PDAA and was not substantively modified by it.2 Therefore, the “f-dash” subsections are\nnot affected by the above exemption. All “f-dash” subsections of Section 513b1 of the\nCode have applied with respect to Medicaid managed care plans since they took effect on January 1,\n2026.\n\nQuestions regarding this company bulletin can be directed to DOI.InfoDesk@illinois.gov.\n\n           Springfield Office                                                          Chicago Office\n        320 W. Washington Street                                                115 S. LaSalle Street, 13th Floor\n        Springfield, Illinois 62767                                                 Chicago, Illinois 60603\n             (217) 782-4515                                                             (312) 814-2420","text_length":7240}
{"slug":"il-cb-2026-06","jurisdiction":"IL","agency":"IDOI","doc_type":"bulletin","citation":"IDOI CB 2026-06","title":"Company Bulletin 2026-06","official_source_url":"https://idoi.illinois.gov/content/dam/soi/en/web/insurance/companies/companybulletins/revised-cb-2026-06.pdf","access_class":"statutory-public","access_notes":"idoi.illinois.gov; gate-zero IL-a. PARTIAL SET: page-1-per-year harvest; pagination completion pending.","first_seen_at":"2026-07-19T16:34:41.510376+00:00","last_checked_at":"2026-07-20T06:28:38.037958+00:00","versions":[{"fetched_at":"2026-07-19T16:34:41.510376+00:00","version_no":1,"text_length":27363,"effective_date":"2026-05-01","content_sha256_short":"9a08e60bf974"}],"text":"Illinois Department of Insurance\n\nJB PRITZKER                                                                                               ANN GILLESPIE\n  Governor                                                                                                   Director\n\nTO:                All Companies Writing Accident and Health Insurance and Managed Care Plans in Illinois\n\nFROM:              Ann Gillespie, Director\n\nDATE:              May 01, 2026 (REVISED: June 02, 2026)\n\nRE:                COMPANY BULLETIN 2026-06 - Illinois Filing Requirements for Individual and Small Group\n                   Health Plans, On and Off-marketplace (On and Off-exchange) and Stand-alone Dental Plans\n\nPlease note, items in red below have been amended as of the revised published date of this Company Bulletin.\nThe Department of Insurance (The Department) is issuing this Bulletin to provide instructions to Issuers seeking\ncertification or recertification of individual and small group plans and Stand-alone Dental Plans (SADP) offered\non the Individual and Small Business Health Options Program (SHOP) Marketplace. This Bulletin also applies to\nthose plans offered off the Affordable Care Act (ACA) Marketplace (Off-Exchange) in the individual and small\ngroup markets for Plan Year 2027. Student health plans are required to meet the standards for individual Qualified\nHealth Plans (QHP) with the exception of filing dates and rating rules. Student health plans must follow the\nspecific rating and eligibility rules as outlined by Centers for Medicare & Medicaid Services (CMS) for such\nplans.\n     NOTE: The issuer deadlines apply to ALL individual and small group health plans, and stand-alone\n                                  dental plans offered On and Off the Marketplace.\n                                           Activity                                                Dates\n                   Deadline for New Issuer to Declare Intent to be On-Exchange                   5/15/2026\n                   Deadline for Issuers to submit QHP/NQHP Applications to\n                                                                                                  6/3/2026\n                   Illinois DOI, including Plan ID Crosswalk data\n                   Public Posting of the proposed rates                                          6/10/2026\n                   QHP issuer submits the validated Quality Rating System (QRS)\n                   clinical measure data, with attestation, to CMS via NCQA’s                    6/15/2026\n                                                                 1\n  Plan and         Interactive Data Submission System (IDSS)\n  Rate             Deadline for issuers to submit their QHP Application Rates Table\n                                                                                                 7/15/2026\n  Application      Templates to CMS\n  and Review       CMS reviews Rates Table Template data and releases results in the\n  Process          Plan Management (PM) Community for issuers and states to Review         7/16/2026 – 8/7/2026\n\n                    Deadline for issuers to submit changes to their QHP Applications                    8/4/2026\n                    Plan Preview and Data Correction Window                                       8/15/2026-9/15/2026\n                    Get Covered Illinois (GCI) releases certification notices to issuers                9/16/2026\n                    Anonymous Shopping Opens                                                           10/13/2026\n                    Anticipated public display of QHP quality rating information                       10/13/2026\n            Springfield Office                                                                   Chicago Office\n         320 W. Washington Street                                                          115 S. LaSalle St., 13th Floor\n         Springfield, Illinois 62767                                                         Chicago, Illinois 60603\n              (217) 782-4515                                                                     (312) 814-2420\n                               Open Enrollment Begins                                            11/1/2026*\n\n1\n Each QHP issuer must submit and plan-lock its QRS clinical measure data by May 29 to allow the HEDIS®\nCompliance Auditor sufficient time to review, approve, and audit-lock all submissions by the June 15 deadline.\nThere are no fees for QHP issuers associated with accessing and using the IDSS.\n*The Department intends to propose a rule change to start Open Enrollment on 10/15 and the Department will\nprovide an updated notification if that change is adopted.\n\nIssuers are advised to consult federal regulations, the 2027 Final Letter to Issuers released May 28, 2026, and state\nlaw in conjunction with this Bulletin to ensure full compliance. Helpful documents can be found on the\nDepartment’s ACA Issuer Homepage.\n\n    1. All form filings must be submitted in the format of a complete insurance policy. The Department will not\n        accept matrix insert page filings, riders, amendments, variable language, or brackets within individual\n        (including ACA compliant student health plans) and small group filings. Approved filings will only be\n        reopened upon request from CMS. NOTE: Summary of Benefits and Coverage (SBC) may contain\n        bracketed information per the federal template, and the cover page may include brackets for policyholder\n        name, policy number, product name, effective date of policy and other identifying data.\n    2. Issuers are reminded to review all cost-sharing, benefit explanations, limitations and exceptions, listed\n        within the SBC, Plan Summary documents and Plan and Benefits Template to ensure all data is displayed\n        in a consistent and accurate manner to mitigate avoidable plan display inaccuracies and consumer\n        confusion that may result in Special Enrollment Periods.\n    3. Issuers are prohibited from utilizing misleading plan marketing names on all forms and/or corresponding\n        templates. Specifically, issuers are discouraged from using specific benefit and dollar amount references\n        in plan marketing names and templates. All plan marketing name information should be validated to\n        ensure accuracy and consistency across the plan or plan variation marketing name, Plans & Benefits\n        Template, HealthCare.gov plan selection information, and other applicable QHP certification materials.\n    4. Issuers are reminded to use the HIOS module, Marketplace Plan Management System (MPMS). Issuers\n        that previously submitted QHP Application data in the Issuer, Benefits & Service Area, Rating, and\n        Supplemental Submission Modules within HIOS will instead submit these data in the new HIOS MPMS\n        Module to create QHP Applications, submit templates and supporting documents, validate templates, and\n        access some QHP Application review results.\n    5. For Plan Year 2027 plans, Illinois requires the crosswalk template to be uploaded to the binders. Any\n        revised crosswalk submitted to CMS in PM Community, must also be submitted to the state binder in\n        System for Electronic Rate and Form Filing (SERFF).\n    6. Submit all checklists, templates and supporting documentation in SERFF.\n    7. Provide a red-lined version identifying the variations in plan benefit design from the plans submitted for\n        the previous plan year for each form filing submitted for recertification. Red-lined versions must be\n        submitted under the Supporting Documentation tab in the form filing in SERFF.\n    8. Associate all relevant filings in the SERFF binder including, but not limited to, form, rate, external\n        review, and network adequacy filings.\n    9. Do not include symbols, such as the trademark symbol, in any plan names.\n    10. Please note, regardless of any federal flexibility, Get Covered Illinois does not find the following plans to\n        be in the interest of qualified individuals or qualified employers in this State under 50 Ill. Adm. Code\n        4500.40(d)(2) and will not certify them:\n             o Catastrophic plans with terms longer than one year;\n             o Non-network QHPs or SADPs;\n\n                                                   Page 2 of 7\n        o    REVISED: Plans, including Bronze plans, with a Maximum Out of Pocket Limitation that\n             exceeds $12,000 for an individual or $24,000 for a family.\n11. The Department requires full updated network adequacy filings to be submitted. Please note, all network\n    plans other than most excepted benefits are subject to standards and filing requirements pursuant to 215\n    ILCS 124/et seq. as well as 50 Ill. Adm. Code 4540. To the extent that federal law establishes network\n    adequacy and transparency standards for stand-alone dental plans in State-based Marketplaces on the\n    Federal Platform, the Department will enforce those standards as the operator of the Illinois State-based\n    Marketplace. Issuers with planned provider terminations set to take place on or before 1/1/2027 should\n    not include those providers within their PY27 Network Filing. For example, if a termination of a network\n    agreement will take place 9/1/2026, the issuer should not include those providers within the PY27 filing\n    unless the parties have formally executed a renewal of a subsequent contract into PY27. Per the 2027\n    Final Letter to Issuers the appointment wait time standards in the 2025 Letter to Issuers remain in effect\n    for both medical QHPs and SADPs. NOTE: As a reminder to issuers with network plans, while the\n    Department adopted the federal time and distance standards established in Tables 3.1 and 3.2 for medical\n    plans and Table 3.3 for SADPs of the 2023 Letter to Issuers; the Department did not adopt the federal\n    enrollee accessibility threshold of 90 percent. As previously indicated, issuers who are unable to meet 100\n    percent accessibility will be required to complete the Network Adequacy Exception Form (as allowed).\n    See item #14 below.\n12. Network Adequacy County Facilities Collection Template: This excel document must be accurately\n    completed for each applicable network(s) that the plan intends to service. Data collected will identify\n    specific contracted Acute Inpatient Hospital and Inpatient or Residential Behavioral Health Facility\n    information for each respective county the plan intends to service. This document must accompany the\n    Network Adequacy filing. Visit the Accident & Health Checklists section of the Department’s website to\n    access and complete the template.\n13. QHP Service Area Exception: Issuers that fail to offer coverage to an entire county must obtain an\n    exception from the Department. (See QHP Service Area Exception Form) The Issuer must provide\n    service area maps to show compliance with the QHP service area requirement.\n14. Issuers who are not able to comply with the network adequacy standards for time and distance, provider\n    ratio, and appointment wait times are required to complete the with specific details pertaining to the\n    known deficiency for the Department’s review and consideration. NOTE: Pursuant to 215 ILCS\n    124/10(g) no exceptions may be granted for the requirements set forth in 215 ILCS 124/10(d-5), but\n    issuers must still identify and disclose such deficiencies.\n15. Remit the fee of $3,000.00 for certification of each new QHP plan and $1,500.00 for recertification for\n    each existing QHP plan via EFT in SERFF binder filings at the time of binder submission.\n16. For plans that will be terminated, discontinued, or modified, Issuers must submit the appropriate\n    notifications pursuant to 215 ILCS 97/30(C) and 215 ILCS 97/50(C). The issuer must also have provided\n    advance notice to the Department pursuant 215 ILCS 97/60.\n17. Issuers offering individual and small group off-exchange only plans must submit an off-exchange only\n    binder submission with all off-exchange only plans following the requirements outlined in this Bulletin.\n18. Every plan listed on the Plans & Benefits Template that the Issuer intends to market as a High Deductible\n    Health Plan (HDHP) or for use with a Health Savings Account (HSA) must have “HSA-Eligible” checked\n    on the template. Issuers are reminded that as a result of H.R. 1 Section 71307, Section 223(c)(2) of the\n    Internal Revenue Code was amended to expand the definition of “high deductible health plan” to include\n    all individual market qualified health plans available through an Exchange at the catastrophic or bronze\n    level of coverage, which grants such plans “HSA-Eligible” status. As clarified by Q&A #6 of IRS Notice\n    2026-5, this status applies to individual market catastrophic or bronze plans offered off-Exchange that are\n    identical to an individual catastrophic or bronze plan offered through the Exchange, and it even applies to\n\n                                              Page 3 of 7\n       “plans sold exclusively off-Exchange without a CSR reduction load that are otherwise identical to plans\n       sold on-Exchange with a cost sharing reduction load” (emphasis added). However, this provision does\n       not apply to any other plans that are exclusively sold off-Exchange or that are not sold in the individual\n       market. Other than an individual market QHP available through an Exchange at the catastrophic or bronze\n       level of coverage, no plan with a flat-dollar copayment structure for the entire prescription drug benefit as\n       described in 215 ILCS 134/45.3 may be marketed as an HDHP or have the “HSA-Eligible” field checked\n       on the template.”\n   19. All issuers on the SBM are required to complete the Formulary Compliance Template to assist in the\n       evaluation of Illinois specific requirements for prescriptions drugs. The checklist must accompany the\n       medical plan’s binder submission under the Supporting Documentation tab in SERFF.Claim Cost\n       Distributions for Carriers Participating in the Individual ACA: The Department is considering the\n       potential of a reinsurance program for the Individual ACA market through a Section 1332 Waiver. As\n       part of the PY2027 rate filing submission, carriers participating in the Individual ACA market are asked\n       to provide a member level total allowed cost (carrier paid and member paid prior to risk adjustment and\n       any other claim offsets) distribution for calendar year 2024 and 2025. Please bucket the total allowed\n       claim costs into $1,000 increments, for example $0-$999, $1,000-$1,999, etc. Provide the count of\n       members in each bucket as well as the total allowed cost in each bucket. Please also provide a count of\n       members with $0 claims for each year.\n   20. PENDING LEGISLATION THAT MAY IMPACT COVERAGE REQUIREMENTS IN PY 2027:\n       The Department strongly encourages plans to monitor all pending legislation, including but not limited to\n       the following pending bills with effective dates prior to or on January 1, 2027, to ensure compliance for\n       coverage:\n\n       HB 3454 would amend Section 356z.33 of the Illinois Insurance Code to substitute the term “epinephrine\n       injector” with “epinephrine delivery system” and would incorporate a new definition from the\n       Epinephrine Delivery System Act.\n\n       HB 4464 would prohibit DOI-regulated plans - including stand-alone dental plans (SADPs) - from\n       requiring dental providers to only accept electronic payments (including virtual cards).\n\n       SB 2838 would place further oversight on DOI-regulated hearing benefit plans and audiology benefit\n       managers and enact protections for audiology providers.\n\n       SB 3688 would prohibit DOI-regulated plans from requiring prior authorization or step therapy for\n       menopause therapies.\n\n       SB 3707 would give DOI greater oversight of vision benefit managers and vision benefit plan issuers,\n       create eye care provider reimbursement parity, and implement consumer protections.\n\n       SB 3815 would prohibit DOI-regulated plans from denying coverage to an individual or employer due to\n       a failure to pay premiums under a prior policy or contract. Allows plans to continue collecting past-due\n       premiums. Note: this proposal would be effective immediately.\n\nNOTE: Maximum Annual Limitation on Cost Sharing for Plan Year 2027 for IL\n\n                                               Individual Coverage                     Family Coverage\n Health Plans                                        $12,000                                $24,000\n                                                  Page 4 of 7\n SADPs                                                  $450                                   $900\n\nExhibit 1:\n\n2027 Health Plans Filing Requirements – Form and Binder\n\n                                                                Required Submission Via\n                                                                         SERFF\n                                                                  On/Off-        Off-\n               Federal Required Templates                                                              Location\n                                                                 Exchange     Exchange\n  All Applicable templates/documents listed on the CMS\n                                                                    Yes              Yes                Binder\n                  Certification Checklist\n             Illinois Required Documents\n     ACA Individual, Small Group, and Catastrophic\n                                                                    Yes              Yes              Form filing\n                         Checklist\n   ACA Individual and Small Group SADP Checklist                    Yes              Yes           Form filing\n      Network Adequacy and Transparency Checklist                                                   Network\n                                                                    Yes              Yes\n                   (Including SADPs)                                                             Adequacy Filing\n     Mental Health Parity Supporting Documentation\n                                                                    Yes              Yes            Form Filing\n           Template (does not include SADP)\n                                                                                                        Binder\n               Proposed Enrollment Template                         Yes              Yes\n\n                 External Review Checklist                                                       External Review\n                                                                    Yes              Yes\n                 (Not applicable to SADPs)                                                            Filing\n\nQHP Rates Guidance:\nCMS and the National Association for Insurance Commissioners (NAIC) have established a system connection\nbetween the SERFF and the Health Insurance Oversight System Unified Rate Review (HIOS URR) module.\n\nAll new filings created AFTER 3/25/22 should be submitted using the new SERFF to URR Transfer Process. This\nis done by using the new URRT Tab in SERFF. For the rate filing in SERFF, the URRT, Part II Written\nJustification (if required), federal Actuarial Memorandum, and redacted federal Actuarial Memorandum should\nonly be included on the URRT Tab (not on other tabs).\n\nIf an issuer enters their rate submission incorrectly through HIOS instead of SERFF, CMS will deactivate that\nsubmission and notify the issuer that it must be entered through the SERFF Transfer Process.\n\nTwo tutorial videos are below:\n       • URRT tab/filing submission (17 minutes)\n                    ▪ https://naic.webex.com/naic/ldr.php?RCID=8fdd279b684dd81e95f1ed6576bdee6d\n       • URRT Responses/Amendments (6 minutes)\n                    ▪ https://naic.webex.com/naic/ldr.php?RCID=dc62c787e0658801e981c296b1bdfe52\n\n    1. The Department will allow carriers to modify their individual and small group rate filings through July\n       10, 2026 to reflect updated assumptions related to risk adjustment. Other types of changes or changes\n       after this date will be allowed at the discretion of the Department. All documents that change will need to\n       be resubmitted in redline format to allow for a more efficient review.\n    2. Since July 1, 2019, it has been illegal in Illinois to sell tobacco products to individuals under 21 years of\n                                                   Page 5 of 7\n         age. Accordingly, premium rates for consumers in this age group should not include a tobacco load.\n    3.   Actuarial memorandums must include the commission schedules and any recent or anticipated changes\n         thereto.\n    4.   Actuarial memorandums must include a description of the state mandates included in the rate filing and\n         the pricing impact of each mandate.\n    5.   Actuarial Value (AV) screenshots should be included in the rate filing and a summary of the AV\n         calculator output should be provided in Excel.\n    6.   Carriers offering QHPs in the individual market are required by 215 ILCS 5/355(c-5) to apply a cost-\n         sharing reduction defunding factor for on-exchange Silver plans within the range of 1.26 to 1.33. The\n         factor for other plans should be 1.00. NOTE: This guidance is subject to change depending on federal\n         law.\n    7. Carriers offering QHPs in the individual market are required by 215 ILCS 5/355(c-5) to apply induced\n       demand factors based on the formula: (Plan Actuarial Value) ^ 2 - (Plan Actuarial Value) +1.24. Please\n       use the pricing AV for the base plan including (or adjusted for) the CSR load. The induced demand\n       factor should be consistent between the index rate and the plan-adjusted index rate.\n    8. If any other rate adjustment factors apply, please provide narrative and quantitative support detailing all\n       assumptions as well as explain where the adjustment is applied.\n\nPublic Posting of Initial Rate Filings:\n\nAs a result of Public Act 103-0106, the initial rate filings received by the Department will be publicly posted on\nthe Department’s website within 5 business days of the rate filing deadline. Pursuant to the recently amended 50\nIll. Adm. Code 2026.50(c)(2), regardless of any increase, decrease, or continuation in rates, submitted rate filing\nsummary templates must include all information described in 50 Ill. Adm. Code 2026.50(e). An Excel template\ntitled “Plan Year 2027 Public Rate Filing Summary.xlsx” accompanies this Bulletin and is to be completed by\nissuers summarizing the rate filing. Please only complete the shaded areas of the Rate Filing Summary template.\nAll shaded areas are required to be completed except for “Any Other Relevant Comments (optional)”.\n\nThe rate filing summary templates and other public portions of the rate filing will be posted to the Department’s\nwebsite to fulfill this statutory requirement. If an issuer intends to offer both individual and small group coverage,\na separate template for each should be submitted as part of the supporting documentation in each filing.\n\nAside from the summary templates, which are not eligible for redaction, if the QHP issuer deems any rate filing\ninformation to be proprietary, privileged, or confidential such that disclosure of the information would cause\ncompetitive harm to the issuer, the QHP issuer must file both 1) an unredacted version and 2) a version with the\ndeemed confidential information redacted that is separately marked for public access in SERFF. Additionally, to\nqualify for ongoing exemption from production under Section 7(1)(g) of the Freedom of Information Act [5 ILCS\n140], proprietary, privileged, or confidential information must be furnished to the Department with the explicit\nclaim that the disclosure of the information would cause competitive harm to the issuer. The issuer must furnish\nthat claim in a letter separate from the substantive rate filing documents but within the same SERFF filing.\n\nThe posting of the rate filings to the Department’s website will start a 30-day public comment period where\ncomments may be submitted to the Department of Insurance. The comments received will then be posted to the\nDepartment’s website.\n\n                                                    Page 6 of 7\nThe deadlines for small group quarterly rate filings are:\nEffective Date          Due Date\nApril 1, 2027           November 17, 2026\nJuly 1, 2027             February 16, 2027\nOctober 1, 2027         May 19, 2027\n\nSmall group quarterly rate filings will also be posted on the DOI website for public comment.\n\nExhibit 2:\n\n2027 Health Plans Filing Requirements – Rates\n                                                               Required Submission via\n                                                                      SERFF\n\n                                                                                  Off-\n               Federal Required Templates                    On-Exchange                           Location\n                                                                                Exchange\n              QHP Rating Module Documents\n                                                                                                 Rate filing &\n                 • Rates Table Template                           Yes              Yes\n                                                                                                    Binder\n\n                                                                                                Rate Filing &\n              Unified Rate Review Template                        Yes              Yes\n                                                                                                   Binder\n               Illinois Required Documents\n                                                                                                Rate Filing &\n              Health Premium Rate checklist                       Yes              Yes\n                                                                                                   Binder\n                                                                                   Yes          Rate Filing &\n              Proposed Enrollment Template                        Yes\n                                                                                                   Binder\n\nIllinois Health Rate Filing Web Portal:\n\nThe Department is sunsetting the Illinois Health Rate Filing Web Portal. Therefore, effective immediately,\ncarriers are no longer required to submit rates to the Illinois Health Rate Filing Web Portal.\n\nReminders:\n   • The Department requires issuers to submit the applicable federal QHP templates for all off-exchange only\n      non-QHP individual and small group filings via a separate off-exchange only Binder submission.\n   • Network adequacy testing extends to all ACA products, including both individual and small group, with\n      federal requirements in place as of PY 2027.\n\n                                                    Page 7 of 7","text_length":27363}
{"slug":"il-cb-2026-05","jurisdiction":"IL","agency":"IDOI","doc_type":"bulletin","citation":"IDOI CB 2026-05","title":"Company Bulletin 2026-05","official_source_url":"https://idoi.illinois.gov/content/dam/soi/en/web/insurance/companies/companybulletins/cb-2026-05-biomarker-testing-coverage-requirements.pdf","access_class":"statutory-public","access_notes":"idoi.illinois.gov; gate-zero IL-a. PARTIAL SET: page-1-per-year harvest; pagination completion pending.","first_seen_at":"2026-07-19T16:34:41.510376+00:00","last_checked_at":"2026-07-20T06:28:38.037958+00:00","versions":[{"fetched_at":"2026-07-19T16:34:41.510376+00:00","version_no":1,"text_length":4888,"effective_date":"2026-04-03","content_sha256_short":"726ec96b22cc"}],"text":"Illinois Department of Insurance\n\n    JB PRITZKER                                                                              ANN GILLESPIE\n      Governor                                                                                  Director\n\nTO:                  All Health Insurance Issuers Writing Accident and Health Insurance, Health Maintenance\n                     Organization Health Care Plans, Limited Health Care Plans, and Voluntary Health\n                     Services Plans\n\nFROM:                Ann Gillespie, Director\n\nDATE:                April 3, 2026\n\nRE:                  Company Bulletin 2026-05 Biomarker Testing Coverage Requirements\n\nThe purpose of this bulletin is to inform, clarify, and promote uniformity in the application of the\nbiomarker testing coverage as required by 215 ILCS 5/356z.46.\n\nBackground:\n\nThe Department has received inquiries and complaints indicating that some issuers may not be providing\ncoverage for biomarker testing to the extent required by Public Act 102-0203, 1 which is codified as 215\nILCS 5/356z.46. P.A. 102-0203 requires all group and individual accident and health insurance policies,\nHMO health care plans, and limited health care plans or voluntary health services plans that cover\nlaboratory services, which are amended, delivered, issued, or renewed on or after January 1, 2022, to\nprovide coverage for biomarker testing pursuant to criteria established under Section 356z.46(d). This\nbulletin serves as a reminder of issuers’ obligations under this statute.\n\nScope of Biomarker Testing Coverage:\n\nThe statute relies on the following definitions:\n\n           “Biomarker” means “a characteristic that is objectively measured and evaluated as an indicator\n           of normal biological processes, pathogenic processes, or pharmacologic responses to a specific\n           therapeutic intervention” and includes, but is not limited to, gene mutations or protein\n           expression.\n\n           “Biomarker testing” means the analysis of a patient’s tissue, blood, or fluid biospecimen for the\n           presence of a biomarker. “Biomarker testing” includes, but is not limited to, single-analyte tests,\n           multiplex panels, and partial or whole genome sequencing. 215 ILCS 5/356z.46(a).\n\nUnder Section 356z.46(c), biomarker testing, including, but not limited to, single-analyte tests, multiplex\npanels, and partial or whole genome sequencing tests, “must be covered and conducted in an efficient\n\n1\n    Illinois General Assembly - Public Act 102-0203\n               Springfield Office                                                       Chicago Office\n            320 W. Washington Street                                             115 S. LaSalle Street, 13th Floor\n            Springfield, Illinois 62767                                              Chicago, Illinois 60603\n                 (217) 782-4515                                                          (312) 814-2420\nmanner to provide the most complete range of results to the patient’s health care provider without\nrequiring multiple biopsies, biospecimen samples, or other delays or disruptions in patient care.”\n\nThe law requires coverage for biomarker testing “for the purposes of diagnosis, treatment, appropriate\nmanagement, or ongoing monitoring of an enrollee's disease or condition when the test is supported by\nmedical and scientific evidence” as further described in Section 356z.46(d).\n\nIn the event coverage is restricted, Section 356z.46(e) requires issuers to maintain a clear, readily\naccessible, and convenient process for patients and prescribing practitioners to request an exception,\nwhich must be available on the issuer’s website.\n\nIssuers should review and update medical policies and billing practices as appropriate to ensure\ncoverage aligns with current evidence-based recommendations in the statutorily listed sources for\nbiomarker testing.\n\nIssuers retain the right to determine and deny claims for biomarker testing based on medical necessity\nonly if compliant with Section 356z.46 of the Illinois Insurance Code.\n\nIssuers are required to use only current definitions and coverage requirements.\n\nIssuers are required to render a biomarker coverage decision in a timely manner under existing laws.\nE.g., 215 ILCS 5/154.6(c), (i), (m), (o); 215 ILCS 5/368a(c); 215 ILCS 200/25 and 200/30; and 50 Ill.\nAdm. Code 919.50(a).\n\nPlease direct questions regarding this Bulletin to DOI.InfoDesk@illinois.gov.\n\n           Springfield Office                                                       Chicago Office\n        320 W. Washington Street                                             115 S. LaSalle Street, 13th Floor\n        Springfield, Illinois 62767                                              Chicago, Illinois 60603\n             (217) 782-4515                                                          (312) 814-2420","text_length":4888}
{"slug":"il-cb-2022-17","jurisdiction":"IL","agency":"IDOI","doc_type":"bulletin","citation":"IDOI CB 2022-17","title":"Company Bulletin 2022-17","official_source_url":"https://idoi.illinois.gov/content/dam/soi/en/web/insurance/companies/companybulletins/CB2022-17.pdf","access_class":"statutory-public","access_notes":"idoi.illinois.gov; gate-zero IL-a. PARTIAL SET: page-1-per-year harvest; pagination completion pending.","first_seen_at":"2026-07-19T16:34:41.510376+00:00","last_checked_at":"2026-07-20T06:28:38.037958+00:00","versions":[{"fetched_at":"2026-07-19T16:34:41.510376+00:00","version_no":1,"text_length":1962,"effective_date":"2022-11-02","content_sha256_short":"61a09966cf9b"}],"text":"Illinois Department of Insurance\n\n JB PRITZKER                                                                   DANA POPISH SEVERINGHAUS\n   Governor                                                                             Director\n\nTO:              All Companies with Current or Historical Individual Business in Illinois\n\nFROM:            Dana Popish Severinghaus, Director\n                 Illinois Department of Insurance\n\nDATE:            November 2, 2022\n\nRE:              Company Bulletin 2022-17 – Health Insurance Data Call Due November 23, 2022\n\nOliver Wyman is working with the Illinois Department of Insurance (the Department) to collect data for\na study as required per Public Act 102-0900 (the Health Insurance Coverage Premium Misalignment\nStudy Act). Companies who have offered, or will be offering, coverage in the individual market in\nIllinois in 2019, 2020, 2021, 2022, or 2023 are included in this data call.\n\nPlease see the template (‘General Info & Instructions’ tab) for instructions on how to complete the\nrequired items and submit the data to Oliver Wyman. The data requested by this data call is due\nNovember 23, 2022.\n\nAll information provided by the companies will be kept confidential with the exception that aggregated\ninformation may be made publicly available as part of the Department’s analysis.\n\nAll inquiries related to this data call should be directed to John Rienstra\njohn.rienstra@oliverwyman.com, Gabe Rivera at gabe.rivera@oliverwyman.com, and/or Peter\nKaczmarek at peter.kaczmarek@oliverwyman.com.\n\n           Springfield Office                                                        Chicago Office\n        320 W. Washington Street                                              122 S. Michigan Ave., 19th Floor\n        Springfield, Illinois 62767                                               Chicago, Illinois 60603\n             (217) 782-4515                                                           (312) 814-2420","text_length":1962}
{"slug":"ma-bulletin-2004-09","jurisdiction":"MA","agency":"DOI","doc_type":"bulletin","citation":"MA DOI Bulletin 2004-09","title":"2004-09 Credit Insurance Sold by Motor Vehicle Dealers","official_source_url":"https://www.mass.gov/doc/2004-09-credit-insurance-sold-by-motor-vehicle-dealers/download","access_class":"source-wants-visibility","access_notes":"mass.gov ToU: public records can be copied and used for any purpose; gate-zero TOP-20 MA row. Akamai 403s custom UA strings — fetched UA-less with From header.","first_seen_at":"2026-07-20T02:05:30.665551+00:00","last_checked_at":"2026-07-20T02:05:30.665551+00:00","versions":[{"fetched_at":"2026-07-20T02:05:30.665551+00:00","version_no":1,"text_length":0,"effective_date":null,"content_sha256_short":"96b0192beb40"}],"text":"","text_length":0}
{"slug":"ma-bulletin-2003-01","jurisdiction":"MA","agency":"DOI","doc_type":"bulletin","citation":"MA DOI Bulletin 2003-01","title":"2004-04 Amendment to Bulletin 2003-01 Regarding an Insurer's Right to Restrict Use of General Account Fixed Accounts Within Variable Annuity Contracts","official_source_url":"https://www.mass.gov/doc/2004-04-amendment-to-bulletin-2003-01-regarding-an-insurers-right-to-restrict-use-of-general-account-fixed-accounts-within-variable-annuity-contracts/download","access_class":"source-wants-visibility","access_notes":"mass.gov ToU: public records can be copied and used for any purpose; gate-zero TOP-20 MA row. Akamai 403s custom UA strings — fetched UA-less with From header.","first_seen_at":"2026-07-20T02:05:30.665551+00:00","last_checked_at":"2026-07-20T02:05:30.665551+00:00","versions":[{"fetched_at":"2026-07-20T02:05:30.665551+00:00","version_no":1,"text_length":0,"effective_date":null,"content_sha256_short":"2c1ff0fd963d"}],"text":"","text_length":0}
{"slug":"ma-bulletin-2004-10","jurisdiction":"MA","agency":"DOI","doc_type":"bulletin","citation":"MA DOI Bulletin 2004-10","title":"2005-01 Massachusetts Form and Rate Filing Requirements and Procedures to Supplement Bulletin 2004-10 Regarding Uncertainty Related to Expiration of the Terrorism Risk Insurance Act of 2002 ('TRIA')","official_source_url":"https://www.mass.gov/doc/2005-01-massachusetts-form-and-rate-filing-requirements-and-procedures-to-supplement-bulletin-2004-10-regarding-uncertainty-related-to-expiration-of-the-terrorism-risk-insurance-act-of-2002-tria-0/download","access_class":"source-wants-visibility","access_notes":"mass.gov ToU: public records can be copied and used for any purpose; gate-zero TOP-20 MA row. Akamai 403s custom UA strings — fetched UA-less with From header.","first_seen_at":"2026-07-20T02:05:30.665551+00:00","last_checked_at":"2026-07-20T02:05:30.665551+00:00","versions":[{"fetched_at":"2026-07-20T02:05:30.665551+00:00","version_no":1,"text_length":0,"effective_date":null,"content_sha256_short":"17f21a3b6707"}],"text":"","text_length":0}
{"slug":"ma-bulletin-2004-10-f85274b5","jurisdiction":"MA","agency":"DOI","doc_type":"bulletin","citation":"MA DOI Bulletin 2004-10","title":"2004-10 Uncertainty Related to Expiration of the Terrorism Risk Insurance Act of 2002 (TRIA) Exclusions Related to Acts of Terrorism","official_source_url":"https://www.mass.gov/doc/2004-10-uncertainty-related-to-expiration-of-the-terrorism-risk-insurance-act-of-2002-tria-exclusions-related-to-acts-of-terrorism/download","access_class":"source-wants-visibility","access_notes":"mass.gov ToU: public records can be copied and used for any purpose; gate-zero TOP-20 MA row. Akamai 403s custom UA strings — fetched UA-less with From header.","first_seen_at":"2026-07-20T02:05:30.665551+00:00","last_checked_at":"2026-07-20T02:05:30.665551+00:00","versions":[{"fetched_at":"2026-07-20T02:05:30.665551+00:00","version_no":1,"text_length":0,"effective_date":null,"content_sha256_short":"1440962fe71b"}],"text":"","text_length":0}
{"slug":"ma-bulletin-2004-07","jurisdiction":"MA","agency":"DOI","doc_type":"bulletin","citation":"MA DOI Bulletin 2004-07","title":"2004-07 Amendments to Laws Mandating Coverage for Early Intervention Services for Dependent Children","official_source_url":"https://www.mass.gov/doc/2004-07-amendments-to-laws-mandating-coverage-for-early-intervention-services-for-dependent-children/download","access_class":"source-wants-visibility","access_notes":"mass.gov ToU: public records can be copied and used for any purpose; gate-zero TOP-20 MA row. Akamai 403s custom UA strings — fetched UA-less with From header.","first_seen_at":"2026-07-20T02:05:30.665551+00:00","last_checked_at":"2026-07-20T02:05:30.665551+00:00","versions":[{"fetched_at":"2026-07-20T02:05:30.665551+00:00","version_no":1,"text_length":0,"effective_date":null,"content_sha256_short":"59dfaa1a1102"}],"text":"","text_length":0}
{"slug":"ma-bulletin-2004-05","jurisdiction":"MA","agency":"DOI","doc_type":"bulletin","citation":"MA DOI Bulletin 2004-05","title":"2004-05 Individual Annuity Filing Requirements for the New Provision Created With Chapter 59 of the Acts of 2004 for Determining Minimum Nonforfeiture Amounts for Individual Annuities","official_source_url":"https://www.mass.gov/doc/2004-05-individual-annuity-filing-requirements-for-the-new-provision-created-with-chapter-59-of-the-acts-of-2004-for-determining-minimum-nonforfeiture-amounts-for-individual-annuities/download","access_class":"source-wants-visibility","access_notes":"mass.gov ToU: public records can be copied and used for any purpose; gate-zero TOP-20 MA row. Akamai 403s custom UA strings — fetched UA-less with From header.","first_seen_at":"2026-07-20T02:05:30.665551+00:00","last_checked_at":"2026-07-20T02:05:30.665551+00:00","versions":[{"fetched_at":"2026-07-20T02:05:30.665551+00:00","version_no":1,"text_length":0,"effective_date":null,"content_sha256_short":"a9fbe1f76702"}],"text":"","text_length":0}
{"slug":"ma-bulletin-2005-05","jurisdiction":"MA","agency":"DOI","doc_type":"bulletin","citation":"MA DOI Bulletin 2005-05","title":"2005-05 Workers' Compensation Self-Insurance Groups","official_source_url":"https://www.mass.gov/doc/2005-05-workers-compensation-self-insurance-groups/download","access_class":"source-wants-visibility","access_notes":"mass.gov ToU: public records can be copied and used for any purpose; gate-zero TOP-20 MA row. Akamai 403s custom UA strings — fetched UA-less with From header.","first_seen_at":"2026-07-20T02:05:30.665551+00:00","last_checked_at":"2026-07-20T02:05:30.665551+00:00","versions":[{"fetched_at":"2026-07-20T02:05:30.665551+00:00","version_no":1,"text_length":0,"effective_date":null,"content_sha256_short":"5e46c82e6ca3"}],"text":"","text_length":0}
{"slug":"ma-bulletin-2005-03","jurisdiction":"MA","agency":"DOI","doc_type":"bulletin","citation":"MA DOI Bulletin 2005-03","title":"2005-03 Changes in Requirements for Licensed Foreign Insurers Transacting Business in Massachusetts","official_source_url":"https://www.mass.gov/doc/2005-03-changes-in-requirements-for-licensed-foreign-insurers-transacting-business-in-massachusetts/download","access_class":"source-wants-visibility","access_notes":"mass.gov ToU: public records can be copied and used for any purpose; gate-zero TOP-20 MA row. Akamai 403s custom UA strings — fetched UA-less with From header.","first_seen_at":"2026-07-20T02:05:30.665551+00:00","last_checked_at":"2026-07-20T02:05:30.665551+00:00","versions":[{"fetched_at":"2026-07-20T02:05:30.665551+00:00","version_no":1,"text_length":0,"effective_date":null,"content_sha256_short":"4a48ca7b3a8c"}],"text":"","text_length":0}
{"slug":"ma-bulletin-2004-12","jurisdiction":"MA","agency":"DOI","doc_type":"bulletin","citation":"MA DOI Bulletin 2004-12","title":"2004-12 Changes in the Requirements for Workers Compensation Insurers Doing Business in Massachusetts","official_source_url":"https://www.mass.gov/doc/2004-12-changes-in-the-requirements-for-workers-compensation-insurers-doing-business-in-massachusetts/download","access_class":"source-wants-visibility","access_notes":"mass.gov ToU: public records can be copied and used for any purpose; gate-zero TOP-20 MA row. Akamai 403s custom UA strings — fetched UA-less with From header.","first_seen_at":"2026-07-20T02:05:30.665551+00:00","last_checked_at":"2026-07-20T02:05:30.665551+00:00","versions":[{"fetched_at":"2026-07-20T02:05:30.665551+00:00","version_no":1,"text_length":0,"effective_date":null,"content_sha256_short":"601f488baf49"}],"text":"","text_length":0}
{"slug":"ma-bulletin-2004-11","jurisdiction":"MA","agency":"DOI","doc_type":"bulletin","citation":"MA DOI Bulletin 2004-11","title":"2004-11 Addendum to 2004 Guide to Health Insurance for People with Medicare","official_source_url":"https://www.mass.gov/doc/2004-11-addendum-to-2004-guide-to-health-insurance-for-people-with-medicare/download","access_class":"source-wants-visibility","access_notes":"mass.gov ToU: public records can be copied and used for any purpose; gate-zero TOP-20 MA row. Akamai 403s custom UA strings — fetched UA-less with From header.","first_seen_at":"2026-07-20T02:05:30.665551+00:00","last_checked_at":"2026-07-20T02:05:30.665551+00:00","versions":[{"fetched_at":"2026-07-20T02:05:30.665551+00:00","version_no":1,"text_length":0,"effective_date":null,"content_sha256_short":"5ba13fe90fc4"}],"text":"","text_length":0}
{"slug":"ma-bulletin-2004-08","jurisdiction":"MA","agency":"DOI","doc_type":"bulletin","citation":"MA DOI Bulletin 2004-08","title":"2004-08 The Deregulation of Certain Commercial Contracts of Insurance Pursuant to Chapter 146 of the Acts of 2004","official_source_url":"https://www.mass.gov/doc/2004-08-the-deregulation-of-certain-commercial-contracts-of-insurance-pursuant-to-chapter-146-of-the-acts-of-2004/download","access_class":"source-wants-visibility","access_notes":"mass.gov ToU: public records can be copied and used for any purpose; gate-zero TOP-20 MA row. Akamai 403s custom UA strings — fetched UA-less with From header.","first_seen_at":"2026-07-20T02:05:30.665551+00:00","last_checked_at":"2026-07-20T02:05:30.665551+00:00","versions":[{"fetched_at":"2026-07-20T02:05:30.665551+00:00","version_no":1,"text_length":0,"effective_date":null,"content_sha256_short":"ead1b40578ee"}],"text":"","text_length":0}
{"slug":"ma-bulletin-2004-03","jurisdiction":"MA","agency":"DOI","doc_type":"bulletin","citation":"MA DOI Bulletin 2004-03","title":"2004-03 Long-Term Care Policies that are Intended to Satisfy Minimum Coverage Requirements for Certain MassHealth Exemptions","official_source_url":"https://www.mass.gov/doc/2004-03-long-term-care-policies-that-are-intended-to-satisfy-minimum-coverage-requirements-for-certain-masshealth-exemptions/download","access_class":"source-wants-visibility","access_notes":"mass.gov ToU: public records can be copied and used for any purpose; gate-zero TOP-20 MA row. Akamai 403s custom UA strings — fetched UA-less with From header.","first_seen_at":"2026-07-20T02:05:30.665551+00:00","last_checked_at":"2026-07-20T02:05:30.665551+00:00","versions":[{"fetched_at":"2026-07-20T02:05:30.665551+00:00","version_no":1,"text_length":0,"effective_date":null,"content_sha256_short":"a89cfd15d5b9"}],"text":"","text_length":0}
{"slug":"md-comar-31-16-10","jurisdiction":"MD","agency":"MIA","doc_type":"regulation","citation":"COMAR 31.16.10","title":"Chapter 10 Complaint Investigation and Determination Process","official_source_url":"https://regs.maryland.gov/us/md/exec/comar/31.16.10/","access_class":"open-license","access_notes":"Official bulk channel: maryland-dsd/law-html-cc0 (CC0/public-domain snapshot; site footer directs bulk download over scraping). Gate-zero TOP-20 MD-b.","first_seen_at":"2026-07-20T21:11:25.340395+00:00","last_checked_at":"2026-07-20T21:11:25.340395+00:00","versions":[{"fetched_at":"2026-07-20T21:11:25.340395+00:00","version_no":1,"text_length":1941,"effective_date":null,"content_sha256_short":"13bbb00cac17"}],"text":"Chapter 10 Complaint Investigation and Determination Process | Library of Maryland Regulations\n\n        \n\n       Skip to main content\n\n              Library of   Maryland Regulations\n\n               Toggle mobile menu\n\n               Navigation\n\n                   Library of Maryland Regulations\n\n                   Code of Maryland Regulations\n\n                   Title 31 MARYLAND INSURANCE ADMINISTRATION\n\n                   Subtitle 16 MISCELLANEOUS\n\n                   Chapter 10 Complaint Investigation and Determination Process\n\n             Code of Maryland Regulations\n\n                 Chapter 10 Complaint Investigation and Determination Process\n\n                       .01 Scope.\n\n                       .02 Definitions.\n\n                       .03 Complaint investigation.\n\n                       .04 Determination.\n\n                       .05 Reporting.\n\n                       .06 Information.\n\n                       .07 Commissioner’s Actions.\n\n                       .08 Sanctions.\n\n                       .09 Hearings.\n\n                   Administrative History\n                   Effective date: November 12, 2012 (39:22 Md. R. 1430)\n                   Authority\n                    Insurance Article, §2-109(a) ; Health-General Article, §19-705(a)(2); Annotated Code of Maryland\n\n                 Previous\n                 Chapter 09 Registry and Report on Slavery Era Insurance\n\n                 Next\n                 Subtitle 17 MARYLAND HEALTH INSURANCE PLAN\n\n This version of the laws and codes on this website is licensed under the  CC BY-NC-SA 4.0  license with copyright held by the State of Maryland.  This version of the laws and codes on this website will be dedicated to the public domain under the  CC0 1.0  license 180 days after publication.\n\n      Please do not scrape. Instead, bulk download the CC BY-NC-SA-4.0  HTML  or  XML  or CC0  HTML  or  XML .\n      Powered by the non-profit  Open Law Library .","text_length":1941}
{"slug":"md-comar-31-17-04","jurisdiction":"MD","agency":"MIA","doc_type":"regulation","citation":"COMAR 31.17.04","title":"Chapter 04 Senior Prescription Drug Assistance Program","official_source_url":"https://regs.maryland.gov/us/md/exec/comar/31.17.04/","access_class":"open-license","access_notes":"Official bulk channel: maryland-dsd/law-html-cc0 (CC0/public-domain snapshot; site footer directs bulk download over scraping). Gate-zero TOP-20 MD-b.","first_seen_at":"2026-07-20T21:11:25.340395+00:00","last_checked_at":"2026-07-20T21:11:25.340395+00:00","versions":[{"fetched_at":"2026-07-20T21:11:25.340395+00:00","version_no":1,"text_length":2642,"effective_date":null,"content_sha256_short":"22fe396f1740"}],"text":"Chapter 04 Senior Prescription Drug Assistance Program | Library of Maryland Regulations\n\n        \n\n       Skip to main content\n\n              Library of   Maryland Regulations\n\n               Toggle mobile menu\n\n               Navigation\n\n                   Library of Maryland Regulations\n\n                   Code of Maryland Regulations\n\n                   Title 31 MARYLAND INSURANCE ADMINISTRATION\n\n                   Subtitle 17 MARYLAND HEALTH INSURANCE PLAN\n\n                   Chapter 04 Senior Prescription Drug Assistance Program\n\n             Code of Maryland Regulations\n\n                 Chapter 04 Senior Prescription Drug Assistance Program\n\n                   Administrative History\n                   Effective date:\n                   Regulations .01—.08 adopted as an emergency provision effective July 1, 2000 (27:15 Md. R. 1397); emergency status amended and extended at 28:3 Md. R. 202; adopted permanently effective April 16, 2001 (28:7 Md. R. 689)\n                   ——————\n                   Chapter revised as an emergency provision effective July 1, 2001 (28:16 Md. R. 1480); revised permanently effective October 15, 2001 (28:20 Md. R. 1782)\n                   ——————\n                   Chapter revised and recodified from  10.09.28  Senior Assistance: Short-Term Prescription Drug Subsidy Program, to  31.17.04  Senior Prescription Drug Program, as an emergency provision effective July 1, 2003 (30:14 Md. R. 934); revised and recodified permanently effective December 22, 2003 (30:25 Md. R. 1851)\n                   ——————\n                   Chapter revised effective October 8, 2007 (34:20 Md. R. 1742)\n                   Regulation .01B amended effective August 10, 2009 (36:16 Md. R. 1252)\n                   Regulation .02A, B amended effective August 10, 2009 (36:16 Md. R. 1252)\n                   ——————\n                   Chapter recodified from  31.17.04  Senior Prescription Drug Assistance Program, to  10.09.60  Senior Prescription Drug Program effective July 1, 2016\n\n                 Previous\n                 Chapter 03 Operation and Administration of the Plan\n\n                 Next\n                 Title 32 MARYLAND DEPARTMENT OF AGING\n\n This version of the laws and codes on this website is licensed under the  CC BY-NC-SA 4.0  license with copyright held by the State of Maryland.  This version of the laws and codes on this website will be dedicated to the public domain under the  CC0 1.0  license 180 days after publication.\n\n      Please do not scrape. Instead, bulk download the CC BY-NC-SA-4.0  HTML  or  XML  or CC0  HTML  or  XML .\n      Powered by the non-profit  Open Law Library .","text_length":2642}
{"slug":"md-comar-31-16-06","jurisdiction":"MD","agency":"MIA","doc_type":"regulation","citation":"COMAR 31.16.06","title":"Chapter 06 Bulk Reinsurance, Stock, and Mutual Insurers","official_source_url":"https://regs.maryland.gov/us/md/exec/comar/31.16.06/","access_class":"open-license","access_notes":"Official bulk channel: maryland-dsd/law-html-cc0 (CC0/public-domain snapshot; site footer directs bulk download over scraping). Gate-zero TOP-20 MD-b.","first_seen_at":"2026-07-20T21:11:25.340395+00:00","last_checked_at":"2026-07-20T21:11:25.340395+00:00","versions":[{"fetched_at":"2026-07-20T21:11:25.340395+00:00","version_no":1,"text_length":1815,"effective_date":null,"content_sha256_short":"39bb390bd7c1"}],"text":"Chapter 06 Bulk Reinsurance, Stock, and Mutual Insurers | Library of Maryland Regulations\n\n        \n\n       Skip to main content\n\n              Library of   Maryland Regulations\n\n               Toggle mobile menu\n\n               Navigation\n\n                   Library of Maryland Regulations\n\n                   Code of Maryland Regulations\n\n                   Title 31 MARYLAND INSURANCE ADMINISTRATION\n\n                   Subtitle 16 MISCELLANEOUS\n\n                   Chapter 06 Bulk Reinsurance, Stock, and Mutual Insurers\n\n             Code of Maryland Regulations\n\n                 Chapter 06 Bulk Reinsurance, Stock, and Mutual Insurers\n\n                       .01 Reinsurance Agreement.\n\n                   Administrative History\n                   Effective date: March 25, 1966\n                   Amended effective May 1, 1968\n                   ——————\n                   Chapter recodified from COMAR 09.30.41 to  COMAR 31.16.06  effective September 7, 1998 (25:18 Md. R. 1439)\n                   Authority\n                   Insurance Article, §§ 2-109  and  3-124 , and  3-125 , Annotated Code of Maryland\n\n                 Previous\n                 Chapter 05 Cancellation of Insurance Contracts by Premium Finance Companies [Repealed]\n\n                 Next\n                 Chapter 07 Holocaust Victims Insurance Claims and Reports [Repealed]\n\n This version of the laws and codes on this website is licensed under the  CC BY-NC-SA 4.0  license with copyright held by the State of Maryland.  This version of the laws and codes on this website will be dedicated to the public domain under the  CC0 1.0  license 180 days after publication.\n\n      Please do not scrape. Instead, bulk download the CC BY-NC-SA-4.0  HTML  or  XML  or CC0  HTML  or  XML .\n      Powered by the non-profit  Open Law Library .","text_length":1815}
{"slug":"md-comar-31-16-09","jurisdiction":"MD","agency":"MIA","doc_type":"regulation","citation":"COMAR 31.16.09","title":"Chapter 09 Registry and Report on Slavery Era Insurance","official_source_url":"https://regs.maryland.gov/us/md/exec/comar/31.16.09/","access_class":"open-license","access_notes":"Official bulk channel: maryland-dsd/law-html-cc0 (CC0/public-domain snapshot; site footer directs bulk download over scraping). Gate-zero TOP-20 MD-b.","first_seen_at":"2026-07-20T21:11:25.340395+00:00","last_checked_at":"2026-07-20T21:11:25.340395+00:00","versions":[{"fetched_at":"2026-07-20T21:11:25.340395+00:00","version_no":1,"text_length":1914,"effective_date":null,"content_sha256_short":"f3a6715abc05"}],"text":"Chapter 09 Registry and Report on Slavery Era Insurance | Library of Maryland Regulations\n\n        \n\n       Skip to main content\n\n              Library of   Maryland Regulations\n\n               Toggle mobile menu\n\n               Navigation\n\n                   Library of Maryland Regulations\n\n                   Code of Maryland Regulations\n\n                   Title 31 MARYLAND INSURANCE ADMINISTRATION\n\n                   Subtitle 16 MISCELLANEOUS\n\n                   Chapter 09 Registry and Report on Slavery Era Insurance\n\n             Code of Maryland Regulations\n\n                 Chapter 09 Registry and Report on Slavery Era Insurance\n\n                       .01 Purpose.\n\n                       .02 Definitions.\n\n                       .03 Reporting Insurers.\n\n                       .04 Report Format and Content.\n\n                       .05 Submission.\n\n                       .06 Availability of the Slavery Era Insurance Policy Registry and Report.\n\n                       .07 Enforcement.\n\n                   Administrative History\n                   Effective date: December 28, 2009 (36:26 Md. R. 1999)\n                   Authority\n                   Insurance Article, §§ 2-109 (a)( 1 ) and  30-102 (c), Annotated Code of Maryland\n\n                 Previous\n                 Chapter 08 Privacy of Consumer Financial and Health Information\n\n                 Next\n                 Chapter 10 Complaint Investigation and Determination Process\n\n This version of the laws and codes on this website is licensed under the  CC BY-NC-SA 4.0  license with copyright held by the State of Maryland.  This version of the laws and codes on this website will be dedicated to the public domain under the  CC0 1.0  license 180 days after publication.\n\n      Please do not scrape. Instead, bulk download the CC BY-NC-SA-4.0  HTML  or  XML  or CC0  HTML  or  XML .\n      Powered by the non-profit  Open Law Library .","text_length":1914}
{"slug":"md-comar-31-17-02","jurisdiction":"MD","agency":"MIA","doc_type":"regulation","citation":"COMAR 31.17.02","title":"Chapter 02 Medically Uninsurable Individual Based on a Medical or Health Condition","official_source_url":"https://regs.maryland.gov/us/md/exec/comar/31.17.02/","access_class":"open-license","access_notes":"Official bulk channel: maryland-dsd/law-html-cc0 (CC0/public-domain snapshot; site footer directs bulk download over scraping). Gate-zero TOP-20 MD-b.","first_seen_at":"2026-07-20T21:11:25.340395+00:00","last_checked_at":"2026-07-20T21:11:25.340395+00:00","versions":[{"fetched_at":"2026-07-20T21:11:25.340395+00:00","version_no":1,"text_length":2077,"effective_date":null,"content_sha256_short":"43e131fc51ac"}],"text":"Chapter 02 Medically Uninsurable Individual Based on a Medical or Health Condition | Library of Maryland Regulations\n\n        \n\n       Skip to main content\n\n              Library of   Maryland Regulations\n\n               Toggle mobile menu\n\n               Navigation\n\n                   Library of Maryland Regulations\n\n                   Code of Maryland Regulations\n\n                   Title 31 MARYLAND INSURANCE ADMINISTRATION\n\n                   Subtitle 17 MARYLAND HEALTH INSURANCE PLAN\n\n                   Chapter 02 Medically Uninsurable Individual Based on a Medical or Health Condition\n\n             Code of Maryland Regulations\n\n                 Chapter 02 Medically Uninsurable Individual Based on a Medical or Health Condition\n\n                       .01 Purpose.\n\n                       .02 Definitions.\n\n                       .03 Proof of a Medical or Health Condition.\n\n                   Administrative History\n                   Effective date:\n                   Regulations  .01 — .03  adopted as an emergency provision effective February 6, 2003 (30:5 Md. R. 365); adopted permanently effective August 4, 2003 (30:15 Md. R. 993)\n                    Regulation .02B  amended effective January 30, 2006 (33:2 Md. R. 85); May 5, 2008 (35:9 Md. R. 900); December 29, 2008 (35:26 Md. R. 2251)\n                   Authority\n                   Insurance Article, §§ 14-501 (h)( 1 )(iv) and  14-503 (k), Annotated Code of Maryland\n\n                 Previous\n                 Chapter 01 Plan Administrator Criteria\n\n                 Next\n                 Chapter 03 Operation and Administration of the Plan\n\n This version of the laws and codes on this website is licensed under the  CC BY-NC-SA 4.0  license with copyright held by the State of Maryland.  This version of the laws and codes on this website will be dedicated to the public domain under the  CC0 1.0  license 180 days after publication.\n\n      Please do not scrape. Instead, bulk download the CC BY-NC-SA-4.0  HTML  or  XML  or CC0  HTML  or  XML .\n      Powered by the non-profit  Open Law Library .","text_length":2077}
{"slug":"md-comar-31-17-03","jurisdiction":"MD","agency":"MIA","doc_type":"regulation","citation":"COMAR 31.17.03","title":"Chapter 03 Operation and Administration of the Plan","official_source_url":"https://regs.maryland.gov/us/md/exec/comar/31.17.03/","access_class":"open-license","access_notes":"Official bulk channel: maryland-dsd/law-html-cc0 (CC0/public-domain snapshot; site footer directs bulk download over scraping). Gate-zero TOP-20 MD-b.","first_seen_at":"2026-07-20T21:11:25.340395+00:00","last_checked_at":"2026-07-20T21:11:25.340395+00:00","versions":[{"fetched_at":"2026-07-20T21:11:25.340395+00:00","version_no":1,"text_length":3459,"effective_date":null,"content_sha256_short":"506fb876570a"}],"text":"Chapter 03 Operation and Administration of the Plan | Library of Maryland Regulations\n\n        \n\n       Skip to main content\n\n              Library of   Maryland Regulations\n\n               Toggle mobile menu\n\n               Navigation\n\n                   Library of Maryland Regulations\n\n                   Code of Maryland Regulations\n\n                   Title 31 MARYLAND INSURANCE ADMINISTRATION\n\n                   Subtitle 17 MARYLAND HEALTH INSURANCE PLAN\n\n                   Chapter 03 Operation and Administration of the Plan\n\n             Code of Maryland Regulations\n\n                 Chapter 03 Operation and Administration of the Plan\n\n                       .01 Purpose.\n\n                       .02 Definitions.\n\n                       .03 Board Meetings.\n\n                       .04 Executive Director.\n\n                       .05 Independent Consultants.\n\n                       .06 Plan Administrator.\n\n                       .07 Hospital Assessments.\n\n                       .08 Investment of Fund Assets.\n\n                       .09 Determination of Plan Benefits and Plan Structure.\n\n                       .10 Determination of Plan Premium.\n\n                       .10-1 Low-Income Subsidy.\n\n                       .11 Evaluation of Plan.\n\n                       .12 Marketing of Plan.\n\n                       .13 Certificates of Coverage.\n\n                       .14 Eligibility Requirements.\n\n                       .15 Plan Enrollment Procedures.\n\n                       .16 Preexisting Condition Limitations.\n\n                       .17 Termination of Coverage.\n\n                       .18 Coordination of Benefits With Other Coverage.\n\n                       .19 Complaints.\n\n                   Administrative History\n                   Effective date:\n                   Regulations  .01 — .19  adopted as an emergency provision effective April 8, 2003 (30:9 Md. R. 609); emergency text amended effective July 1, 2003 (30:16 Md. R. 1072); adopted permanently effective December 22, 2003 (30:25 Md. R. 1851)\n                   Regulation .01B amended effective May 21, 2007 (34:10 Md. R. 891)\n                    Regulation .02B  amended effective February 22, 2010 (37:4 Md. R. 343); August 9, 2010 (37:16 Md. R. 1060); January 7, 2013 (39:26 Md. R. 1666)\n                    Regulation .10E  amended effective January 7, 2013 (39:26 Md. R. 1666)\n                    Regulation .10-1  adopted effective May 21, 2007 (34:10 Md. R. 891)\n                    Regulation .12C  amended effective January 30, 2006 (33:2 Md. R. 85)\n                    Regulation .14  amended effective May 4, 2009 (36:9 Md. R. 654); February 22, 2010 (37:4 Md. R. 343)\n                   Authority\n                    Insurance Article, §14-503(k),  Annotated Code of Maryland\n\n                 Previous\n                 Chapter 02 Medically Uninsurable Individual Based on a Medical or Health Condition\n\n                 Next\n                 Chapter 04 Senior Prescription Drug Assistance Program\n\n This version of the laws and codes on this website is licensed under the  CC BY-NC-SA 4.0  license with copyright held by the State of Maryland.  This version of the laws and codes on this website will be dedicated to the public domain under the  CC0 1.0  license 180 days after publication.\n\n      Please do not scrape. Instead, bulk download the CC BY-NC-SA-4.0  HTML  or  XML  or CC0  HTML  or  XML .\n      Powered by the non-profit  Open Law Library .","text_length":3459}
{"slug":"md-comar-31-16-04","jurisdiction":"MD","agency":"MIA","doc_type":"regulation","citation":"COMAR 31.16.04","title":"Chapter 04 Provision of Completed Premium Finance Agreement to Insured","official_source_url":"https://regs.maryland.gov/us/md/exec/comar/31.16.04/","access_class":"open-license","access_notes":"Official bulk channel: maryland-dsd/law-html-cc0 (CC0/public-domain snapshot; site footer directs bulk download over scraping). Gate-zero TOP-20 MD-b.","first_seen_at":"2026-07-20T21:11:25.340395+00:00","last_checked_at":"2026-07-20T21:11:25.340395+00:00","versions":[{"fetched_at":"2026-07-20T21:11:25.340395+00:00","version_no":1,"text_length":1958,"effective_date":null,"content_sha256_short":"2ecad074b3c5"}],"text":"Chapter 04 Provision of Completed Premium Finance Agreement to Insured | Library of Maryland Regulations\n\n        \n\n       Skip to main content\n\n              Library of   Maryland Regulations\n\n               Toggle mobile menu\n\n               Navigation\n\n                   Library of Maryland Regulations\n\n                   Code of Maryland Regulations\n\n                   Title 31 MARYLAND INSURANCE ADMINISTRATION\n\n                   Subtitle 16 MISCELLANEOUS\n\n                   Chapter 04 Provision of Completed Premium Finance Agreement to Insured\n\n             Code of Maryland Regulations\n\n                 Chapter 04 Provision of Completed Premium Finance Agreement to Insured\n\n                       .01 When Insured Is Present at Time of Signing.\n\n                       .02 When Insured Is Not Present at Time of Signing.\n\n                       .03 Records.\n\n                   Administrative History\n                   Effective date: March 15, 1993 (20:5 Md. R. 513)\n                   ——————\n                   Chapter recodified from COMAR 09.30.79 to  COMAR 31.16.04  effective September 7, 1998 (25:18 Md. R. 1439)\n                   Authority\n                   Insurance Article, §§ 2-109 ,  23-103 ,  23-207 , and  23-302 (c), Annotated Code of Maryland\n\n                 Previous\n                 Chapter 03 Title Insurance Companies — MAHT Account\n\n                 Next\n                 Chapter 05 Cancellation of Insurance Contracts by Premium Finance Companies [Repealed]\n\n This version of the laws and codes on this website is licensed under the  CC BY-NC-SA 4.0  license with copyright held by the State of Maryland.  This version of the laws and codes on this website will be dedicated to the public domain under the  CC0 1.0  license 180 days after publication.\n\n      Please do not scrape. Instead, bulk download the CC BY-NC-SA-4.0  HTML  or  XML  or CC0  HTML  or  XML .\n      Powered by the non-profit  Open Law Library .","text_length":1958}
{"slug":"md-comar-31-16-05","jurisdiction":"MD","agency":"MIA","doc_type":"regulation","citation":"COMAR 31.16.05","title":"Chapter 05 Cancellation of Insurance Contracts by Premium Finance Companies [Repealed]","official_source_url":"https://regs.maryland.gov/us/md/exec/comar/31.16.05/","access_class":"open-license","access_notes":"Official bulk channel: maryland-dsd/law-html-cc0 (CC0/public-domain snapshot; site footer directs bulk download over scraping). Gate-zero TOP-20 MD-b.","first_seen_at":"2026-07-20T21:11:25.340395+00:00","last_checked_at":"2026-07-20T21:11:25.340395+00:00","versions":[{"fetched_at":"2026-07-20T21:11:25.340395+00:00","version_no":1,"text_length":1787,"effective_date":null,"content_sha256_short":"2bec09abb05f"}],"text":"Chapter 05 Cancellation of Insurance Contracts by Premium Finance Companies [Repealed] | Library of Maryland Regulations\n\n        \n\n       Skip to main content\n\n              Library of   Maryland Regulations\n\n               Toggle mobile menu\n\n               Navigation\n\n                   Library of Maryland Regulations\n\n                   Code of Maryland Regulations\n\n                   Title 31 MARYLAND INSURANCE ADMINISTRATION\n\n                   Subtitle 16 MISCELLANEOUS\n\n                   Chapter 05 Cancellation of Insurance Contracts by Premium Finance Companies [Repealed]\n\n             Code of Maryland Regulations\n\n                 Chapter 05 Cancellation of Insurance Contracts by Premium Finance Companies [Repealed]\n\n                   Administrative History\n                   Effective date: November 23, 1992 (19:23 Md. R. 2040)\n                   ——————\n                   Chapter recodified from COMAR 09.30.87 to  COMAR 31.16.05  effective September 7, 1998 (25:18 Md. R. 1439)\n                   ——————\n                   Regulation .01 repealed effective February 15, 2016 (43:3 Md. R. 274)\n\n                 Previous\n                 Chapter 04 Provision of Completed Premium Finance Agreement to Insured\n\n                 Next\n                 Chapter 06 Bulk Reinsurance, Stock, and Mutual Insurers\n\n This version of the laws and codes on this website is licensed under the  CC BY-NC-SA 4.0  license with copyright held by the State of Maryland.  This version of the laws and codes on this website will be dedicated to the public domain under the  CC0 1.0  license 180 days after publication.\n\n      Please do not scrape. Instead, bulk download the CC BY-NC-SA-4.0  HTML  or  XML  or CC0  HTML  or  XML .\n      Powered by the non-profit  Open Law Library .","text_length":1787}
{"slug":"md-comar-31-16-07","jurisdiction":"MD","agency":"MIA","doc_type":"regulation","citation":"COMAR 31.16.07","title":"Chapter 07 Holocaust Victims Insurance Claims and Reports [Repealed]","official_source_url":"https://regs.maryland.gov/us/md/exec/comar/31.16.07/","access_class":"open-license","access_notes":"Official bulk channel: maryland-dsd/law-html-cc0 (CC0/public-domain snapshot; site footer directs bulk download over scraping). Gate-zero TOP-20 MD-b.","first_seen_at":"2026-07-20T21:11:25.340395+00:00","last_checked_at":"2026-07-20T21:11:25.340395+00:00","versions":[{"fetched_at":"2026-07-20T21:11:25.340395+00:00","version_no":1,"text_length":1575,"effective_date":null,"content_sha256_short":"cc0dc429f90b"}],"text":"Chapter 07 Holocaust Victims Insurance Claims and Reports [Repealed] | Library of Maryland Regulations\n\n        \n\n       Skip to main content\n\n              Library of   Maryland Regulations\n\n               Toggle mobile menu\n\n               Navigation\n\n                   Library of Maryland Regulations\n\n                   Code of Maryland Regulations\n\n                   Title 31 MARYLAND INSURANCE ADMINISTRATION\n\n                   Subtitle 16 MISCELLANEOUS\n\n                   Chapter 07 Holocaust Victims Insurance Claims and Reports [Repealed]\n\n             Code of Maryland Regulations\n\n                 Chapter 07 Holocaust Victims Insurance Claims and Reports [Repealed]\n\n                   Administrative History\n                   Effective date: June 25, 2001 (28:12 Md. R. 1118)\n                   ——————\n                   Regulations .01—.09 repealed effective February 15, 2016 (43:3 Md. R. 274)\n\n                 Previous\n                 Chapter 06 Bulk Reinsurance, Stock, and Mutual Insurers\n\n                 Next\n                 Chapter 08 Privacy of Consumer Financial and Health Information\n\n This version of the laws and codes on this website is licensed under the  CC BY-NC-SA 4.0  license with copyright held by the State of Maryland.  This version of the laws and codes on this website will be dedicated to the public domain under the  CC0 1.0  license 180 days after publication.\n\n      Please do not scrape. Instead, bulk download the CC BY-NC-SA-4.0  HTML  or  XML  or CC0  HTML  or  XML .\n      Powered by the non-profit  Open Law Library .","text_length":1575}
{"slug":"md-comar-31-16-08","jurisdiction":"MD","agency":"MIA","doc_type":"regulation","citation":"COMAR 31.16.08","title":"Chapter 08 Privacy of Consumer Financial and Health Information","official_source_url":"https://regs.maryland.gov/us/md/exec/comar/31.16.08/","access_class":"open-license","access_notes":"Official bulk channel: maryland-dsd/law-html-cc0 (CC0/public-domain snapshot; site footer directs bulk download over scraping). Gate-zero TOP-20 MD-b.","first_seen_at":"2026-07-20T21:11:25.340395+00:00","last_checked_at":"2026-07-20T21:11:25.340395+00:00","versions":[{"fetched_at":"2026-07-20T21:11:25.340395+00:00","version_no":1,"text_length":3763,"effective_date":null,"content_sha256_short":"0f9c046999f2"}],"text":"Chapter 08 Privacy of Consumer Financial and Health Information | Library of Maryland Regulations\n\n        \n\n       Skip to main content\n\n              Library of   Maryland Regulations\n\n               Toggle mobile menu\n\n               Navigation\n\n                   Library of Maryland Regulations\n\n                   Code of Maryland Regulations\n\n                   Title 31 MARYLAND INSURANCE ADMINISTRATION\n\n                   Subtitle 16 MISCELLANEOUS\n\n                   Chapter 08 Privacy of Consumer Financial and Health Information\n\n             Code of Maryland Regulations\n\n                 Chapter 08 Privacy of Consumer Financial and Health Information\n\n                       .01 Scope.\n\n                       .02 Purpose.\n\n                       .03 Definitions.\n\n                       .04 Exemption from Notice and Opt Out Requirements for Nonpublic Personal Financial Information.\n\n                       .05 Initial Privacy Notice for Financial Information to Consumers Required.\n\n                       .06 Annual Privacy Notice for Financial Information to Customers Required.\n\n                       .07 Information To Be Included in Privacy Notices for Financial Information.\n\n                       .08 Form of Opt Out Notice to Consumers and Opt Out Methods.\n\n                       .09 Revised Privacy Notices for Financial Information.\n\n                       .10 Delivery of Privacy Notices for Financial Information.\n\n                       .11 Limits on Disclosure of Nonpublic Personal Financial Information to Nonaffiliated Third Parties.\n\n                       .12 Limits on Redisclosure and Reuse of Nonpublic Personal Financial Information.\n\n                       .13 Limits on Sharing Account Number Information for Marketing Purposes.\n\n                       .14 Exception to Opt Out Requirements for Disclosure of Nonpublic Personal Financial Information for Service Providers and Joint Marketing.\n\n                       .15 Exceptions to Notice and Opt Out Requirements for Disclosure of Nonpublic Personal Financial Information for Processing and Servicing Transactions.\n\n                       .16 Other Exceptions to Notice and Opt Out Requirements for Disclosure of Nonpublic Personal Financial Information.\n\n                       .17 When Authorization Required for Disclosure of Nonpublic Personal Health Information.\n\n                       .18 Authorizations for Disclosure of Health Information.\n\n                       .19 Authorization Request Delivery.\n\n                       .20 Relationship to Federal Rules.\n\n                       .21 Relationship to Maryland Laws.\n\n                       .22 Protection of Fair Credit Reporting Act.\n\n                       .23 Nondiscrimination.\n\n                       .24 Effective Date.\n\n                   Administrative History\n                   Effective date: January 21, 2002 (29:1 Md. R. 26)\n                    Regulation .06  amended effective February 27, 2017 (44:4 Md. R. 256)\n                   Authority\n                    Insurance Article, §2-109(d),  Annotated Code of Maryland\n\n                 Previous\n                 Chapter 07 Holocaust Victims Insurance Claims and Reports [Repealed]\n\n                 Next\n                 Chapter 09 Registry and Report on Slavery Era Insurance\n\n This version of the laws and codes on this website is licensed under the  CC BY-NC-SA 4.0  license with copyright held by the State of Maryland.  This version of the laws and codes on this website will be dedicated to the public domain under the  CC0 1.0  license 180 days after publication.\n\n      Please do not scrape. Instead, bulk download the CC BY-NC-SA-4.0  HTML  or  XML  or CC0  HTML  or  XML .\n      Powered by the non-profit  Open Law Library .","text_length":3763}
{"slug":"md-comar-31-17-01","jurisdiction":"MD","agency":"MIA","doc_type":"regulation","citation":"COMAR 31.17.01","title":"Chapter 01 Plan Administrator Criteria","official_source_url":"https://regs.maryland.gov/us/md/exec/comar/31.17.01/","access_class":"open-license","access_notes":"Official bulk channel: maryland-dsd/law-html-cc0 (CC0/public-domain snapshot; site footer directs bulk download over scraping). Gate-zero TOP-20 MD-b.","first_seen_at":"2026-07-20T21:11:25.340395+00:00","last_checked_at":"2026-07-20T21:11:25.340395+00:00","versions":[{"fetched_at":"2026-07-20T21:11:25.340395+00:00","version_no":1,"text_length":1796,"effective_date":null,"content_sha256_short":"d92b720e79ae"}],"text":"Chapter 01 Plan Administrator Criteria | Library of Maryland Regulations\n\n        \n\n       Skip to main content\n\n              Library of   Maryland Regulations\n\n               Toggle mobile menu\n\n               Navigation\n\n                   Library of Maryland Regulations\n\n                   Code of Maryland Regulations\n\n                   Title 31 MARYLAND INSURANCE ADMINISTRATION\n\n                   Subtitle 17 MARYLAND HEALTH INSURANCE PLAN\n\n                   Chapter 01 Plan Administrator Criteria\n\n             Code of Maryland Regulations\n\n                 Chapter 01 Plan Administrator Criteria\n\n                       .01 Scope.\n\n                       .02 Definitions.\n\n                       .03 Selection Criteria for Plan Administrator.\n\n                   Administrative History\n                   Effective date:\n                   Regulations  .01 — .03  adopted as an emergency provision effective February 6, 2003 (30:5 Md. R. 365); adopted permanently effective August 4, 2003 (30:15 Md. R. 993)\n                   Authority\n                    Insurance Article, §14-506(a),  Annotated Code of Maryland\n\n                 Previous\n                 Subtitle 17 MARYLAND HEALTH INSURANCE PLAN\n\n                 Next\n                 Chapter 02 Medically Uninsurable Individual Based on a Medical or Health Condition\n\n This version of the laws and codes on this website is licensed under the  CC BY-NC-SA 4.0  license with copyright held by the State of Maryland.  This version of the laws and codes on this website will be dedicated to the public domain under the  CC0 1.0  license 180 days after publication.\n\n      Please do not scrape. Instead, bulk download the CC BY-NC-SA-4.0  HTML  or  XML  or CC0  HTML  or  XML .\n      Powered by the non-profit  Open Law Library .","text_length":1796}
{"slug":"md-comar-31-10-07","jurisdiction":"MD","agency":"MIA","doc_type":"regulation","citation":"COMAR 31.10.07","title":"Chapter 07 Limited Benefits Policies — Reporting Requirements [Repealed]","official_source_url":"https://regs.maryland.gov/us/md/exec/comar/31.10.07/","access_class":"open-license","access_notes":"Official bulk channel: maryland-dsd/law-html-cc0 (CC0/public-domain snapshot; site footer directs bulk download over scraping). Gate-zero TOP-20 MD-b.","first_seen_at":"2026-07-20T21:11:25.169214+00:00","last_checked_at":"2026-07-20T21:11:25.169214+00:00","versions":[{"fetched_at":"2026-07-20T21:11:25.169214+00:00","version_no":1,"text_length":1721,"effective_date":null,"content_sha256_short":"939b4c043184"}],"text":"Chapter 07 Limited Benefits Policies — Reporting Requirements [Repealed] | Library of Maryland Regulations\n\n        \n\n       Skip to main content\n\n              Library of   Maryland Regulations\n\n               Toggle mobile menu\n\n               Navigation\n\n                   Library of Maryland Regulations\n\n                   Code of Maryland Regulations\n\n                   Title 31 MARYLAND INSURANCE ADMINISTRATION\n\n                   Subtitle 10 HEALTH INSURANCE — GENERAL\n\n                   Chapter 07 Limited Benefits Policies — Reporting Requirements [Repealed]\n\n             Code of Maryland Regulations\n\n                 Chapter 07 Limited Benefits Policies — Reporting Requirements [Repealed]\n\n                   Administrative History\n                   Effective date: December 21, 1992 (19:25 Md. R. 2205)\n                   ——————\n                   Chapter recodified from COMAR 09.30.92 to  COMAR 31.10.07  effective September 7, 1998 (25:18 Md. R. 1439)\n                   Chapter repealed effective October 5, 1998 (25:20 Md. R. 1534)\n\n                 Previous\n                 Chapter 06 Standards for Medicare Supplement Policies\n\n                 Next\n                 Chapter 08 Limited Benefits Policies — Minimum Loss Ratio [Repealed]\n\n This version of the laws and codes on this website is licensed under the  CC BY-NC-SA 4.0  license with copyright held by the State of Maryland.  This version of the laws and codes on this website will be dedicated to the public domain under the  CC0 1.0  license 180 days after publication.\n\n      Please do not scrape. Instead, bulk download the CC BY-NC-SA-4.0  HTML  or  XML  or CC0  HTML  or  XML .\n      Powered by the non-profit  Open Law Library .","text_length":1721}
{"slug":"mo-bulletin-21-01","jurisdiction":"MO","agency":"DCI","doc_type":"bulletin","citation":"MO DCI Bulletin 21-01","title":"21-01 - Updated Disaster Contact Information, January 14, 2021","official_source_url":"https://insurance.mo.gov/media/23776","access_class":"statutory-public","access_notes":"insurance.mo.gov; gate-zero TOP-20 MO-a.","first_seen_at":"2026-07-19T22:20:35.460086+00:00","last_checked_at":"2026-07-19T22:20:35.460086+00:00","versions":[{"fetched_at":"2026-07-19T22:20:35.460086+00:00","version_no":1,"text_length":2384,"effective_date":"2021-01-14","content_sha256_short":"c6db2884a4ec"}],"text":"INSURANCE BULLETIN 21-01\n          Updated Disaster Contact Information\n\n          Issued: January 14, 2021\n\nThe following Bulletin is issued by the Missouri Department of Commerce and Insurance (“Department”) to\ninform and educate the reader on the specified issue. It does not have the force and effect of law, is not an\nevaluation of any specific facts or circumstances, and is not binding on the Department. See section 374.015,\nRSMo.\n\nTo:              All insurers issuing policies covering real or personal property in Missouri\n\nFrom:            Chlora-Lindley Myers, Director\n\nRe:              Updated Disaster Contact Information\n\nIn anticipation of the upcoming spring storm season, and to ensure prompt and efficient communications with\nthe insurance industry following a disaster, the DCI requests each insurer insuring real or personal property in\nthe state to provide the following contact information to the DCI:\n\n         Primary regulatory contact: This contact should be available to directly communicate with the\n          Director and senior DCI leadership following a disaster within the state. These would be high-level\n          communications about the DCI’s response efforts, the company’s response efforts, logistic issues and\n          other urgent regulatory matters following a disaster.\n      Secondary regulatory contact: This secondary contact should be able to discuss non-urgent regulatory\n       issues with DCI staff as well as participate in industry conference calls and meetings regarding disaster\n       response matters.\n\n      Communications contact: This contact should be available to discuss inquiries received from press\n       outlets and to coordinate joint communication and consumer outreach efforts.\n\nFor each insurer contact type identified above, the DCI is requesting contact information (name, title telephone\nnumbers, email address) be submitted on the accompanying Excel spreadsheet form. Responses can be emailed\nto CompanyContacts@insurance.mo.gov\n\nWhere there are multiple insurers within a larger group, a single response may be submitted if the individuals\nidentified for the larger group can speak to the issues identified above for each insurer within the group.\n\nAny questions or comments regarding this Bulletin should be directed to Samantha Mueller at 573-751-2430 or\nvia email to Samantha.Mueller@insurance.mo.gov","text_length":2384}
{"slug":"mo-bulletin-26-09","jurisdiction":"MO","agency":"DCI","doc_type":"bulletin","citation":"MO DCI Bulletin 26-09","title":"26-09 - Post Storm Cancellations and Non-Renewals, May 29, 2026","official_source_url":"https://insurance.mo.gov/media/30091","access_class":"statutory-public","access_notes":"insurance.mo.gov; gate-zero TOP-20 MO-a.","first_seen_at":"2026-07-19T22:20:35.460086+00:00","last_checked_at":"2026-07-19T22:20:35.460086+00:00","versions":[{"fetched_at":"2026-07-19T22:20:35.460086+00:00","version_no":1,"text_length":3736,"effective_date":"2026-05-29","content_sha256_short":"f2cca1846f74"}],"text":"DEPARTMENT OF COMMERCE & INSURANCE\n                         P.O. Box 690, Jefferson City, Mo. 65102-0690\n\n             INSURANCE BULLETIN 26-09\n             Post Storm Cancellations and Non-Renewals\n             Issued: May 29, 2026\nThe following Bulletin is issued by the Missouri Department of Commerce\nand Insurance (\"Department'? to inform and educate the reader on the\nspecified issue. It does not have the force and effect of law, is not an\nevaluation of any specific facts or circumstances, shall not be considered a\nstatement of general applicability and is not binding on the Department.\nSee§ 374.015, RSMo (2016).\n\n  To:        All property and casualty insurers writing homeowners and dwelling\n             insurance covering residential properties and Condominium Master\n             Policies\n  From:      Angela L. Nelson, Director\n\n  Re:        Post Storm Policy Non-Renewals and Cancellations\n\nFollowing last year's devastating severe storm and tornado events, Governor Kehoe\nissued a series of Executive Orders, declaring a State of Emergency in the State of\nMissouri.\nBased upon that State of Emergency, the significant effort and resources required for\nMissourians to recover from these events and based upon inquiries and requests\nreceived, the Department issued Bulletin 25-10 and Bulletin 25-11. These Bulletins\nrequested insurers to cease issuing cancellations and non-renewals on properties that\nwere damaged by a storm anywhere within Missouri after March 1, 2025. The\nDepartment acknowledges and appreciates the insurance industry’s broad cooperation\nwith those requests.\n\nThe State of Emergency, as declared and extended under Executive Order 26-13, is set\nto expire on May 31, 2026 and will not be extended further. As such, this Bulletin\nhereby rescinds Bulletins 25-10 and 25-11, effective June 1, 2026.\nDespite this, the Department is aware that recovery efforts in some parts of the State\nare still underway and that many property owners are actively repairing their properties.\nTo the extent these repairs are not finished, the property owner may have difficulty\nsecuring new coverage. In addition, the Department acknowledges the unnecessary\nstress and burden a property owner would experience if they had to obtain replacement\ninsurance coverage while still completing repairs.\n\nTherefore, through the issuance of this Bulletin, the Department requests insurers\ncontinue to provide additional time to impacted Missourians before instituting (or\ninitiating) cancellation or non-renewal of policies where the property owner is making\ngood-faith efforts to complete repairs to the damaged property. Delays in repairs may be\ncaused by issues with contractors or supplies, or unresolved aspects of the claim.\nFor those insurers who comply with this request to continue coverage for impacted\nMissourians, the Department extends a regulatory safe harbor and states it will not take\nany regulatory action against an insurer for making case exceptions to their filed\nunderwriting standards and policies.\nIf, for reasons such as administrative efficiency, an insurer extends the application of\nthis policy on a broader basis, the Department would support such measures and would\nlikewise extend a regulatory safe harbor to those insurers.\n\nRegardless of what actions the insurer takes, the Department reminds insurers to\nensure their underwriting files contain all necessary information and documentation to\nsupport their ultimate decision and actions.\nThis Bulletin will remain in effect until otherwise rescinded.\n\nAny questions or comments regarding this Bulletin should be directed to the Market\nRegulation Division by email at marketconduct@insurance.mo.gov.\n\n                                            ###","text_length":3736}
{"slug":"mo-bulletin-26-08","jurisdiction":"MO","agency":"DCI","doc_type":"bulletin","citation":"MO DCI Bulletin 26-08","title":"26-08 - Conduent Cybersecurity Breach, May 5, 2026","official_source_url":"https://insurance.mo.gov/media/30061","access_class":"statutory-public","access_notes":"insurance.mo.gov; gate-zero TOP-20 MO-a.","first_seen_at":"2026-07-19T22:20:35.460086+00:00","last_checked_at":"2026-07-19T22:20:35.460086+00:00","versions":[{"fetched_at":"2026-07-19T22:20:35.460086+00:00","version_no":1,"text_length":4419,"effective_date":"2026-05-05","content_sha256_short":"bdf73fe5a119"}],"text":"DEPARTMENT OF COMMERCE & INSURANCE\n                         P.O. Box 690 , Jefferson C ity. Mo, 65102-0690\n\n       INSURANCE BULLETIN 26-08\n\n       Conduent Cybersecurity Breach\n\n       Issued: May 5, 2026\n\nThe following Bulletin is issued by the Missouri Department of Commerce and\nInsurance (\"Department'? to inform and educate the reader on the specified\nissue. It does not have the force and effect of law, is not an evaluation of any\nspecific facts or circumstances, and is not binding on the Department. See\nsection 374.015, RSMo.\n\nTo:     All entities regulated by the Department\n                                                        I\n                                                            V1 ' Ii _     /'I\n\nFrom: Angela L. Nelson, Director        ~ 17( / I ~\nRe:     Addendum - Conduent Cybersecurity Breach\n\nThis bulletin is issued as a follow-up to Insurance Bulletin 26-05 to provide additional\ninformation to insurers and other entities regulated by the Missouri Department of\nCommerce and Insurance (\"Department\") regarding the Conduent cybersecurity breach.\nThis bulletin also requests information from insurers and other entities regulated by the\nDepartment.\nBackground\n\nConduent Business Services, LLC (“Conduent”) provides document processing\nservices, including receiving insurance claim forms, payment integrity services, and\nother back-office support services to a variety of entities, including but not limited to\ninsurers.\n\nAccording to media reports, on January 13, 2025, Conduent discovered that an\nunauthorized third party had access to a portion of its network from October 21, 2024, to\nJanuary 13, 2025. The affected files contained names, addresses, social security\nnumbers, and medical records. Reports vary on the impact of the breach, with some\nestimating that potentially 25 million Americans or more were affected.\n\nSince the issuance of Insurance Bulletin 26-05 on March 17, 2026, the Department has\nbeen in direct contact with Conduent to better understand the Conduent cybersecurity\nbreach and its impact on Missouri insurance consumers, and to ensure that Missourians\nreceive the identity protection assistance they deserve.\n\nTo date, Conduent has been unwilling to provide the Department with the information\nthe Department needs to assess the impact of what is reportedly one of the largest\ncybersecurity breaches in United States history.\n\nAs a result of Conduent’s lack of cooperation, the Department is reminding insurers and\nother entities regulated by the Department to review Insurance Bulletin 26-05 and\nensure they have taken the steps outlined therein.\n\nActions Needed:\n\nBecause of Conduent’s failure to provide information, the Department asks that any\ninsurer or other entity regulated by the Department that utilized the services of\nConduent or any of its affiliates prior to or during the time period of the cybersecurity\nbreach, either directly or indirectly, contact the Department’s Market Conduct Section at\nmarketconduct@insurance.mo.gov.\n\nThe Department would greatly appreciate insurers or other entities also providing\ninformation on the nature of services provided by Conduent or its affiliates. This\ninformation will guide the Department’s response to the cybersecurity breach.\n\n                                              2\nThe Department also reminds insurers and other regulated entities of their duties to\nreport cybersecurity breaches to the Director using the form available on the\nDepartment’s website at https://apps.dci.mo.gov/forms/CybersecurityEventNotification,\nand as further outlined in the resources below:\n\n             Insurance Bulletin 26-01\n             Insurance Bulletin 23-04\n             Section 407.1500 RSMo\n             The Insurance Data Security Act\n\nQuestions for the Department regarding an entity’s duties can be sent to\ncyberbreach@insurance.mo.gov.\n\nQuestions relating to the Conduent cybersecurity breach may be directed to Conduent.\nConduent has a dedicated assistance line at 877-332-1658 (toll free), Monday-Friday,\nfrom 9:00 a.m. to 9:00 p.m. Eastern Time, and may also be contacted at Attn: Data\nIncident, 100 Campus Drive, Suite 200, Florham Park, New Jersey 07932.\n\nQuestions relating to the content of this bulletin may be directed to the Department’s\nMarket Conduct Section at marketconduct@insurance.mo.gov\n\n                                           ###\n\n                                            3","text_length":4419}
{"slug":"mo-bulletin-22-03","jurisdiction":"MO","agency":"DCI","doc_type":"bulletin","citation":"MO DCI Bulletin 22-03","title":"22-03 - Health Insurance Rate Filings - Filing Dates for Plan Year 2023, March 15, 2022","official_source_url":"https://insurance.mo.gov/media/23796","access_class":"statutory-public","access_notes":"insurance.mo.gov; gate-zero TOP-20 MO-a.","first_seen_at":"2026-07-19T22:20:35.460086+00:00","last_checked_at":"2026-07-19T22:20:35.460086+00:00","versions":[{"fetched_at":"2026-07-19T22:20:35.460086+00:00","version_no":1,"text_length":8050,"effective_date":"2022-03-15","content_sha256_short":"7b5b504c1be9"}],"text":"DEPARTMENT OF COMMERCE AND INSURANCE\n                                               P.O. Box 690, Jefferson City, Mo. 65102-0690\n\n                   INSURANCE BULLETIN 22-03\n                   Health Insurance Rate Filings - Filing Dates for Plan Year 2023\n\n                   Issued: March 15, 2022\n\n          The following Bulletin is issued by the Missouri Department of Commerce and\n          Insurance (“Department”) to inform and educate the reader on the specified issue. It\n          does not have the force and effect of law, is not an evaluation of any specific facts or\n          circumstances, shall not be considered a statement of general applicability and is not\n          binding on the Department. See § 374.015, RSMo (2016).\n\n          To:       Health carriers writing health insurance or health benefit plan coverage in Missouri\n\n          From: Director Chlora Lindley-Myers\n\n          Re:       Health Insurance Rate Filing Key Dates (2023 Plan Year)\n\n          This Bulletin provides notice to health carriers of key filing dates for health benefit plans that will\n          be offered during 2023, as required by §376.465, RSMo (2016)1, and 20 CSR 400-13.100. These\n          dates are based on current federal guidance, and are subject to change.\n\n          As of the date of issuance of this bulletin, Congress has not taken action to extend beyond calendar\n          year 2022 the expanded eligibility for Advanced Premium Tax Credits enacted as part of the\n          American Rescue Plan. The Department’s expectation for the 2023 plan year is that carriers will\n          file ONE set of rates and outline their assumptions in the actuarial memorandum. The Department\n          will not accept a rate filing with multiple rates for multiple contingencies for plan year 2023.\n\n1\n    All statutory references herein are to RSMo (2016) unless otherwise noted.\n                                                                     1\nFor plan year 2023, the Department strongly encourages carriers in the individual market to assume\nthat Cost Sharing Reduction (CSR) payments will not be made by the federal government, and to\napply the CSR payment load only to Silver plans sold on the exchange. Furthermore, carriers are\nstrongly encouraged to include in their actuarial memorandum the amount of CSR load included in\nthe silver plan rates and the methodology for determining the load.\n\n                          Summary of Filing Timeframes for Plan Year 2023\n\n           Type of Plan                                    Filing Timeframe\n Single Risk Pool – Plans in      File between June 18, 2022 and June 22, 2022 to meet federal\n Individual and Small Group       and state guidelines.\n ACA markets\n Transitional                     File at least 60 days prior to use. Filings, which include finalized\n                                  rates, that are submitted on or before August 17, 2022 will have\n                                  their reviews prioritized.\n                                  Filings submitted later than August 17 may have reviews\n                                  extend beyond the intended implementation date.\n\n Grandfathered                    File at least 30 days prior to use.\n Student Health Plans             File at least 60 days prior to use.\n Other Health Benefit Plans       File at least 30 days prior to use.\n (Dental, Vision, etc.)\n\n                                           #        #       #\n\nFor additional detail regarding the timeframes in the chart above, please see the following sections.\n\nApplicability\nThe purpose of this Bulletin is to announce rate filing timeframes for plan types subject to a\ndetermination of “reasonableness” pursuant to §376.465.7. For ease, this Bulletin will refer to the\nfollowing plans as “Subsection 7 Plans”:\n\n           “Health benefit plans” as defined in §376.465 (excluding plans sold in the large\n            employer group market);\n           Individual and small employer group plans subject to the requirements of the single risk\n            pool;\n           Student health plans; and\n           Transitional plans.\n\nSection 376.465 specifies the timeframes applicable to rate filings for all other health benefit plans\nincluding, but not limited to, grandfathered plans and excepted benefit plans.\n\n                                                   2\nFile Rates for Individual and Small Group ACA Plans No Later than June 22, 2022\nThe Centers for Medicare and Medicaid Services (CMS), Center for Consumer Information and\nInsurance Oversight (CCIIO) designated Missouri as an “Effective Rate Review” state in 2017. To\nretain that status, the Department must ensure rate filings meet federal guidelines. This Bulletin\nserves to indicate that the Department intends to follow federal filing and posting guidelines to the\nextent possible under Missouri law.\n\nFor Plan Year 2023, proposed rates for Individual and Small Group ACA plans must be submitted to\nthe Department no earlier than June 18, 2022, and no later than June 22, 2022.\n\nFederal law exempts student health plans from the filing deadlines applicable to single risk pool\nplans. Likewise, federal guidance indicates that transitional plans have different deadlines than\nsingle risk pool plans. However, in order to comply with Missouri law, rates for student health plans\nand transitional plans should be filed with the Department at least 60 days prior to the proposed\neffective date.\n\nPost Proposed Rates for Individual and Small Group ACA Plans – July 27, 2022\nCurrent federal guidelines require “Effective Rate Review” states to post proposed rates for single\nrisk pool plans no later than July 27, 2022. The Department does not intend to post proposed rates\nearlier than this date.\n\nOptional Quarterly Rate Filings for the Small Group Market\nCurrent federal law permits single risk pool plans in the small group market to adjust rates as often\nas quarterly. As Missouri law does not limit the frequency of rate filings, health carriers may submit\nquarterly rate filings for small group market plans.\n\n         2023 Plans: Health carriers should submit rate filings by June 22, 2022. Rate filings for\n          subsequent quarters should be filed at least 60 days prior to the proposed effective date, as\n          required by §376.465.\n\nTransitional Plan Rate Filings\nMissouri law doesn’t differentiate between transitional plans and other Subsection 7 plans.\nTherefore, transitional plan rates must be filed at least 60 days prior to implementation, and are\nsubject to the same standards of review as other Subsection 7 plans. However, while current federal\nguidance for transitional health plans only requires rate submissions where the proposed rate\nincrease exceeds the federally identified rate review threshold, under Missouri law all transitional\nplan rate changes must be filed with the Department, regardless of the magnitude or direction of the\nrate change.\n\nPlease note, for transitional plan rate changes that are less than the federal threshold, the Department\nwill not require companies to also file concurrently with CMS per 20 CSR 400-13.100(8).\n\nFor Additional Rate Filing Guidance\nGeneral Instructions are available via the System for Electronic Rate and Form Filing (SERFF) for\nMissouri. Additional filing guidelines will be posted on the Department’s website and updated as\nnecessary.\n\n                                                   3\nRate Filings for other Health Benefit Plans\nFor filing requirements applicable to grandfathered and excepted benefit plans that are not\nSubsection 7 plans, please see §376.465. For dental plans that a health carrier or licensed pre-paid\ndental plan intends to make available on the exchange, rates must be filed in accordance with\n§376.465, or thirty (30) days prior to the intended effective date.\n\nAny questions or comments regarding this Bulletin should be directed to Camille Anderson-Weddle\nat 573-522-3311 or Camille.Anderson-Weddle@insurance.mo.gov.\n\n                                                  4","text_length":8050}
{"slug":"mo-bulletin-22-02","jurisdiction":"MO","agency":"DCI","doc_type":"bulletin","citation":"MO DCI Bulletin 22-02","title":"22-02 - Updated Disaster Contact Information, February 18, 2022","official_source_url":"https://insurance.mo.gov/media/23791","access_class":"statutory-public","access_notes":"insurance.mo.gov; gate-zero TOP-20 MO-a.","first_seen_at":"2026-07-19T22:20:35.460086+00:00","last_checked_at":"2026-07-19T22:20:35.460086+00:00","versions":[{"fetched_at":"2026-07-19T22:20:35.460086+00:00","version_no":1,"text_length":2419,"effective_date":"2022-02-18","content_sha256_short":"7fc64abc8828"}],"text":"INSURANCE BULLETIN 22-02\n          Updated Disaster Contact Information\n\n          Issued: February 18th, 2022\n\nThe following Bulletin is issued by the Missouri Department of Commerce and Insurance\n(“Department”) to inform and educate the reader on the specified issue. It does not have the\nforce and effect of law, is not an evaluation of any specific facts or circumstances, and is not\nbinding on the Department. See section 374.015, RSMo.\n\nTo:              All insurers issuing policies covering real or personal property in Missouri\n\nFrom:            Chlora-Lindley Myers, Director\n\nRe:              Updated Disaster Contact Information\n\nIn anticipation of the upcoming spring storm season, and to ensure prompt and efficient\ncommunications with the insurance industry following a disaster, the DCI requests each insurer\ninsuring real or personal property in the state to provide the following contact information to the\nDCI:\n\n      •   Primary regulatory contact: This contact should be available to directly communicate\n          with the Director and senior DCI leadership following a disaster within the state. These\n          would be high-level communications about the DCI’s response efforts, the company’s\n          response efforts, logistic issues and other urgent regulatory matters following a disaster.\n   •   Secondary regulatory contact: This secondary contact should be able to discuss non-\n       urgent regulatory issues with DCI staff as well as participate in industry conference calls\n       and meetings regarding disaster response matters.\n\n   •   Communications contact: This contact should be available to discuss inquiries received\n       from press outlets and to coordinate joint communication and consumer outreach efforts.\n\nFor each insurer contact type identified above, the DCI is requesting contact information (name,\ntitle telephone numbers, email address) be submitted on the accompanying Excel spreadsheet\nform. Responses can be emailed to CompanyContacts@insurance.mo.gov\n\nWhere there are multiple insurers within a larger group, a single response may be submitted if\nthe individuals identified for the larger group can speak to the issues identified above for each\ninsurer within the group.\n\nAny questions or comments regarding this Bulletin should be directed to the Market Conduct\nExamination Section by telephone at (573)751-2430 or you may utilize the email provided\nabove.","text_length":2419}
{"slug":"mo-bulletin-22-01","jurisdiction":"MO","agency":"DCI","doc_type":"bulletin","citation":"MO DCI Bulletin 22-01","title":"22-01 - Termination and Placement of Insurance Coverages, February 2, 2022","official_source_url":"https://insurance.mo.gov/media/23786","access_class":"statutory-public","access_notes":"insurance.mo.gov; gate-zero TOP-20 MO-a.","first_seen_at":"2026-07-19T22:20:35.460086+00:00","last_checked_at":"2026-07-19T22:20:35.460086+00:00","versions":[{"fetched_at":"2026-07-19T22:20:35.460086+00:00","version_no":1,"text_length":3055,"effective_date":"2022-02-02","content_sha256_short":"6bee2e2fb5a0"}],"text":"INSURANCE BULLETIN 22-01\nTermination and Placement of Insurance Coverages\n\nIssued: February 2, 2022\n\n      The following Bulletin is issued by the Missouri Department of Commerce and Insurance\n      (“Department”) to inform and educate the reader on the specified issue. It does not have the\n      force and effect of law, is not an evaluation of any specific facts or circumstances, and is not\n      binding on the Department. See section 374.015, RSMo.\n\nTo:         All insurers writing insurance coverages in the State of Missouri\n\nFrom:       Chlora Lindley-Myers, Director\n\nRe:         Termination and Placement of Insurance Coverages\n\nThis Bulletin is issued to provide information regarding the practice of replacing insurance coverage\nterminated by one carrier (“terminating carrier”) with insurance coverage provided by a different carrier\n(“new carrier”). There appears to be uncertainty in the marketplace regarding the consumer consent required\nto be obtained by the new carrier to issue and bind coverage after coverage is discontinued by the\nterminating carrier. Specifically, the question has arisen whether a new carrier may collect data from the\nterminating carrier or its producers, without an application from the consumer, and simply issue new\npolicies or new certificates of coverage to those consumers whose policies or certificates are being non-\nrenewed by the terminating carrier. This bulletin only applies where an offer of coverage to consumers is\nmade by a new carrier who is unaffiliated with the terminating carrier.\n\nA contract of insurance, like other contracts, requires a meeting of the minds of the parties to the contract.\nSee Byrne v. Prudential Ins. Co. of America, 88 S.W.2d 344 (Mo. 1935); Helmkamp v. American Family\nMutual Insurance Company, 407 S.W.2d 559 (MO. App. S.D. 1966). Where the consumer has not\nsubmitted an application for coverage, some other affirmative consent is required from the consumer to\nestablish a meeting of the minds, and for the new carrier to bind coverage or issue a policy or certificate to\na consumer. A policy or certificate issued to a consumer without application or affirmative consent is not a\nvalid contract.\nThe provisions of Section 375.936.6 RSMo regarding misrepresentations of insurance policies are\nimplicated where an insurer or producer enrolls a consumer in insurance coverage or issues an insurance\npolicy or certificate without the affirmative consent of the consumer. In addition, 15 CSR 60-8.060 prohibits\nof the use of negative option plans. The use of an opt-out or negative option methodology is not sufficient\nto show affirmative consent, nor is the payment of premium, in and of itself, sufficient to show affirmative\nconsent. Affirmative consent, in this instance, means an affirmative statement, either verbally or in writing,\nthat indicates acceptance of the offer of coverage.\n\nAny questions or comments regarding this Bulletin should be directed to Teresa Kroll at\nmarketconduct@insurance.mo.gov\n\n                                                     ###","text_length":3055}
{"slug":"mo-bulletin-26-07","jurisdiction":"MO","agency":"DCI","doc_type":"bulletin","citation":"MO DCI Bulletin 26-07","title":"26-07 - Scam Alert: Phishing Email Campaign Targeting Producers and Other Users of the National Insurance Producer Registry (NIPR) Licensing Platform, April 9, 2026","official_source_url":"https://insurance.mo.gov/media/29821","access_class":"statutory-public","access_notes":"insurance.mo.gov; gate-zero TOP-20 MO-a.","first_seen_at":"2026-07-19T22:20:35.460086+00:00","last_checked_at":"2026-07-19T22:20:35.460086+00:00","versions":[{"fetched_at":"2026-07-19T22:20:35.460086+00:00","version_no":1,"text_length":2700,"effective_date":"2026-04-09","content_sha256_short":"e06c23557418"}],"text":"OF COMMERCE\n         DEPARTMENT         AND INSURANCE\n                           P.O. Box 690, Jefferson City, Mo. 65102-0690\n\n        INSURANCE BULLETIN 26-07\n        Scam Alert: Phishing Email Campaign Targeting Producers\n        and Other Users of the National Insurance Producer Registry\n        (NIPR) Licensing Platform\n\n        Issued: April 9, 2026\n\nThe following Bulletin is issued by the Missouri Department of Commerce\nand Insurance (\"Department\") to inform and educate the reader on the\nspecified issue. It does not have the force and effect of law, is not an\nevaluation of any specific facts or circumstances, shall not be considered a\nstatement of general applicability and is not binding on the Department.\nSee § 37 4.015, RS Mo (2016).\n\nTo:      All users of the National Insurance Producer Registry (NIPR) licensing platform,\n\nFrom:    ::~:~:~\n               .i::::~D:::::er\nRe:      Phishing Scam Targeting NIPR Users\n\nThe Director of the Department of Commerce and Insurance issues this bulletin to alert\ninsurance producers and other users of the National Insurance Producer Registry\n(NIPR) to an active phishing email campaign targeting NIPR users.\n\nThe phishing email campaign sends fraudulent emails to NIPR users that reference\npast-due invoices and may appear to originate from familiar or trusted domains,\nincluding @nipr.com, @naic.org, or @stripe. The emails falsely claim to be from\nNIPR and request payment. These messages are fraudulent and were not sent from an\nofficial NIPR email address or account.\n\nAny unexpected or unsolicited invoice should be treated as suspicious:\n\n   •   If a producer or other NIPR user receives an unexpected invoice email claiming\n       to be from NIPR, stop immediately.\n\n   •   Do not open attachments, click links, or submit payment in response to\n       suspicious or unexpected invoice emails.\n\n   •   If there is any doubt about the legitimacy of an invoice or email, contact\n       niprbillingdept@nipr.com before responding or taking further action\n\nFor more information, insurance producers and other NIPR users are encouraged to\nvisit NIPR’s phishing information page. This page includes helpful tips for identifying\nfraudulent emails, including unmasking vanity/fake email domains, looking for generic\ngreetings (e.g., “Dear Customer”), and examining the tone and grammar of emails for\nsigns of phishing.\n\nNIPR's and NAIC’s cybersecurity teams are actively investigating and monitoring this\nphishing activity.\n\nQuestions regarding this Bulletin can be directed to the Licensing Section at 573-751-\n3518 or licensing@insurance.mo.gov.\n\n                                          ###\n\n                                           2","text_length":2700}
{"slug":"mo-bulletin-26-06","jurisdiction":"MO","agency":"DCI","doc_type":"bulletin","citation":"MO DCI Bulletin 26-06","title":"26-06 - Health Insurance Rate Filings - Filing Dates for Plan Year 2027, April 2, 2026","official_source_url":"https://insurance.mo.gov/media/29801","access_class":"statutory-public","access_notes":"insurance.mo.gov; gate-zero TOP-20 MO-a.","first_seen_at":"2026-07-19T22:20:35.460086+00:00","last_checked_at":"2026-07-19T22:20:35.460086+00:00","versions":[{"fetched_at":"2026-07-19T22:20:35.460086+00:00","version_no":1,"text_length":6816,"effective_date":"2026-04-02","content_sha256_short":"2a1da4941b18"}],"text":"DEPARTMENT OF COMMERCE AND INSURANCE\n                                P.O. Box 690, Jefferson City, Mo. 65102-0690\n\n        INSURANCE BULLETIN 26-06\n        Health Insurance Rate Filings - Filing Dates for Plan Year 2027\n\n        Issued: April 2, 2026\nThe following Bulletin is issued by the Missouri Department of Commerce\nand Insurance (\"Department\") to inform and educate the reader on the\nspecified issue. It does not have the force and effect of law, is not an\nevaluation of any specific facts or circumstances, shall not be considered a\nstatement of general applicability and is not binding on the Department.\nSee § 37 4.015, RSMo (2016).\n\nTo:       Health carriers writing health insurance or health benefit plan coverage in\n          Missouri\n\nFrom: Angela L. Nelson, Director\n\nRe:       Health Insurance Rate Filing Key Dates (2027 Plan Year)\n\nThis Bulletin provides notice to health carriers of key filing dates for health benefit plans\nthat will be offered during 2027, as required by§ 376.465, RSMo (2016) 1 , and 20 CSR\n400-13.100. These dates are based on current federal guidance contained in the\nPatient Protection and Affordable Care Act, HHS Proposed Notice of Benefit and\nPayment Parameters for 2027; and Basic Health Program, 91 Fed. Reg 6292 (Feb.11,\n\n1 All statutory references herein are to RSMo (2016) unless otherwise noted.\n 2026), and are subject to change.\n\nIn recent plan years, similar bulletins also included technical information. For this plan\nyear, any necessary technical information will be provided separately.\n\n                   Summary of Filing Timeframes for Plan Year 2027\n        Type of Plan                             Filing Timeframe\nSingle Risk Pool – Plans   File by June 3, 2026, to meet federal and state guidelines.\nin Individual and Small\nGroup ACA markets\nTransitional               File at least 60 days prior to use. Filings, which include\n                           finalized rates, that are submitted on or before August 12,\n                           2026, will have their reviews prioritized.\n                           Filings submitted later than August 12 may have\n                           reviews extend beyond the intended implementation\n                           date.\nGrandfathered              File at least 30 days prior to use.\nStudent Health Plans       File at least 60 days prior to use.\nOther Health Benefit Plans File at least 30 days prior to use.\n(Dental, Vision, etc.)\n\nFor additional detail regarding the timeframes in the chart above, please see the\nfollowing sections.\n\nApplicability\nThe rate filing timeframes apply to plan types subject to a determination of\n“reasonableness” pursuant to § 376.465.7. For ease, this Bulletin will refer to the\nfollowing plans as “Subsection 7 Plans”:\n    • “Health benefit plans” as defined in § 376.465 (excluding plans sold in the large\n       employer group market);\n    • Individual and small employer group plans subject to the requirements of the\n       single risk pool;\n    • Student health plans; and\n    • Transitional plans.\n\nSection 376.465 specifies the timeframes applicable to rate filings for all other health\nbenefit plans including, but not limited to, grandfathered plans and excepted benefit\nplans.\nFile Rates for Individual and Small Group ACA Plans No Later than June 3, 2026\nThe Centers for Medicare and Medicaid Services (CMS) Center for Consumer\nInformation and Insurance Oversight (CCIIO) designated Missouri as an “Effective Rate\nReview” state in 2017. To retain that status, the Department must ensure rate filings\nmeet federal guidelines. This Bulletin serves to indicate that the Department intends to\nfollow federal filing and posting guidelines to the extent possible under Missouri law.\n\nFor Plan Year 2027, proposed rates for Individual and Small Group ACA plans must be\nsubmitted to the Department no later than June 3, 2026.\n\nFederal law exempts student health plans from the filing deadlines applicable to single\nrisk pool plans. Likewise, federal guidance indicates that transitional plans have\ndifferent deadlines than single risk pool plans. However, to comply with Missouri law,\nrates for student health plans and transitional plans should be filed with the Department\nat least 60 days prior to the proposed effective date.\n\nPost Proposed Rates for Individual and Small Group ACA Plans – July 31, 2026\nCurrent federal guidelines require “Effective Rate Review” states to publicly post\nproposed rates for single risk pool plans no later than July 31, 2026. The Department\ndoes not intend to publicly post proposed rates earlier than this date.\n\nOptional Quarterly Rate Filings for the Small Group Market\nCurrent federal law permits single risk pool plans in the small group market to adjust\nrates as often as quarterly. As Missouri law does not limit the frequency of rate filings,\nhealth carriers may submit quarterly rate filings for small group market plans.\n\n   •   2027 Plans: Health carriers should submit rate filings by June 3, 2026. Rate\n       filings for subsequent quarters should be filed at least 60 days prior to the\n       proposed effective date, as required by § 376.465.\n\nTransitional Plan Rate Filings\nMissouri law does not differentiate between transitional plans and other Subsection 7\nplans. Therefore, transitional plan rates must be filed at least 60 days prior to\nimplementation, and are subject to the same standards of review as other Subsection 7\nplans. However, while current federal guidance for transitional health plans only requires\nrate submissions where the proposed rate increase exceeds the federally identified rate\nreview threshold, under Missouri law all transitional plan rate changes must be filed with\nthe Department, regardless of the magnitude or direction of the rate change.\n\nPlease note, for transitional plan rate changes that are less than the federal threshold,\nthe Department will not require companies to also file concurrently with CMS per 20\nCSR 400-13.100(8).\n\nFor Additional Rate Filing Guidance\nGeneral Instructions are available via the System for Electronic Rate and Form Filing\n(SERFF) for Missouri. Additional filing guidelines will be posted on the Department’s\nwebsite and updated as necessary.\n\nRate Filings for other Health Benefit Plans\nFor filing requirements applicable to grandfathered and excepted benefit plans that are\nnot Subsection 7 plans, please see § 376.465. For dental plans that a health carrier or\nlicensed pre-paid dental plan intends to make available on the exchange, rates must be\nfiled in accordance with § 376.465, or thirty (30) days prior to the intended effective\ndate.\n\nAny questions or comments regarding this Bulletin should be directed to Camille\nAnderson-Weddle at 573-522-3311 or productfilings@insurance.mo.gov.\n\n                                          ###","text_length":6816}
{"slug":"mo-bulletin-26-04","jurisdiction":"MO","agency":"DCI","doc_type":"bulletin","citation":"MO DCI Bulletin 26-04","title":"26-04 – Claims Valuation Software, March 17, 2026","official_source_url":"https://insurance.mo.gov/media/29621","access_class":"statutory-public","access_notes":"insurance.mo.gov; gate-zero TOP-20 MO-a.","first_seen_at":"2026-07-19T22:20:35.460086+00:00","last_checked_at":"2026-07-19T22:20:35.460086+00:00","versions":[{"fetched_at":"2026-07-19T22:20:35.460086+00:00","version_no":1,"text_length":3636,"effective_date":"2026-03-17","content_sha256_short":"1a4fd5b38eb9"}],"text":"Insurers that rely on valuation software should be aware of potential issues that may\nlead to the undervaluation of total loss vehicles, potentially in violation of the Unfair\nClaims Settlement Practices Act. These issues include arbitrary or undocumented\ncondition adjustments and other vehicle-specific factors not captured by the software.\nCondition adjustments are increases or decreases to the vehicle's value to account for\nits condition at the time of the loss. Typically, these adjustments involve reductions in\nvalue for pre-existing wear and tear, including dents, stains, or mechanical issues.\n\nValuation software typically establishes a base value for a loss vehicle by comparing it\nto similar vehicles. Insurers also often have the option to choose a starting base value\nthat may include a reduction of the comparable vehicles initially from dealer level (ready\nto sell) to varying levels of privately owned. A starting level less than the highest\nincludes deductions for wear and tear on the vehicle. The valuation software may apply\na weighting factor to the comparable vehicles to approximate an actual cash value\n(ACV) that is closest to the vehicle most resembling the loss vehicle. The claims handler\nmay also further adjust the value based on vehicle-specific factors, such as dealer\npackages, other options, condition, and mileage of the loss vehicle.\n\nPursuant to section 375.1007,RSMo, insurers are required to conduct a reasonable\ninvestigation and ensure that a prompt, fair, and equitable settlement is achieved where\nliability has become reasonably clear. During the investigation and settlement process,\ninsurers are encouraged to consider the following when determining a fair and equitable\nsettlement:\n\n   •   Identify and apply any vehicle-specific options, including dealer trim packages;\n\n   •   Consider post-purchase upgrades that may be compensable under the terms of\n       the policy;\n\n   •   Ensure that any deductions due to the condition applied by the claims handler\n       are not duplicative of deductions already applied by the valuation software;\n\n   •   Apply increases to the value of the loss vehicle, if the loss vehicle is in better\n       condition than the condition ratings provided by the valuation software vendor,\n       and;\n\n   •   Avoid modifying or adjusting values based on negotiation tactics, such as\n       haggling, because these practices are highly subjective and may lead to unfair\n       settlements.\n\n                                             2\nConsistent with 20 CSR 100-1.050(2)(E), all adjustments based on betterment or\ndepreciation must be documented in the claim file, itemized, explained, and must be fair\nand reasonable. Insurers are instructed to clearly state what was deducted from the\nvalue, how the loss vehicle differs from the comparable vehicles and why those\ndeductions were made. Additionally, 20 CSR 100-8.040(3)(B) requires the file to be\nmaintained in a manner that clearly shows the inception, handling, and disposition of\neach claim. Therefore, pertinent factors and selections built into the valuation software,\nsuch as weighting and condition adjustments, must also be maintained in the claim file.\nThese inputs are needed to audit the vehicle's value.\n\nIf an internal review identifies missing documentation for total loss claims, insurers are\nencouraged to notify the Department in accordance with section 374.049.9,RSMo.\n\nFor inquiries regarding this Bulletin, please contact the Market Conduct Section at\nmarketconduct@insurance.mo.gov.\n\n                                            ###\n\n                                             3","text_length":3636}
{"slug":"mo-bulletin-26-05","jurisdiction":"MO","agency":"DCI","doc_type":"bulletin","citation":"MO DCI Bulletin 26-05","title":"26-05 – Conduent Cybersecurity Breach, March 17, 2026","official_source_url":"https://insurance.mo.gov/media/29626","access_class":"statutory-public","access_notes":"insurance.mo.gov; gate-zero TOP-20 MO-a.","first_seen_at":"2026-07-19T22:20:35.460086+00:00","last_checked_at":"2026-07-19T22:20:35.460086+00:00","versions":[{"fetched_at":"2026-07-19T22:20:35.460086+00:00","version_no":1,"text_length":2028,"effective_date":"2026-03-17","content_sha256_short":"e6add4d46b89"}],"text":"portion of its network from October 21, 2024 to January 13, 2025. The affected files\ncontained names, addresses, and social security numbers.\n\nConduent has taken steps to notify insurers, members, and law enforcement of the\ncybersecurity breach. Conduent is offering affected members access to 12 months of\ncredit monitoring and identity restoration services at no charge. To take advantage of\nthis offer, members must enroll by April 30, 2026.\n\nThe Department strongly encourages insurers and other entities regulated by the\nDepartment that have utilized Conduent to determine if their members have been\naffected by the cybersecurity breach, and, if so, to ensure that their members have been\nnotified by Conduent. Insurers are also encouraged to provide information on their\nwebsites relating to the cybersecurity breach, to alert members to the April 30, 2026\ndeadline to take advantage of credit monitoring services, and to provide a point of\ncontact with the insurer or with Conduent where members can address concerns\nrelating to the cybersecurity breach.\n\nThe Department also reminds insurers and other regulated entities of their duties to\nreport cybersecurity breaches to the Director. Entities should review Insurance Bulletins\n23-04 and 26-01, section 407.1500 RSMo, and the Insurance Data Security Act,\nsections 375.1400 to 375.1427 RSMo Supp. 2025. Questions for the Department\nregarding an entity’s duties can be sent to cyberbreach@insurance.mo.gov.\n\nQuestions relating to the Conduent cybersecurity breach may be directed to Conduent.\nConduent has a dedicated assistance line at 877-332-1658 (toll free), Monday-Friday,\nfrom 9:00 a.m. to 9:00 p.m. Eastern Time, and may also be contacted at Attn: Data\nIncident, 100 Campus Drive, Suite 200, Florham Park, New Jersey 07932.\n\nQuestions relating to the content of this bulletin may be directed to the Department’s\nMarket Conduct Section at marketconduct@insurance.mo.gov\n\n                                           ###\n\n                                            2","text_length":2028}
{"slug":"mo-bulletin-26-03","jurisdiction":"MO","agency":"DCI","doc_type":"bulletin","citation":"MO DCI Bulletin 26-03","title":"26-03 – Annual Statistical Reporting Requirements, February 4, 2026","official_source_url":"https://insurance.mo.gov/media/29561","access_class":"statutory-public","access_notes":"insurance.mo.gov; gate-zero TOP-20 MO-a.","first_seen_at":"2026-07-19T22:20:35.460086+00:00","last_checked_at":"2026-07-19T22:20:35.460086+00:00","versions":[{"fetched_at":"2026-07-19T22:20:35.460086+00:00","version_no":1,"text_length":5118,"effective_date":"2026-02-04","content_sha256_short":"9ac1b9986acf"}],"text":"DEPARTMENT OF COMMERCE & INSURANCE\n                              P.O. Box 690. Jefferson C ity, Mo. 65102·0690\n\n        INSURANCE BULLETIN 26-03\n\n        Annual Statistical Reporting Requirements\n\n        Issued: February 4, 2026\n\nThe following Bulletin is issued by the Missouri Department ofCommerce and Insurance\n(\"Department'') to inform and educate the reader on the specified issue. It does not have the\nforce and effect oflaw, is not an evaluation ofany specific facts or circumstances and is not\nbinding on the Department. See Section 374.015, RSMo.\n\nTo:       All insurers writing insurance coverages in th      •        • ouri\n\nFrom:     Angela L. Nelson, Director\n\nRe:       Annual Statistical Reporting Requirements\n\nThe purpose ofthis Bulletin is to provide a helpful reminder to all insurers of the annual statistical\nreporting obligations.\n\n      NOTE: There are!!!! new statistical reporting requirements specified in this Bulletin;\n      this Bulletin only provides a reminder and reference guide to assist insurers so they\n      may timely provide the statistical data as required.\n\nInsurers doing business in Missouri are required to annually report certain aspects of their\nbusiness. The statutory authority for each filing requirement, the applicable filing deadline and\ndetailed reporting instructions can be found on Appendix A of this Bulletin and on the Department's\nwebsite at: https://insurance.mo.gov/industry/filings/stats/statreprt.php.\n\nAll statistical reports (with the exception of the private passenger automobile/residential property\nMissouri ZIP code data) can be submitted online. Insurers are encouraged to file the required\nreports using the Statistics Claims Reporting Portal found at\nhttps://apps.dci.mo.gov/ProfLiab/MedMal/Login.aspx.\n\nThe private passenger automobile/residential property Missouri ZIP code data should be submitted\nvia email to statistics@insurance.mo.gov.\n\nAny questions or comments regarding this Bulletin or the statistical reporting requirements should\nbe directed to the Department’s Business Analytics/Statistics Section at\nstatistics@insurance.mo.gov.\n\n                                                 ###\n\n                                                   2\nAppendix A\n\n                               Property and Casualty Reports\n\n                                        Statutory/Regulatory                              Filing\n                 Filing                         References          Filing Deadline      Method\n Annual Statement: Page 19          374.040, 374.045 RSMo.,      March 1st              Reporting\n Supplement                         20 CSR 200-1.037                                    Portal\n Commercial liability               379.895 RSMo.                April 15th             Reporting\n profitability/loss                                                                     Portal\n development/closed claims\n Dram shop liability insurance      375.1730 RSMo,               March 31st             Reporting\n premium and loss report            20 CSR 600-1.020                                    Portal\n Legal malpractice open/closed      383.077, 383.079, 383.081,   January 1st / within   Reporting\n claims                             383.083 RSMo.                6 months of final      Portal\n                                                                 disposition\n Medical malpractice open/closed    383.105, 383.110, 383.115,   Quarterly              Reporting\n claims                             383.120, 383.125 RSMo.                              Portal\n Mortgage guaranty                                               July 1st               Reporting\n                                                                                        Portal\n Private passenger                  374.400, 374.405 RSMo.,      March 1st              Via\n automobile/residential property    20 CSR 600-3.100                                    Email\n Missouri ZIP code\n Products liability closed claims   374.415 RSMo.                March 1st              Reporting\n                                                                                        Portal\n Real estate open/closed claims     383.060, 383.067, 383.069    January 1st / within   Reporting\n                                    RSMo.                        6 months of final      Portal\n                                                                 disposition\n\n                             Life, Health and Accident Reports\n                                       Statutory/Regulatory                               Filing\n              Filing                        References            Filing Deadline        Method\n Annual Statement: Supplement        374.040, 374.045 RSMo.,     March 1st              Reporting\n for Missouri                       20 CSR 200-1.037                                    Portal\n Medicare supplement                 374.045, 374.190, 376.874   April 1st              Reporting\n experience                         RSMo., 20 CSR 600-1.010                             Portal\n\n                                                 3","text_length":5118}
{"slug":"mo-bulletin-21-02","jurisdiction":"MO","agency":"DCI","doc_type":"bulletin","citation":"MO DCI Bulletin 21-02","title":"21-02 - Health Insurance Rate Filings - Filing Dates for Plan Year 2022, March 5, 2021","official_source_url":"https://insurance.mo.gov/media/23781","access_class":"statutory-public","access_notes":"insurance.mo.gov; gate-zero TOP-20 MO-a.","first_seen_at":"2026-07-19T22:20:35.460086+00:00","last_checked_at":"2026-07-19T22:20:35.460086+00:00","versions":[{"fetched_at":"2026-07-19T22:20:35.460086+00:00","version_no":1,"text_length":2384,"effective_date":"2021-03-05","content_sha256_short":"c6db2884a4ec"}],"text":"INSURANCE BULLETIN 21-01\n          Updated Disaster Contact Information\n\n          Issued: January 14, 2021\n\nThe following Bulletin is issued by the Missouri Department of Commerce and Insurance (“Department”) to\ninform and educate the reader on the specified issue. It does not have the force and effect of law, is not an\nevaluation of any specific facts or circumstances, and is not binding on the Department. See section 374.015,\nRSMo.\n\nTo:              All insurers issuing policies covering real or personal property in Missouri\n\nFrom:            Chlora-Lindley Myers, Director\n\nRe:              Updated Disaster Contact Information\n\nIn anticipation of the upcoming spring storm season, and to ensure prompt and efficient communications with\nthe insurance industry following a disaster, the DCI requests each insurer insuring real or personal property in\nthe state to provide the following contact information to the DCI:\n\n         Primary regulatory contact: This contact should be available to directly communicate with the\n          Director and senior DCI leadership following a disaster within the state. These would be high-level\n          communications about the DCI’s response efforts, the company’s response efforts, logistic issues and\n          other urgent regulatory matters following a disaster.\n      Secondary regulatory contact: This secondary contact should be able to discuss non-urgent regulatory\n       issues with DCI staff as well as participate in industry conference calls and meetings regarding disaster\n       response matters.\n\n      Communications contact: This contact should be available to discuss inquiries received from press\n       outlets and to coordinate joint communication and consumer outreach efforts.\n\nFor each insurer contact type identified above, the DCI is requesting contact information (name, title telephone\nnumbers, email address) be submitted on the accompanying Excel spreadsheet form. Responses can be emailed\nto CompanyContacts@insurance.mo.gov\n\nWhere there are multiple insurers within a larger group, a single response may be submitted if the individuals\nidentified for the larger group can speak to the issues identified above for each insurer within the group.\n\nAny questions or comments regarding this Bulletin should be directed to Samantha Mueller at 573-751-2430 or\nvia email to Samantha.Mueller@insurance.mo.gov","text_length":2384}
{"slug":"nj-bulletin-20-08","jurisdiction":"NJ","agency":"DOBI","doc_type":"bulletin","citation":"NJDOBI Bulletin 20-08","title":"Temporary External Appeal Application Procedures for the Independent Health Care Appeals Program","official_source_url":"https://www.nj.gov/dobi/bulletins/blt20_08.pdf","access_class":"source-wants-visibility","access_notes":"nj.gov legal.shtml §F affirmative copy/distribute grant; gate-zero NJ-a. Incapsula WAF: keep cadence polite.","first_seen_at":"2026-07-19T21:48:03.227193+00:00","last_checked_at":"2026-07-20T06:36:25.926106+00:00","versions":[{"fetched_at":"2026-07-19T21:48:03.227193+00:00","version_no":1,"text_length":0,"effective_date":null,"content_sha256_short":"318659c68c93"}],"text":"","text_length":0}
{"slug":"nj-bulletin-20-15","jurisdiction":"NJ","agency":"DOBI","doc_type":"bulletin","citation":"NJDOBI Bulletin 20-15","title":"90-Day Grace Period for Property and Casualty Insurance Premium Payments Due to the Disruption Caused by COVID-19","official_source_url":"https://www.nj.gov/dobi/bulletins/blt20_15.pdf","access_class":"source-wants-visibility","access_notes":"nj.gov legal.shtml §F affirmative copy/distribute grant; gate-zero NJ-a. Incapsula WAF: keep cadence polite.","first_seen_at":"2026-07-19T21:48:03.227193+00:00","last_checked_at":"2026-07-20T06:36:25.926106+00:00","versions":[{"fetched_at":"2026-07-19T21:48:03.227193+00:00","version_no":1,"text_length":6296,"effective_date":null,"content_sha256_short":"3deb500527d9"}],"text":"State of New Jersey\n                                 DEPARTMENT OF BANKING AND INSURANCE\nPHIL MURPHY                           OFFICE OF THE COMMISSIONER\n Governor                                         PO BOX 325\n                                             TRENTON, NJ 08625-0325                                 MARLENE CARIDE\n                                                                                                     Commissioner\nSHEILA OLIVER                                   TEL (609) 633-7667\n Lt. Governor\n\n                                         BULLETIN NO. 20-15\n\n TO:             ALL INSURERS TRANSACTING PROPERTY AND CASUALTY\n                 INSURANCE IN NEW JERSEY, ALL LICENSED INSURANCE\n                 PRODUCERS, INSUREDS, AND OTHER INTERESTED PARTIES\n\n FROM:           MARLENE CARIDE, COMMISSIONER\n\n RE:             90-DAY GRACE PERIOD FOR PROPERTY AND CASUALTY\n                 INSURANCE PREMIUM PAYMENTS DUE TO THE DISRUPTION\n                 CAUSED BY COVID-19\n\n         On March 9, 2020, Governor Phil Murphy declared a state of emergency and public health\n emergency through the issuance of Exec. Order No. 103 (March 21, 2020) ___ N.J.R. ___ (“EO\n 103”) to contain the spread of the Coronavirus (“COVID-19”) pandemic. Governor Murphy later\n directed New Jersey residents to remain in their homes unless leaving was essential through the\n issuance of Exec. Order No. 107 (March 21, 2020) ___ N.J.R. ___ (“EO 107”). These Executive\n Orders were issued to contain the spread of the COVID-19 pandemic. On April 9, 2020, Governor\n Murphy issued Executive Order No. 123 (“EO 123”). EO 123 directed insurers transacting\n property and casualty to refrain from cancelling any policy or contract for nonpayment for a period\n of time as directed by the Commissioner of the Department of Banking and Insurance\n (“Commissioner”); to exercise appropriate forbearances on collection documentation; to amortize\n any unpaid payments over the remainder of the policy term or a period of up to 12 months, as\n appropriate, as directed by the Commissioner; and to refrain from seeking recoupment of any\n unpaid claims paid during the emergency grace period. The Department of Banking and Insurance\n (“Department”) is issuing this Bulletin to direct all property and casualty insurance carriers to\n extend a grace period to their insureds as set forth herein.\n\n         Since the outbreak of the respiratory disease COVID-19, individuals and businesses in the\n State of New Jersey have been negatively impacted in a variety of ways. For example, small\n businesses in the travel, entertainment, hospitality, and food service industries, have been\n adversely impacted by significant drops in business activities resulting, for some entities, in\n dramatic declines in revenue. Employees of these industries will be impacted, which may include\n the failure to be paid their regular salary or receive reimbursements when normally due. This, in\n turn, can adversely affect the ability of these individuals or businesses to make payments for\n obligations, such as insurance coverage, when due.\n\n                                       Visit us on the Web at dobi.nj.gov\n           New Jersey is an Equal Opportunity Employer • Printed on Recycled Paper and Recyclable\n        In response to the disruption caused by COVID-19, the Department is directing all licensed\nproperty and casualty insurance carriers to provide their insureds who may be experiencing a\nfinancial hardship due to COVID-19 with at least a 90-day grace period to pay insurance premiums\nso that insurance policies are not cancelled for nonpayment of premium during this challenging\ntime due to circumstances beyond the control of the insured. A policyholder may elect this 90-\nday emergency grace period to begin retroactively on April 1, 2020 or opt for the grace period to\nbegin on May 1, 2020. During this extended grace period, insurers shall not cancel any insurance\npolicy for nonpayment.\n\n    Insurers are also directed to:\n\n   •   Waive late payment fees otherwise due, and not report late payments to credit rating\n       agencies, during the 90-day period;\n   •   Allow premiums due but not paid during the 90-day period to be paid over the remainder\n       of the current policy term or up to 12 months in up to 12 equal installments, whichever is\n       longer, except that an insurer may permit a longer repayment period; and\n   •   Ensure that late payments during the 90-day period are not considered in any future\n       premium calculations at any time (i.e. applicable late payments should not be counted for\n       any rating, pricing, tiering attributes, etc.).\n\n       This grace period is intended to be applied to all installment payments, including renewal\ndown payments, provided that the insured provides notice to the insurer that the insured wishes to\ncontinue coverage. It is not intended to change the terms of the issued policy or be considered a\nforgiveness of the premium. Rather, it is intended that the insurer grant the policyholder an\nextended grace period for the payment of premium due without penalty or interest.\n\n       Insurers are further directed to, in addition to posting information on their website, provide\neach policyholder with an easily readable written description of the terms of the extended grace\nperiod offered pursuant to this guidance, which shall be submitted to the Department through the\nSystem for Electronic Rates and Forms Filing (“SERFF”) as an informational filing.\n        In addition, to eliminate the need for in person payment methods, in order to protect the\nsafety of workers and customers, all agents, brokers, and other licensees who accept premium\npayments on behalf of insurers must take steps to ensure that customers able to make payments\nhave the ability to make prompt insurance payments through alternate methods of payment, such\nas online payments.\n\n      Please note that this position may be revised or extended at any time in the discretion of\nthe Commissioner.\n\nApril 10, 2020\nDate                                                                 Marlene Caride\n                                                                     Commissioner\nJd PC Ins Prem Grace Pd Bul/COVID 19\n                                                 2","text_length":6296}
{"slug":"nj-bulletin-20-12","jurisdiction":"NJ","agency":"DOBI","doc_type":"bulletin","citation":"NJDOBI Bulletin 20-12","title":"Guidance Concerning Circumstances Related to the COVID-19 Pandemic (Small Employer Market)","official_source_url":"https://www.nj.gov/dobi/bulletins/blt20_12.pdf","access_class":"source-wants-visibility","access_notes":"nj.gov legal.shtml §F affirmative copy/distribute grant; gate-zero NJ-a. Incapsula WAF: keep cadence polite.","first_seen_at":"2026-07-19T21:48:03.227193+00:00","last_checked_at":"2026-07-20T06:36:25.926106+00:00","versions":[{"fetched_at":"2026-07-19T21:48:03.227193+00:00","version_no":1,"text_length":14722,"effective_date":null,"content_sha256_short":"67c0a6d7d19e"}],"text":"State of New Jersey\n                                 DEPARTMENT OF BANKING AND INSURANCE\nPHIL MURPHY                           OFFICE OF THE COMMISSIONER\n Governor                                         PO BOX 325\n                                             TRENTON, NJ 08625-0325                              MARLENE CARIDE\n                                                                                                  Commissioner\nSHEILA OLIVER                                   TEL (609) 633-7667\n Lt. Governor\n\n                                         BULLETIN NO. 20-12\n TO:             ALL HEALTH CARRIERS, DENTAL SERVICE CORPORATIONS, AND\n                 DENTAL PLAN ORGANIZATIONS ISSUING STANDARD SMALL\n                 EMPLOYER HEALTH AND DENTAL BENEFITS PLANS IN THIS STATE\n                 AND ALL LICENSED BROKERS SELLING STANDARD SMALL\n                 EMPLOYER HEALTH AND DENTAL BENEFITS PLANS IN THIS STATE\n\n FROM:           MARLENE CARIDE, COMMISSIONER\n RE:             GUIDANCE CONCERNING CIRCUMSTANCES RELATED TO THE\n                 COVID-19 PANDEMIC (SMALL EMPLOYER MARKET)\n\n        On March 9, 2020, Governor Phil Murphy declared a state of emergency and public health\n emergency through the issuance of Executive Order No. 103 to contain the spread of the\n Coronavirus (“COVID-19”) pandemic and, on April 7, 2020, issued Executive Order No. 119\n (“EO 103” and “EO 119”) declaring that the Public Health Emergency declared in Executive Order\n No. 103 continues to exist. The Governor subsequently issued Executive Order 104 on March 16,\n 2020 which required some businesses to close, followed by Executive Order 107 on March 21,\n 2020 which required all non-essential employees to stay home.\n\n         Thus, many small businesses have closed and/or substantially reduced the hours and\n services they offer. For a variety of reasons associated with the pandemic, many employees\n currently covered under small employer health and dental benefits plans are being laid off,\n furloughed and are thus not actively at work, or given reduced work hours. The health coverage\n of employees no longer working is in jeopardy. The renewal of group policies of employers whose\n plans are under review prior to renewal may be threatened.\n\n         On April 9, 2020, Governor Murphy also issued Executive Order No. 123 (“EO 123”). EO\n 123 directed carriers to refrain from cancelling any policy or contract for nonpayment for a period\n of time, to exercise appropriate forbearances on collection documentation, to amortize any unpaid\n payments, and to refrain from seeking recoupment of any unpaid claims paid during the emergency\n grace period. The Department of Banking and Insurance (“Department”) is issuing this Bulletin\n to provide required guidance to all to health carriers, dental service corporations, and dental plan\n organizations (carriers) issuing small employer health and dental benefits plans in this State as\n well as brokers selling such plans regarding circumstances related to the COVID-19 pandemic.\n The following guidance is effective immediately and continues for the duration of the state of\n\n                                        Visit us on the Web at dobi.nj.gov\n            New Jersey is an Equal Opportunity Employer • Printed on Recycled Paper and Recyclable\nemergency and public health emergency declared pursuant to EO 103 and EO 119. The\nDepartment will continue to review this guidance during the duration of EO 119 to ensure\nconsumers receive the intended relief.\n\n         Small Employer: Refers to an employer who employed an average of at least 1 but not\nmore than 50 employees on business days during the preceding calendar year and who employs\nat least 1 employee on the first day of the plan year.\n\nGuidance Related to the COVID-19 Pandemic\n\n2020 Renewals\nCarriers must deem all small employers that have group plans with anniversary dates occurring\nduring the month of March through the end of the state of emergency period as eligible for\nrenewal.\nCarriers must rescind the termination notices that may already have been sent to small employers\nfor small employer health benefits plans with anniversary dates occurring during the month of\nMarch and through the end of the state of emergency period. Those small employers shall be\ndeemed eligible.\nIf a group wishes to terminate its small employer health benefits plan(s), the small employer\nmust submit a written termination letter to the carrier prior to the renewal date.\nCarriers must delay renewal reviews as may be necessary during the state of emergency.\n\n2021 Renewal Review\nThe employees of an inforce group are reviewed annually prior to renewal with the renewal review\nstarting about 150 days prior to renewal. That review looks at the number of employees on\nbusiness days in the preceding calendar year. For many businesses in New Jersey, the period of\ntime encompassed within the state of emergency did not constitute normal business days.\nTherefore, when groups are renewing in 2021 and the business days in 2020 are reviewed, the\nState of Emergency period must be excluded from review.\n\nWaiting Period\nA small employer that lays off one or more employees may seek to re-hire those employees once\nbusiness resumes operations. Carriers must waive any applicable waiting period that would apply\nto employees who were laid off after March 1, 2020 and again become full time employees eligible\nfor health insurance under the small employer’s policy.\n\nActively at Work or Active Work Requirement\nSince the Health Insurance Portability and Accountability Act (HIPAA), the active work\nrequirement has not applied when absence from work is due to health status-related factors.\n“Health status” is one such factor. When a temporary lay-off or furlough is the result of a\ngovernment declaration of a public health emergency requiring small employer businesses to close\nor substantially reduce hours, and non-essential employees are directed to stay home generally to\nmitigate the spread of a virus and the consequent health effects of it, then it is reasonable to\n\n                                                2\ndetermine failure to be actively at work under these circumstances is due to health status and is\nthus a health status related factor under HIPAA.\n\nCarriers may consider the public health emergency as health status. Thus, employees who are\nfurloughed or temporarily laid off during this public health emergency are not required to be found\nineligible due to not being actively at work. Employers who continue to cover furloughed or\ntemporarily laid-off employees must remit the required premium for such coverage to the carrier.\n\nFull -Time Requirement\nCarriers must relax the full-time requirement to allow continued employee coverage for employees\nwhose hours have been reduced. The reduced hour requirements would apply only to employees\nwho are currently covered and whose hours have been reduced. By relaxing the full-time\nrequirements, the employee may remain covered under the group policy without having to elect\nCOBRA.\n\nExtended Grace Period\nCarriers shall make available an emergency 60-day grace period to any small employer that\nrequests it.\n\nThe grace period may be initially applied towards the April or May premium as the policyholder\ndetermines and will continue for 60 calendar days from that date. During this emergency grace\nperiod, a carrier shall not terminate that policy for nonpayment of premium. Coverage must remain\nin force and claims must be paid and may not be pended.\n\nIf a carrier has already provided a policyholder with a legally required grace period for April 2020\npremiums, the time period for which a grace period has already been granted shall be applied\ntoward the emergency grace period. This 60-day grace period shall only apply to policyholders\nthat were in good standing with their insurance carrier on March 1, 2020 and shall only apply to\npremiums due after the initial premium has been made to secure coverage.\n\nAfter the 60-day emergency grace period, a policyholder must be offered the option of amortizing\nany unpaid premium over the remaining months of the policy, but for not less than six months.\nFor example, if six months are remaining on the policy, the policyholder must be given the option\nto pay the unpaid premium in six installments in addition to the regular monthly premium. If less\nthan three months remain on the policy, the carrier must allow at least six months for the deferred\npremium to be paid.\n\nCarriers are directed that they are not to seek recoupment from any policyholder for any claims\nincurred during this emergency grace period. Carriers shall not report late payments to credit\nreporting agencies, consistent with this guidance, for policyholders taking advantage of COVID-\n19-related relief.\n\nCarriers are further directed to, in addition to posting information on the carrier’s website, provide\neach small employer policyholder with an easily readable written description of the terms of the\nextended grace period offered pursuant to this guidance. Carriers must also report to the\nDepartment the manner in which they will comply with this bulletin concurrent with those changes\n                                                  3\ntaking effect. All carrier changes must be uniformly applied to all small employer health benefits\nplans to which the changes would be applicable. Carriers are directed to file this information with\nthe Department’s Office of Life and Health at lifehealth@dobi.nj.gov.\n\nApril 10, 2020\nDate                                                        Marlene Caride\n                                                            Commissioner\n\nSmall Employer Bulletin/COVID-19\n\n                                                4\n                                   STATE OF NEW JERSEY\n                      DEPARTMENT OF BANKING AND INSURANCE\n                             NOTICE OF RULE MODIFICATION\n   PURSUANT TO EXECUTIVE ORDER NO. 103 (MURPHY)(MARCH 9, 2020) AND\n                  EXECUTIVE ORDER NO. 123 (MURPHY)(APRIL 9, 2020)\n                             COVID-19 STATE OF EMERGENCY\n\nTemporary Rule Modification adopted by Marlene Caride, Commissioner, Department of Banking\nand Insurance\n\nDate: April 10, 2020\nAuthority: N.J.S.A. App.A:9-45 & App. A:9-47; Exec. Order No. 103 (March 9, 2020) ___ N.J.R.\n___ (“EO 103”); Exec. Order No. 123 (April 9, 2020) ___ N.J.R. ___ (“EO 123”)\nEffective Date: April 10, 2020\nExpiration Date: Concurrent with end of EO 103\n          This is an emergency adoption of a temporary rule modification of the Department’s\nInsurance rules at N.J.A.C. 11:21-7.11, N.J.A.C. 11:21-7.5, N.J.A.C. 11:21-7.6, N.J.A.C. 11:21-\n6.2, and N.J.A.C. 11:21-1.2. Section 6 of EO 103, issued in response to the COVID-19 pandemic,\nauthorizes agency heads to waive/suspend/modify any existing rule, where the enforcement of the\nrule would be detrimental to the public welfare during the emergency, notwithstanding the\nprovisions of the Administrative Procedure Act or any law to the contrary. Further, Section 5 of\nEO 123 authorizes the Commissioner of the Department of Banking and Insurance to take all\nappropriate steps to effectuate EO 123. Pursuant to that authority, and with the approval of the\nGovernor and in consultation with the State Director of Emergency Management and the\nCommissioner of the Department of Health, the Department of Banking and Insurance\n(“Department”) is modifying certain rules as follows:\n          In order to provide relief to insureds with health coverage under small employer health\nbenefits plans designed by the Small Employer Health Benefits (“SEH”) Program, so that their\npolicies are not cancelled for nonpayment of premium, the Department is taking the following\naction:\n\n                                                 5\n       N.J.A.C. 11:21-7.11 states a carrier may discontinue a health benefits plan if the\npolicyholder does not meet the minimum participation and contribution requirements. These\nrequirements are modified as it relates 2020 renewals, as all carriers must keep small employers\nthat have group plans with anniversary dates occurring during the month of March until the end of\nthe state emergency period, as eligible for renewal. Further, carriers must rescind termination\nnotices that may already have been sent to small employers for small employer health benefits\nplans with anniversary dates occurring during the month of March and through the end of the state\nof emergency period. Those small employers shall be deemed eligible. If a group wishes to\nterminate its small employer health benefits plan(s), the small employer must submit a written\ntermination letter to the carrier prior to the renewal date. Carriers must delay renewal reviews as\nmay be necessary during the state of emergency.\n       Further, N.J.A.C. 11:21-7.5 requires a minimum participation of 75 percent of full-time\nemployees under a small employer’s health benefits plan for purposes of eligibility of coverage\nand N.J.A.C. 11:21-7.6 requires a small employer carrier shall not require a minimum small\nemployer contribution of more than 10 percent of the annual cost of the small employer’s health\nbenefits plan. As carriers must keep all small employers with anniversary dates occurring during\nthe month of March until the end of the state emergency period as eligible, these requirements are\nbeing relaxed.\n       In addition, employees of an inforce group are reviewed annually pursuant to N.J.A.C.\n11:21-6.2. The review looks at the number of employees on business days in the preceding\ncalendar year. For many businesses in New Jersey, the period of time encompassed within the\nstate of emergency did not constitute normal business days. Therefore, when groups are renewing\nin 2021 and the business days in 2020 are reviewed, the state of emergency period must be\nexcluded from review.\n       N.J.A.C. 11:21-1.2 defines “full time employee” as an employee who works 25 hours per\nweek. This requirement is modified as it relates to employees who are currently covered under\nSEH plan whose hours have been reduced so that these employees may remain covered under the\ngroup policy without having to elect continuation of benefits.\n\n                                                6\n       I find that modification of the rules above is necessary because enforcement of the existing\nrules would be detrimental to the public welfare during this emergency.\n\nApril 10, 2020\nDate                                                                Marlene Caride\n                                                                    Commissioner\n\nAR Small Employer Notice of Modification/COVID\n\n                                                 7","text_length":14722}
{"slug":"nj-bulletin-20-09","jurisdiction":"NJ","agency":"DOBI","doc_type":"bulletin","citation":"NJDOBI Bulletin 20-09","title":"No Action Position Regarding Potential Disruptions Due to COVID-19","official_source_url":"https://www.nj.gov/dobi/bulletins/blt20_09.pdf","access_class":"source-wants-visibility","access_notes":"nj.gov legal.shtml §F affirmative copy/distribute grant; gate-zero NJ-a. Incapsula WAF: keep cadence polite.","first_seen_at":"2026-07-19T21:48:03.227193+00:00","last_checked_at":"2026-07-20T06:36:25.926106+00:00","versions":[{"fetched_at":"2026-07-19T21:48:03.227193+00:00","version_no":1,"text_length":8683,"effective_date":null,"content_sha256_short":"4d40f8f4fb70"}],"text":"State of New Jersey\n                                 DEPARTMENT OF BANKING AND INSURANCE\nPHIL MURPHY                           OFFICE OF THE COMMISSIONER\n Governor                                         PO BOX 325\n                                             TRENTON, NJ 08625-0325                                 MARLENE CARIDE\n                                                                                                     Commissioner\nSHEILA OLIVER                                   TEL (609) 633-7667\n Lt. Governor\n\n                                         BULLETIN NO. 20-09\n TO:             ALL LICENSED NEW JERSEY REAL ESTATE LICENSEES, SCHOOL\n                 DIRECTORS, INSTRUCTORS, AND OTHER INTERESTED PARTIES\n\n FROM:           MARLENE CARIDE, COMMISSIONER\n\n RE:             NO ACTION POSITION REGARDING POTENTIAL DISRUPTIONS DUE\n                 TO COVID-19\n\n On March 9, 2020, Governor Phil Murphy declared a state of emergency and public health\n emergency to contain the spread of COVID-19. As Governor Murphy has stated, “The State of\n New Jersey is committed to deploying every available resource, across all levels of government,\n to help respond to the spread of COVID-19 and keep our residents informed.”\n\n Due to the heightened concern regarding the outbreak of the respiratory disease COVID-19, the\n Department of Banking and Insurance (“Department”) encourages you to continue to meet the\n needs of your clients while recognizing the potential impact of COVID-19 on the operations of\n many real estate brokerages, schools, and licensees. We recognize the potential impact of COVID-\n 19 on the employees and operations of many real estate brokerages and will provide appropriate\n regulatory assistance to affected institutions subject to our supervision.\n\n EDUCATION\n\n The Department recognizes that real estate schools may need to close in response to orders issued\n by the Department of Health, or due to real estate classes taught in a public school, college,\n university, or other public building that may have been closed or inaccessible during the state of\n emergency and public health emergency. While Exec. Order No. 103 (March 9, 2020) ___ N.J.R.\n ___(“EO 103”) is active, real estate prelicensure courses may be taught in an on-line format, such\n as in a webinar, a virtual classroom, or by video conferencing. Persons seeking to teach these\n courses online should direct questions by email to Gwendolyn Cobb, Supervisor of Licensing and\n Education, at Gwendolyn.Cobb@dobi.nj.gov. Courses must still meet the regulatory requirements\n regarding length and subject matter.\n\n                                       Visit us on the Web at dobi.nj.gov\n           New Jersey is an Equal Opportunity Employer • Printed on Recycled Paper and Recyclable\nLICENSURE TEST\n\nIn the normal course, applicants must pass the licensure test within one year of passing a\nprelicensure course. While EO 103 is in effect, the Department will evaluate any applications for\nlicensure where the applicant passed the licensure test after one year of passing the prelicensure\ncourse. As part of that process, the Department may request the submission of additional\ndocuments and undertakings by the requesting applicant or related parties.\n\nLICENSURE APPLICATION\n\nIn the normal course, applications for licensure must be submitted within one year following the\ndate an individual passes the real estate prelicensure course. While EO 103 is in effect, the\nDepartment will evaluate any applications for licensure that are submitted after one year of passing\nthe real estate prelicensure course. As part of that process, the Department may request the\nsubmission of additional documents and undertakings by the requesting applicant or related\nparties.\n\nThis position may be revised or extended at any time at the discretion of the Commissioner and\ndoes not constitute a statutory or regulatory exemption from the educational requirement for\nlicensure.\n\nWe will continue to process applications and respond to your requests. Effective immediately\nand until further notice, all notices, inquiries, and correspondence, must be submitted\nelectronically by email, to the appropriate contacts listed below, rather than by courier,\novernight, mail or fax.\n\nAll submissions and inquiries should be directed by e-mail to relic@dobi.nj.gov with copy to:\n\nGwendolyn Cobb, Supervisor of Licensing and Education, 609-292-7272 or 609-940-7373\nGwendolyn.Cobb@dobi.nj.gov\n\nFor other inquiries:\nAurelio Romero, Executive Director of Real Estate, 609-940-7474\nAurelio.Romero@dobi.nj.gov\n\n3/30/20\nDate                                                                 Marlene Caride\n                                                                     Commissioner\n\nJd Covid19 RE/Covid 19\n                                                 2\n                                    STATE OF NEW JERSEY\n                      DEPARTMENT OF BANKING AND INSURANCE\n                                NOTICE OF RULE SUSPENSION\n      PURSUANT TO EXECUTIVE ORDER NO. 103 (MURPHY)(MARCH 9, 2020)\n                              COVID-19 STATE OF EMERGENCY\n\nTemporary Rule Suspension adopted by Marlene Caride, Department of Banking and Insurance\nDate: March 30, 2020\nAuthority: N.J.S.A. App.A:9-45 & App. A:9-47; Exec. Order No. 103 (March 9, 2020) ___ N.J.R.\n___(“EO 103”)\nEffective Date: March 30, 2020\nExpiration Date: Concurrent with end of EO 103\nThis is an emergency adoption of a temporary rule suspension of the Department’s Real Estate\nrules at N.J.A.C. 11:5-2.2(f), N.J.A.C. 11:5-3.6(c), and N.J.A.C. 11:5-3.8(e). Section 6 of EO 103,\nissued in response to the COVID-19 pandemic, authorizes agency heads to waive/suspend/modify\nany existing rule, where the enforcement of the rule would be detrimental to the public welfare\nduring the emergency, notwithstanding the provisions of the Administrative Procedure Act or any\nlaw to the contrary. Pursuant to that authority, and with the approval of the Governor and in\nconsultation with the State Director of Emergency Management and the Commissioner of the\nDepartment of Health, Department of Banking and Insurance is suspending certain rules as\nfollows:\nIn order to facilitate social distancing and other virus mitigation strategies in real estate offices and\nschools, licensed under the N.J.S.A. 45:15-1 et seq., the Department is taking the following action:\nN.J.A.C. 11:5-2.2(f) requiring that every licensed school maintain a bona fide office open to the\npublic during normal business hours for the purpose of assisting former and current students and\nmeet certain other requirements to adequately serve their students is suspended, so that real estate\nschools may be able to operate online, if the building where the school is held either closed or is\notherwise inaccessible for a reason related to COVID-19. Persons seeking to teach these courses\nonline should direct questions by email to Gwendolyn Cobb, Supervisor of Licensing and\nEducation at Gwendolyn.Cobb@dobi.nj.gov. Courses must still meet the regulatory requirements\nregarding length and subject matter.\n\nN.J.A.C. 11:5-3.6(c) requiring that salespersons and referral agents pass the examination and apply\nfor a license not later than one year after the date of successful completion of a prelicensure course\nis suspended. The Department will evaluate any applications for licensure where the applicant\npassed the examination after one year of passing the prelicensure course or where the applicant\napplies for licensure after one year of passing the prelicensure course.\nSimilarly, N.J.A.C. 11:5-3.8(e), requiring that an applicant for a real estate broker or broker-\nsalesperson license must pass the broker license examination and apply for a license as a broker or\nbroker-salesperson not later than one year after successful completion of prelicensure education\nrequirements is suspended. The Department will evaluate any applications for licensure where the\napplicant passed the licensure examination after one year of passing the prelicensure course or\nwhere the applicant applies for licensure after one year of passing the prelicensure course.\n\nPlease note that this Notice may be revised or extended at any time in the discretion of the\nCommissioner and does not constitute a statutory or regulatory exemption from licensure.\n\nI find that suspension of the rules above is necessary because enforcement of the existing rules\nwould be detrimental to the public welfare during this emergency.\n\n3/30/20\nDate                                                                Marlene Caride\n                                                                    Commissioner\n\nJd COVID 19 Suspensions","text_length":8683}
{"slug":"nj-bulletin-20-17","jurisdiction":"NJ","agency":"DOBI","doc_type":"bulletin","citation":"NJDOBI Bulletin 20-17","title":"90-Day Grace Period to Clients of Insurance Premium Finance Companies Due to the Disruption Caused by COVID-19 Bulletin 20-17 Frequently Asked Questions","official_source_url":"https://www.nj.gov/dobi/bulletins/blt20_17.pdf","access_class":"source-wants-visibility","access_notes":"nj.gov legal.shtml §F affirmative copy/distribute grant; gate-zero NJ-a. Incapsula WAF: keep cadence polite.","first_seen_at":"2026-07-19T21:48:03.227193+00:00","last_checked_at":"2026-07-20T06:36:25.926106+00:00","versions":[{"fetched_at":"2026-07-19T21:48:03.227193+00:00","version_no":1,"text_length":6969,"effective_date":null,"content_sha256_short":"0eebda8fa98a"}],"text":"State of New Jersey\n                                 DEPARTMENT OF BANKING AND INSURANCE\nPHIL MURPHY                           OFFICE OF THE COMMISSIONER\n Governor                                         PO BOX 325\n                                             TRENTON, NJ 08625-0325                                 MARLENE CARIDE\n                                                                                                     Commissioner\nSHEILA OLIVER                                   TEL (609) 633-7667\n Lt. Governor\n\n                                         BULLETIN NO. 20-17\n\n TO:             ALL INSURANCE PREMIUM FINANCE COMPANIES, INSUREDS, AND\n                 OTHER INTERESTED PARTIES\n\n FROM:           MARLENE CARIDE, COMMISSIONER\n\n RE:             90-DAY GRACE PERIOD TO CLIENTS OF INSURANCE PREMIUM\n                 FINANCE COMPANIES DUE TO THE DISRUPTION CAUSED BY\n                 COVID-19\n\n         On March 9, 2020, Governor Phil Murphy declared a state of emergency and public health\n emergency through the issuance of Exec. Order No. 103 (March 21, 2020) ___ N.J.R. ___ (“EO\n 103”) to contain the spread of the Coronavirus (“COVID-19”) pandemic. Governor Murphy later\n directed New Jersey residents to remain in their homes unless leaving was essential through the\n issuance of Exec. Order No. 107 (March 21, 2020) ___ N.J.R. ___ (“EO 107”). These Executive\n Orders were issued to contain the spread of the COVID-19 pandemic. On April 9, 2020, Governor\n Murphy Issued Exec. Order No. 123 __ N.J.R. __ (“EO 123”). EO 123 directed insurance\n premium finance companies to refrain from cancelling any policy or contract for nonpayment for\n a period of time as directed by the Commissioner of the Department of Banking and Insurance\n (“Commissioner”), to exercise appropriate forbearances on collection documentation, amortizing\n any unpaid payments over the remainder of the policy term or a period of up to 12 months, as\n appropriate, as directed by the Commissioner, and to refrain from seeking recoupment of paid\n claims during the emergency grace period. The Department of Banking and Insurance\n (“Department”) is issuing this Bulletin to direct all insurance premium finance companies licensed\n pursuant to N.J.S.A. 17:16D-1 to -16 (“Insurance Premium Finance Company Act”) to extend a\n grace period for the payment of premiums to their clients as set forth herein.\n\n         Since the outbreak of the respiratory disease COVID-19, individuals and businesses in the\n State of New Jersey have been negatively impacted in a variety of ways. For example, small\n businesses in the travel, entertainment, hospitality, and food service industries, have been\n adversely impacted by significant drops in business activities resulting, for some entities, in\n dramatic declines in revenue. Employees of these industries will be impacted, which may include\n the failure to be paid their regular salary or receive reimbursements when normally due. This, in\n turn, can adversely affect the ability of these individuals or businesses to make payments for\n obligations, such as insurance coverage, when due.\n\n                                       Visit us on the Web at dobi.nj.gov\n           New Jersey is an Equal Opportunity Employer • Printed on Recycled Paper and Recyclable\n         Currently, an insurance premium finance company may cancel an insurance contract for\nfailure to pay premium upon not less than 10 days’ notice. In response to the disruption caused by\nCOVID-19, all licensed insurance premium finance companies are directed to provide their clients\nwho are experiencing a financial hardship due to COVID-19 with a 90-day grace period to pay for\ntheir insurance premiums so that insurance policies are not cancelled for nonpayment of premium\nduring this challenging time due to circumstances beyond the control of the insured. A\npolicyholder may elect this 90-day emergency grace period to begin retroactively on April 1, 2020\nor opt for the grace period to begin on May 1, 2020. During this extended grace period, insurance\npremium finance companies shall not cancel any insurance policy for nonpayment of installment\npayments for the term of the insurance policy.\n\n       Insurance premium finance companies are also directed to:\n\n       •       Waive late payment fees, finance charges, and delinquency charges otherwise due,\n               and not report late payments to credit rating agencies, during the 90-day period;\n       •       Allow premiums due but not paid during the 90-day period to be paid over either\n               12 months or the remainder of the current policy term, whichever is longer, except\n               that a premium finance company may provide a longer repayment period; and\n       •       Ensure that late payments during the 90-day period are not considered in any future\n               premium calculations at any time.\n\n         The extended grace periods described above shall apply to policyholders that were in good\nstanding with their insurance carrier on March 1, 2020. This grace period is intended to be applied\nto all installment payments, including renewal down payments, provided that the insured provides\nnotice to the insurer that the insured wishes to continue coverage. If renewal is due during the\nterm of the grace period, the contract can be renewed with the same terms with client approval,\neven if the client has not paid the installment during the grace period. The grace period is not\nintended to change the terms of the issued policy or be considered a forgiveness of installment\npayments. Rather, it is directed that the insurance premium finance company grant COVID-19\nimpacted clients an extended grace period for the payment of installments due without penalty or\ninterest.\n\n       Insurance premium finance companies are further directed to, in addition to posting\ninformation on the its website, provide each policyholder with an easily readable written\ndescription of the terms of the extended grace period offered pursuant to this guidance, which shall\nbe submitted to the Department at bliconline@dobi.nj.gov as an informational filing.\n\n        In addition, to eliminate the need for in person payment methods, in order to protect the\nsafety of workers and customers, all agents, brokers, and other licensees who accept premium\npayments on behalf of insurers must take steps to ensure that customers able to make payments\nhave the ability to make prompt insurance payments through alternate methods of payment, such\nas online payments.\n\n                                                 2\n       The Department will monitor events as they develop to determine if this emergency grace\nperiod must be extended.\n\nApril 10, 2020\nDate                                                             Marlene Caride\n                                                                 Commissioner\n\nJd prem fin co grace pd Bul/COVID 19\n\n                                              3","text_length":6969}
{"slug":"nj-bulletin-20-16","jurisdiction":"NJ","agency":"DOBI","doc_type":"bulletin","citation":"NJDOBI Bulletin 20-16","title":"90-Day Grace Period for Life Insurance Premium Payments Due to the Disruption Caused by COVID-19","official_source_url":"https://www.nj.gov/dobi/bulletins/blt20_16.pdf","access_class":"source-wants-visibility","access_notes":"nj.gov legal.shtml §F affirmative copy/distribute grant; gate-zero NJ-a. Incapsula WAF: keep cadence polite.","first_seen_at":"2026-07-19T21:48:03.227193+00:00","last_checked_at":"2026-07-20T06:36:25.926106+00:00","versions":[{"fetched_at":"2026-07-19T21:48:03.227193+00:00","version_no":1,"text_length":6570,"effective_date":null,"content_sha256_short":"77dc00b478d4"}],"text":"State of New Jersey\n                                 DEPARTMENT OF BANKING AND INSURANCE\nPHIL MURPHY                           OFFICE OF THE COMMISSIONER\n Governor                                         PO BOX 325\n                                             TRENTON, NJ 08625-0325                                 MARLENE CARIDE\n                                                                                                     Commissioner\nSHEILA OLIVER                                   TEL (609) 633-7667\n Lt. Governor\n\n                                         BULLETIN NO. 20-16\n\n TO:             ALL INSURERS AUTHORIZED OR ADMITTED TO TRANSACT LIFE\n                 INSURANCE IN NEW JERSEY, LICENSED INSURANCE PRODUCERS,\n                 INSUREDS, AND OTHER INTERESTED PARTIES\n\n FROM:           MARLENE CARIDE, COMMISSIONER\n\n RE:             90-DAY GRACE PERIOD FOR LIFE INSURANCE PREMIUM\n                 PAYMENTS DUE TO THE DISRUPTION CAUSED BY COVID-19\n\n          On March 9, 2020, Governor Phil Murphy declared a state of emergency and public health\n emergency through the issuance of Exec. Order No. 103 (March 21, 2020) ___ N.J.R. ___ (“EO\n 103”) to contain the spread of the Coronavirus (“COVID-19”) pandemic. Governor Murphy later\n directed New Jersey residents to remain in their homes unless leaving was essential through the\n issuance of Exec. Order No. 107 (March 21, 2020) ___ N.J.R. ___ (“EO 107”). These Executive\n Orders were issued to contain the spread of the COVID-19 pandemic. On April 9, 2020, Governor\n Murphy Issued Exec. Order No. 123 __ N.J.R. __ (“EO 123”). EO 123 directed insurance\n companies to refrain from cancelling any policy or contract for nonpayment for a period of time\n as directed by the Commissioner of the Department of Banking and Insurance (“Commissioner”);\n to exercise appropriate forbearances on collection documentation; to amortize any unpaid\n payments over the remainder of the policy term or a period of up to 12 months, as appropriate, as\n directed by the Commissioner; and to refrain from seeking recoupment of any unpaid claims paid\n during the emergency grace period. The Department of Banking and Insurance (“Department”) is\n issuing this Bulletin to direct all life carriers to extend a grace period for the payment of premiums\n to their insureds as set forth herein.\n         Since the outbreak of the respiratory disease COVID-19, individuals and businesses in the\n State of New Jersey have been negatively impacted in a variety of ways. For example, small\n businesses in the travel, entertainment, hospitality, and food service industries, have been\n adversely impacted by significant drops in business activities resulting, for some entities, in\n dramatic declines in revenue. Employees of these industries will be impacted, which may include\n the failure to be paid their regular salary or receive reimbursements when normally due. This, in\n turn, can adversely affect the ability of these individuals or businesses to make payments for\n obligations, such as insurance coverage, when due.\n        Currently, traditional life insurance policies include a grace period of not less than 30 days,\n and in certain circumstances for account value life insurance policies not less than 60 days. In\n\n                                       Visit us on the Web at dobi.nj.gov\n           New Jersey is an Equal Opportunity Employer • Printed on Recycled Paper and Recyclable\nresponse to the disruption caused by COVID-19, the Department is directing all licensed life\ninsurers to provide their policyholders or certificate holders who may be experiencing a financial\nhardship due to COVID-19 with at least a 90-day grace period to pay life insurance and annuity\ncontracts premiums so that insurance policies or contracts are not cancelled for nonpayment of\npremium during this challenging time due to circumstances beyond the control of the insured. A\npolicyholder may elect this 90-day emergency grace period to begin retroactively on April 1, 2020\nor opt for the grace period to begin on May 1, 2020. During this extended grace period, life\ninsurance companies cannot cancel any insurance policy for nonpayment of premium.\n        Insurers are directed to:\n    •     Waive late payment fees otherwise due, including any interest permitted pursuant to\n          N.J.S.A.17B:25-3, and not report late payments to credit rating agencies, during the 90-\n          day period;\n    •     Allow premiums due but not paid during the 90-day period to be paid over the course of\n          the following year in up to 12 equal installments, except that an insurer may permit a longer\n          repayment period; and\n    •     Extend to 90 days the period to exercise policyholder and contract holder rights and\n          benefits under life insurance and annuity contracts.\n        The extended grace periods described above shall apply to policyholders that were in good\nstanding with their insurance carrier on March 1, 2020. This grace period is intended to be applied\nto premiums due after the initial premium has been made to secure coverage. It is not intended to\nchange the terms of the issued policy or contract or be considered a forgiveness of the premium.\nRather, it is intended that the insurer grant the policyholder or certificate holder an extended grace\nperiod for the payment of premium due without penalty or interest.\n       Insurers are further directed to, in addition to posting information on their website, provide\neach policyholder with an easily readable written description of the terms of the extended grace\nperiod offered pursuant to this guidance, which shall be submitted to the Department through the\nSystem for Electronic Rates and Forms Filing (“SERFF”) as an informational filing.\n        In addition, to eliminate the need for in person payment methods, in order to protect the\nsafety of workers and customers, all agents, brokers, and other licensees who accept premium\npayments on behalf of insurers must take steps to ensure that customers able to make payments\nhave the ability to make prompt insurance payments through alternate methods of payment, such\nas online payments.\n       The Department will monitor events as they develop to determine if this emergency grace\nperiod must be extended.\n\nApril 10, 2020\nDate                                                                    Marlene Caride\n                                                                        Commissioner\n\nJd Life ins prem grace pd Bulletin/COVID 19\n                                                    2","text_length":6570}
{"slug":"nj-bulletin-20-14","jurisdiction":"NJ","agency":"DOBI","doc_type":"bulletin","citation":"NJDOBI Bulletin 20-14","title":"Response to COVID-19 (Medicare Supplement)","official_source_url":"https://www.nj.gov/dobi/bulletins/blt20_14.pdf","access_class":"source-wants-visibility","access_notes":"nj.gov legal.shtml §F affirmative copy/distribute grant; gate-zero NJ-a. Incapsula WAF: keep cadence polite.","first_seen_at":"2026-07-19T21:48:03.227193+00:00","last_checked_at":"2026-07-20T06:36:25.926106+00:00","versions":[{"fetched_at":"2026-07-19T21:48:03.227193+00:00","version_no":1,"text_length":5691,"effective_date":null,"content_sha256_short":"de068a5c1dd2"}],"text":"State of New Jersey\n                                 DEPARTMENT OF BANKING AND INSURANCE\nPHIL MURPHY                           OFFICE OF THE COMMISSIONER\n Governor                                         PO BOX 325\n                                             TRENTON, NJ 08625-0325                              MARLENE CARIDE\n                                                                                                  Commissioner\nSHEILA OLIVER                                   TEL (609) 633-7667\n Lt. Governor\n\n                                         BULLETIN NO. 20-14\n\n TO:             ALL   HEALTH   INSURANCE     COMPANIES   AND  HEALTH\n                 MAINTENANCE     ORGANIZATIONS,    ISSUING    MEDICARE\n                 SUPPLEMENT PLANS IN THIS STATE\n\n FROM:           MARLENE CARIDE, COMMISSIONER\n\n RE:             RESPONSE TO COVID-19 (MEDICARE SUPPLEMENT)\n\n          On March 9, 2020, Governor Phil Murphy declared a state of emergency and public health\n emergency through the issuance of Executive Order No. 103 to contain the spread of the\n Coronavirus (“COVID-19”) pandemic and, on April 7, 2020, issued Executive Order No. 119\n (“EO 103” and “EO 119”) declaring that the Public Health Emergency declared in Executive Order\n No. 103 continues to exist. The Governor subsequently issued Executive Order 104 on March 16,\n 2020, which required some businesses to close, followed by Executive Order 107 on March 21,\n 2020, which required all non-essential employees to stay home. Thus, many businesses have\n closed and/or substantially reduced the hours and services they offer. For a variety of reasons\n associated with the pandemic, many individuals covered under Medicare Supplement plans may\n experience difficulty paying premiums on a timely basis thereby jeopardizing maintenance of this\n critical coverage for these individuals.\n\n         On April 9, 2020, Governor Murphy also issued Executive Order No. 123 (“EO 123”). EO\n 123 directed carriers to refrain from cancelling any policy or contract for nonpayment for a period\n of time, to exercise appropriate forbearances on collection documentation, to amortize any unpaid\n payments, and to refrain from seeking recoupment of any unpaid claims paid during the emergency\n grace period. The purpose of this Bulletin is to provide guidance to all health insurance companies\n and health maintenance organizations issuing Medicare Supplement plans in this State\n (collectively “carriers”) as the State responds to the Coronavirus Disease 2019 (“COVID-19”)\n outbreak.\n\n         Medicare supplement plans provide a 31-day grace period consistent with New Jersey law\n at N.J.S.A. 17B:26-6 which governs individual Medicare Supplement plans and N.J.S.A. 17B:27-\n 37 which governs group Medicare Supplement plans. In the case of a 31-day grace period, the\n policyholder has 31 days from the due date in which to pay the premiums. While the state of\n emergency is in effect, the Department of Banking and Insurance is directing carriers to provide a\n 60-day grace period during which Medicare Supplement plans may not be terminated for\n nonpayment of premium.\n\n                                        Visit us on the Web at dobi.nj.gov\n            New Jersey is an Equal Opportunity Employer • Printed on Recycled Paper and Recyclable\n       The grace period may be initially applied towards the April or May premium as the\npolicyholder determines and will continue for 60 calendar days from that date. During this\nemergency grace period, a carrier shall not terminate that policy for nonpayment of premium.\nCoverage must remain in force and claims must be paid and may not be pended.\n\n       If a carrier has already provided a policyholder with a legally required grace period for\nApril 2020 premiums, the time period for which a grace period has already been granted shall be\napplied toward the emergency grace period. This 60-day grace period shall only apply to\npolicyholders that were in good standing with their insurance carrier on March 1, 2020 and shall\nonly apply to premiums due after the initial premium has been made to secure coverage.\n\n        After the 60-day emergency grace period, a policyholder must be offered the option of\namortizing any unpaid premium over the remaining months of the policy, but for not less than six\nmonths. For example, if six months are remaining on the policy, the policyholder must be given\nthe option to pay the unpaid premium in six installments in addition to the regular monthly\npremium. If less than six months remain on the policy, the carrier must allow at least six months\nfor the deferred premium to be paid.\n\n        Carriers are directed that they are not to seek recoupment from any policyholder for any\nclaims incurred during this emergency grace period. Carriers are further directed to, in addition to\nposting information on the carrier’s website, provide each policyholder with an easily readable\nwritten description of the terms of the extended grace period offered pursuant to this guidance,\nwhich shall be submitted to the Department through the System for Electronic Rates and Forms\nFiling (“SERFF”) as an informational filing.\n\n       The Department will continue to review this guidance during the duration of EO 103 and\nEO 119 to ensure policyholders receive the intended relief. If you have any questions, please\ncontact the Department’s Office of Life and Health Unit at lifehealth@dobi.nj.gov.\n\nApril 10, 2020\nDate                                                         Marlene Caride\n                                                             Commissioner\n\nMedicare Supplement COVID 19/COVID-19\n\n                                                 2","text_length":5691}
{"slug":"nj-bulletin-20-13","jurisdiction":"NJ","agency":"DOBI","doc_type":"bulletin","citation":"NJDOBI Bulletin 20-13","title":"Guidance Concerning Circumstances Related to the COVID-19 Pandemic (Large Employer Market)","official_source_url":"https://www.nj.gov/dobi/bulletins/blt20_13.pdf","access_class":"source-wants-visibility","access_notes":"nj.gov legal.shtml §F affirmative copy/distribute grant; gate-zero NJ-a. Incapsula WAF: keep cadence polite.","first_seen_at":"2026-07-19T21:48:03.227193+00:00","last_checked_at":"2026-07-20T06:36:25.926106+00:00","versions":[{"fetched_at":"2026-07-19T21:48:03.227193+00:00","version_no":1,"text_length":8840,"effective_date":null,"content_sha256_short":"e29a0b0a8ff5"}],"text":"State of New Jersey\n                               DEPARTMENT OF BANKING AND INSURANCE\nPHIL MURPHY                         OFFICE OF THE COMMISSIONER\n Governor                                      PO BOX 325\n                                          TRENTON, NJ 08625-0325                           MARLENE CARIDE\n                                                                                            Commissioner\nSHEILA OLIVER                                TEL (609) 292-7272\n Lt. Governor\n\n                                      BULLETIN NO. 20-13\n TO:            ALL HEALTH CARRIERS, DENTAL SERVICE CORPORATIONS AND\n                DENTAL BENEFITS ORGANIZATIONS ISSUING EMPLOYER HEALTH\n                AND DENTAL BENEFITS PLANS TO LARGE GROUP EMPLOYERS\n                (51+) IN THIS STATE AND ALL LICENSED BROKERS SELLING LARGE\n                GROUP HEALTH AND DENTAL BENEFITS PLANS IN THIS STATE\n\n FROM:          MARLENE CARIDE, COMMISSIONER\n RE:            GUIDANCE CONCERNING CIRCUMSTANCES RELATED TO THE\n                COVID-19 PANDEMIC (LARGE EMPLOYER MARKET)\n\n         On March 9, 2020, Governor Phil Murphy declared a state of emergency and public health\n emergency through the issuance of Executive Order No. 103 to contain the spread of the\n Coronavirus (“COVID-19”) pandemic and, on April 7, 2020, issued Executive Order No. 119\n (“EO 103” and “EO 119”) declaring that the Public Health Emergency declared in Executive Order\n No. 103 continues to exist. On April 9, 2020, Governor Murphy also issued Executive Order No.\n 123 (“EO 123”). EO 123 directed carriers to refrain from cancelling any policy or contract for\n nonpayment for a period of time, to exercise appropriate forbearances on collection\n documentation, to amortize any unpaid payments, and to refrain from seeking recoupment of any\n unpaid claims paid during the emergency grace period. The Department of Banking and Insurance\n (“Department”) is issuing this Bulletin to provide guidance to all health carriers, dental service\n corporations and dental benefits organizations (“carriers”) issuing large group employer health\n benefits plans in this State as well as brokers selling such plans regarding circumstances related to\n the COVID-19 pandemic.\n\n        The following guidance is effective immediately and continues for the duration of the state\n of emergency and public health emergency declared pursuant to EO 103 and EO 119. The\n Department will continue to review this guidance during the duration of EO 103 and EO 119 to\n ensure policyholders receive the intended relief.\n\n Circumstances Related to the COVID-19 Pandemic\n\n        As required by Executive Order Nos. 104 and 107, many businesses have been required to\n close. Others are operating with reduced hours and/or reduced services. Many of the businesses\n are considered large employers, with 51 or more employees. For a variety of reasons associated\n with the pandemic, many employees currently covered by a large employer health benefits plan\nare being laid off, furloughed or given reduced work hours. The health coverage of employees no\nlonger working full-time is in jeopardy. The renewal of group policies of employers whose plans\nare under review for renewal may be threatened.\n\n       Carriers currently evaluating large group renewals occurring later this year will need to\nconsider one or more of the following provisions.\n\nGuidance Related to COVID-19\n\nParticipation\nAs a result of furlough, lay-off or reduced hours, some employees may elect COBRA. Some laid-\noff employees may elect individual coverage through the Marketplace where they qualify for a\nsubsidy. Employers may fail the participation requirement with the result being non-renewal of\nthe large group policy.\n\nGuidance: Carriers must deem all employers that have policies with anniversary dates occurring\nduring the month of March through the end of the state of emergency period as eligible for renewal.\nCarriers must rescind termination notices that may already have been sent to employers with\nanniversary dates occurring during the month of March and through the end of the state of\nemergency period. Those employers shall be deemed eligible. If a group wishes to terminate its\npolicy the employer must submit a written termination letter to the carrier prior to the renewal\ndate. Carriers must delay renewal reviews as may be necessary during the state of emergency.\n\nFull-Time\nSome employees are working fewer hours per week than the hours required for full-time as stated\nin the group policy or contract and thus they are ineligible to be covered as employees.\n\nGuidance: Carriers may relax the full-time requirement to allow continued employee coverage.\nBy relaxing the full-time requirements, the employee may remain covered under the group policy\nwithout having to elect COBRA.\n\nWaiting Period\nAn employer that lays off one or more employees may seek to re-hire those employees once\nbusiness resumes operations. Since the employees were terminated from employment, they would\nbe subject to the applicable waiting period.\n\nGuidance: Carriers are required to waive any applicable waiting period that would apply to\nemployees who were previously laid off as a result of the pandemic and again become full time\nemployees eligible for health insurance under the employer’s plan.\n\nGrace Period\nCarriers shall make available an emergency 60-day grace period to any policyholder that has been\nfinancially or physically impacted by COVID-19. Also, carriers must provide the emergency grace\nperiod to any large employer that provides the carrier with an attestation from a senior financial\nofficer or certified public accountant attesting to the employer’s financial hardship caused by\nCOVID-19. The attestation shall only require the employer to indicate that as a result of COVID-\n19 it is experiencing a financial hardship, therefore making it difficult to pay its premium\n\n                                                2\npayments. Carriers may also make the emergency grace period available to any other large\nemployer in the carrier’s discretion.\n\nThe grace period may be initially applied towards the April or May premium as the policyholder\ndetermines and will continue for 60 calendar days from that date. During this emergency grace\nperiod, a carrier shall not terminate that policy for nonpayment of premium. Coverage must remain\nin force and claims must be paid and may not be pended.\n\nIf a carrier has already provided a policyholder with a legally required grace period for April 2020\npremiums, the time period for which a grace period has already been granted shall be applied\ntoward the emergency grace period. If coverage has been terminated due to nonpayment of\npremium after April 1, 2020, coverage must be reinstated for the term of the applicable emergency\ngrace period. This 60-day grace period shall only apply to policyholders that were in good standing\nwith their insurance carrier on March 1, 2020 and shall only apply to premiums due after the initial\npremium has been made to secure coverage.\n\nAfter the 60-day emergency grace period, a policyholder must be offered the option of amortizing\nany unpaid premium over the remaining months of the calendar year. For example, if six months\nare remaining in the calendar year, the policyholder must be given the option to pay the unpaid\npremium in six installments in addition to the regular monthly premium. If only three months\nremain on the policy, but 6 months remain in the calendar year, the carrier must allow the\npolicyholder the option to pay the unpaid premium in six installments in addition to the regular\nmonthly premium.\n\nCarriers are directed that they are not to seek recoupment from any policyholder for any claims\nincurred during this emergency grace period. Carriers shall not report late payments to credit\nreporting agencies, consistent with this guidance, for policyholders taking advantage of COVID-\n19-related relief.\n\nCarriers are further directed to, in addition to posting information on the carrier’s website, provide\neach large employer policyholder with an easily readable written description of the terms of the\nextended grace period offered pursuant to this guidance, which shall be submitted as an\ninformational filing to the Department. The above guidance provides carriers with certain areas\nof flexibility. Carriers are directed to advise the Department of the actions the carrier is taking.\nSaid information is to be submitted to the Department through the System for Electronic Rates and\nForms Filing (“SERFF”) as an informational filing.\n\nApril 10, 2020\nDate                                                          Marlene Caride\n                                                              Commissioner\n\nCOVID-19 Bulletin Large Employer/COVID-19\n\n                                                  3","text_length":8840}
{"slug":"nj-bulletin-20-11","jurisdiction":"NJ","agency":"DOBI","doc_type":"bulletin","citation":"NJDOBI Bulletin 20-11","title":"Guidance Concerning Circumstances Related to the COVID-19 Pandemic (Individual Market)","official_source_url":"https://www.nj.gov/dobi/bulletins/blt20_11.pdf","access_class":"source-wants-visibility","access_notes":"nj.gov legal.shtml §F affirmative copy/distribute grant; gate-zero NJ-a. Incapsula WAF: keep cadence polite.","first_seen_at":"2026-07-19T21:48:03.227193+00:00","last_checked_at":"2026-07-20T06:36:25.926106+00:00","versions":[{"fetched_at":"2026-07-19T21:48:03.227193+00:00","version_no":1,"text_length":8839,"effective_date":null,"content_sha256_short":"5ca717bf0b11"}],"text":"State of New Jersey\n                                 DEPARTMENT OF BANKING AND INSURANCE\nPHIL MURPHY                           OFFICE OF THE COMMISSIONER\n Governor                                         PO BOX 325\n                                             TRENTON, NJ 08625-0325                              MARLENE CARIDE\n                                                                                                  Commissioner\nSHEILA OLIVER                                   TEL (609) 633-7667\n Lt. Governor\n\n                                         BULLETIN NO. 20-11\n TO:             ALL HEALTH CARRIERS, DENTAL SERVICE CORPORATIONS, AND\n                 DENTAL BENEFITS ORGANIZATIONS ISSUING STANDARD\n                 INDIVIDUAL HEALTH AND DENTAL BENEFITS PLANS IN THIS\n                 STATE AND ALL LICENSED BROKERS SELLING STANDARD\n                 INDIVIDUAL HEALTH AND DENTAL BENEFITS PLANS IN THIS\n                 STATE\n\n FROM:           MARLENE CARIDE, COMMISSIONER\n RE:             GUIDANCE CONCERNING CIRCUMSTANCES RELATED TO THE\n                 COVID-19 PANDEMIC (INDIVIDUAL MARKET)\n\n        On March 9, 2020, Governor Phil Murphy declared a state of emergency and public health\n emergency through the issuance of Executive Order No. 103 to contain the spread of the\n Coronavirus (“COVID-19”) pandemic and, on April 7, 2020, issued Executive Order No. 119\n (“EO 103” and “EO 119”) declaring that the Public Health Emergency declared in Executive Order\n No. 103 continues to exist. The Governor subsequently issued Executive Order 104 on March 16,\n 2020 which required some businesses to close, followed by Executive Order 107 on March 21,\n 2020 which required all non-essential employees to stay home.\n\n         Thus, many businesses have closed and/or substantially reduced the hours and services\n they offer. For a variety of reasons associated with the pandemic, many persons currently covered\n under individual health benefits plans are struggling to pay premiums for their individual plans.\n\n         On April 9, 2020, Governor Murphy also issued Executive Order No. 123 (“EO 123”). EO\n 123 directed carriers to refrain from cancelling any policy or contract for nonpayment for a period\n of time, to exercise appropriate forbearances on collection documentation, to amortize any unpaid\n payments, and to refrain from seeking recoupment of any unpaid claims paid during the emergency\n grace period. The Department of Banking and Insurance (“Department”) is issuing this Bulletin\n to provide required guidance to health carriers, dental service corporations and dental benefits\n organizations (“carriers”) to remove possible barriers to coverage and accommodate their covered\n lives given the circumstances related to the COVID-19 pandemic. The following guidance is\n effective immediately and continues for the duration of the state of emergency and public health\n emergency declared pursuant to EO 103 and EO 119. The Department will continue to review this\n guidance during the duration of EO 119 to ensure consumers receive the intended relief.\n\n                                        Visit us on the Web at dobi.nj.gov\n            New Jersey is an Equal Opportunity Employer • Printed on Recycled Paper and Recyclable\nEmergency Grace Period Extension\n       Currently, standard individual health benefits plans include a 31-day grace period, with the\ngrace period increased to 90 days when the individual policyholder is receiving advanced premium\ntax credits (“APTC”). This bulletin requires an extension of these grace periods for each\ncircumstance as described below.\n\n        With respect to individual market policyholders that do not receive APTC, the current 31-\nday grace period must be extended to a period of at least 60 calendar days. During this period, a\ncarrier may not terminate a policy for nonpayment of premium. A policyholder may elect this\nemergency grace period to begin retroactively on April 1, 2020 or opt for the grace period to begin\non May 1, 2020. During this extended grace period, coverage must remain in force and claims\nmay not be pended.\n\n        With respect to individual market policyholders that receive APTCs, currently the federally\nrequired grace period is 90 days. If a policyholder fails to timely make payments, issuers must\npay all appropriate claims for services rendered to the policyholder during the first month of the\nthree-month grace period and may pend claims for services rendered to the enrollee in the second\nand third months. The Centers for Medicare and Medicaid Services (CMS) recently issued\nguidance1 related to the COVID-19 emergency, which permits carriers to delay this 90-day grace\nperiod for one or more months if premiums are not paid. Therefore, the Department is requiring\ncarriers to provide a one-month delay of initiation of the 90-day grace period for any policyholders\nthat have missed a premium payment. The one-month delay may begin retroactively on April 1,\n2020 or may begin on May 1, 2020 as the policyholder determines. During this one-month delay,\ncarriers must pay claims. After the one-month delay of the grace period, the currently required\n90-day grace period will begin, as provided under federal guidance.\n\n         The extended grace periods described above shall apply to policyholders that were in good\nstanding with their insurance carrier on March 1, 2020 and shall apply to premiums due after the\ninitial premium has been made to secure coverage.\n\n        After the extended grace period, policyholders must be offered the option of amortizing\nany unpaid premium over the remaining months of the policy. For example, if 6 months are\nremaining on the policy, the policyholder must be given the option to pay the unpaid premium in\n6 installments in addition to the regular monthly premium.\n\n        Carriers are directed that they are not to seek recoupment from policyholders for the cost\nof claims incurred during this extended grace period. Carriers shall not report late payments to\ncredit reporting agencies, consistent with this guidance, for policyholders taking advantage of\nCOVID-19-related relief. Carriers are further directed to, in addition to posting information on the\ncarrier’s website, provide each policyholder with an easily readable written description of the\nterms of the extended grace period offered pursuant to this guidance, which shall be submitted as\nan informational filing to the Department at lifehealth@dobi.nj.gov.\n\n1\n    https://www.cms.gov/files/document/faqs-payment-and-grace-period-covid-19.pdf\n                                                 2\n       The Department will monitor events as they develop to determine if this emergency grace\nperiod must be extended.\n\nRecognition of a Triggering Event\n\n        Triggering events are events that allow for a special enrollment period. There are a variety\nof impacts associated with COVID-19 that will cause a triggering event, including a change in\nlocation, a loss of minimum essential coverage, including a loss of employer sponsored coverage\nor losing coverage you have through a family member. For example, due to the impacts of social\ndistancing and the closing of many businesses, many individuals may lose employer sponsored\ncoverage or coverage they have as a dependent through a family member who has lost coverage.\n\n       Additionally, as a result of the State of Emergency, many colleges and universities have\nprohibited students from living on campus. Therefore, many students have returned to a parent or\nhome in New Jersey. Some of these students had health care coverage, whether individual\ncoverage or otherwise, while they attended school and their coverage either ended or is not\naccessible, effectively terminating upon the student’s move from campus.\n\n        As such, carriers are encouraged to review all possible triggering events to determine if an\nSEP is available to provide access to coverage for impacted individuals. Carriers are reminded\nthat the loss of coverage the student had or the student’s move from campus are triggering events\nsuch that the student may have a 60-day special enrollment period following the date the student’s\ncoverage ended or the campus directed students to leave, during which to purchase an individual\npolicy or be added as a dependent to a parent’s existing individual policy.\n\n       All carrier changes must be uniformly applied to all individual health benefits plans to\nwhich the changes would be applicable. Questions may be directed to the Department’s Office of\nLife and Health at lifehealth@dobi.nj.gov.\n\nApril 10, 2020\nDate                                                         Marlene Caride\n                                                             Commissioner\n\nCOVID-19 Individual Bulletin/COVID-19\n\n                                                 3","text_length":8839}
{"slug":"nj-bulletin-20-10","jurisdiction":"NJ","agency":"DOBI","doc_type":"bulletin","citation":"NJDOBI Bulletin 20-10","title":"Extended Transition for Certain Health Insurance Policies","official_source_url":"https://www.nj.gov/dobi/bulletins/blt20_10.pdf","access_class":"source-wants-visibility","access_notes":"nj.gov legal.shtml §F affirmative copy/distribute grant; gate-zero NJ-a. Incapsula WAF: keep cadence polite.","first_seen_at":"2026-07-19T21:48:03.227193+00:00","last_checked_at":"2026-07-20T06:36:25.926106+00:00","versions":[{"fetched_at":"2026-07-19T21:48:03.227193+00:00","version_no":1,"text_length":2263,"effective_date":null,"content_sha256_short":"cc20f98f9f11"}],"text":"State of New Jersey\n                                  DEPARTMENT OF BANKING AND INSURANCE\nPHIL MURPHY                            OFFICE OF THE COMMISSIONER\n Governor                                          PO BOX 325\n                                              TRENTON, NJ 08625-0325                                MARLENE CARIDE\n                                                                                                     Commissioner\nSHEILA OLIVER                                     TEL (609) 292-7272\n Lt. Governor\n\n                                          BULLETIN NO. 20-10\n\n TO:              ALL NEW JERSEY HEALTH INSURANCE COMPANIES; HOSPITAL\n                  SERVICE CORPORATIONS; MEDICAL SERVICE CORPORATIONS;\n                  HEALTH SERVICE CORPORATIONS; HEALTH MAINTENANCE\n                  ORGANIZATIONS; DENTAL SERVICE CORPORATIONS; DENTAL\n                  PLAN ORGANIZATIONS;  PREPAID   PRESCRIPTION  SERVICE\n                  ORGANIZATIONS; ORGANIZED DELIVERY SYSTEMS; AND OTHER\n                  INTERESTED PARTIES\n\n FROM:            MARLENE CARIDE, COMMISSIONER\n\n RE:              EXTENDED TRANSITION FOR CERTAIN HEALTH INSURANCE\n                  POLICIES\n\n         The purpose of this Bulletin is to advise health plans, health care providers and all other\n interested parties that the Department of Banking and Insurance (“the Department”) will permit\n carriers to extend policies as outlined in the January 31, 2020 memorandum from Director Randy\n Pate of the Center for Consumer Information and Insurance Oversight. The Department extends\n the transitional policy for the full period outlined in the memorandum.\n         The      January      31,     2020       memorandum        is      available                       at\n https://www.cms.gov/files/document/extension-limited-non-enforcement-policy-through-\n calendar-year-2021.pdf\n\n         4/6/20\n Date                                                          Marlene Caride\n                                                               Commissioner\n\n LC 2020 Extended Transition Bulletin/Bulletins\n\n                                       Visit us on the Web at dobi.nj.gov\n           New Jersey is an Equal Opportunity Employer • Printed on Recycled Paper and Recyclable","text_length":2263}
{"slug":"nj-bulletin-20-18","jurisdiction":"NJ","agency":"DOBI","doc_type":"bulletin","citation":"NJDOBI Bulletin 20-18","title":"Extension of Mortgage Servicer License Application and RMLA-Licensed Mortgage Servicer Registration Deadlines","official_source_url":"https://www.nj.gov/dobi/bulletins/blt20_18.pdf","access_class":"source-wants-visibility","access_notes":"nj.gov legal.shtml §F affirmative copy/distribute grant; gate-zero NJ-a. Incapsula WAF: keep cadence polite.","first_seen_at":"2026-07-19T21:48:03.227193+00:00","last_checked_at":"2026-07-20T06:36:25.926106+00:00","versions":[{"fetched_at":"2026-07-19T21:48:03.227193+00:00","version_no":1,"text_length":3962,"effective_date":null,"content_sha256_short":"c52161b58fa1"}],"text":"State of New Jersey\n                                 DEPARTMENT OF BANKING AND INSURANCE\nPHIL MURPHY                           OFFICE OF THE COMMISSIONER\n Governor                                         PO BOX 325\n                                             TRENTON, NJ 08625-0325                                 MARLENE CARIDE\n                                                                                                     Commissioner\nSHEILA OLIVER                                   TEL (609) 633-7667\n Lt. Governor\n\n                                         BULLETIN NO. 20-18\n\n TO:            ALL NEW JERSEY STATE CHARTERED BANKS, SAVINGS BANKS,\n                SAVINGS AND LOAN ASSOCIATIONS, CREDIT UNIONS, NEW JERSEY\n                LICENSED   RESIDENTAL   MORTGAGE     LENDERS,   LICENSED\n                CORRESPONDENT RESIDENTIAL MORTGAGE LENDERS, LICENSED\n                RESIDENTIAL MORTGAGE BROKERS AND OTHER INTERESTED\n                PARTIES\n\n FROM:          MARLENE CARIDE, COMMISSIONER\n\n RE:            EXTENSION OF MORTGAGE SERVICER LICENSE APPLICATION AND\n                RMLA-LICENSED MORTGAGE SERVICER REGISTRATION DEADLINES\n\n        The purpose of this Bulletin is to provide guidance to various entities regulated by the New\n Jersey Department of Banking and Insurance (the “Department”), which are being affected by the\n global Coronavirus (“COVID-19”) pandemic. The Department recognizes the impact of COVID-\n 19 on the operations of many financial institutions and is taking steps to facilitate flexibility, as\n appropriate, in connection with certain regulatory timeframes. Accordingly, the Department is\n extending the deadline for license and registration applications under the Mortgage Servicers\n Licensing Act, N.J.S.A. 17:16F-27 to -46 (the “Act”), as described below.\n         On December 23, 2019 the Department issued Bulletin No.19-13, regarding licensing and\n registration under the Act. The Act requires non-exempt entities that are in the business of\n servicing residential mortgage loans, and which are not already licensed as residential mortgage\n lenders, to become licensed through the Department. N.J.S.A. 17:16F-29(a). The Department is\n also requiring that entities licensed as residential mortgage lenders or correspondent residential\n mortgage lenders, pursuant to the New Jersey Residential Mortgage Lending Act, N.J.S.A.\n 17:11C-51 to -89 (collectively, “RMLA- licensed mortgage servicers”), to register with the\n Department if they conduct mortgage servicing business in New Jersey. Through Bulletin No.19-\n 13, the Department set the deadline for the submission of both mortgage servicer license\n applications and RMLA-licensed mortgage servicer registration applications for April 13, 2020.\n        In order to facilitate flexibility to address the resource constraints and operational\n challenges caused by the COVID-19 public health emergency, the Department is extending the\n application deadline for mortgage servicer licenses and RMLA-licensed mortgage servicer\n registration by sixty (60) days, to June 12, 2020.\n\n                                       Visit us on the Web at dobi.nj.gov\n           New Jersey is an Equal Opportunity Employer • Printed on Recycled Paper and Recyclable\nFor all inquiries related to the Act or to this Bulletin, please contact:\n\n   •   Howard Wegener, Office of Consumer Finance, howard.wegener@dobi.nj.gov, (609) 940-\n       7460\n   •   Daniel Schuster, Office of Consumer Finance, daniel.schuster@dobi.nj.gov, (609) 940-\n       7459\n\n       The Department will continue to monitor this situation and issue further communications\nby bulletin or on its website, www.dobi.nj.gov, as deemed appropriate.\n\nApril 23, 2020\nDate                                                        Marlene Caride\n                                                            Commissioner\n\nJR COVID-19 MSLA App Extension Bulletin/COVID-19\n\n                                                2","text_length":3962}
{"slug":"nj-bulletin-20-07","jurisdiction":"NJ","agency":"DOBI","doc_type":"bulletin","citation":"NJDOBI Bulletin 20-07","title":"Use of Telemedicine and Telehealth to Respond to the COVID-19 Pandemic","official_source_url":"https://www.nj.gov/dobi/bulletins/blt20_07.pdf","access_class":"source-wants-visibility","access_notes":"nj.gov legal.shtml §F affirmative copy/distribute grant; gate-zero NJ-a. Incapsula WAF: keep cadence polite.","first_seen_at":"2026-07-19T21:48:03.227193+00:00","last_checked_at":"2026-07-20T06:36:25.926106+00:00","versions":[{"fetched_at":"2026-07-19T21:48:03.227193+00:00","version_no":1,"text_length":5760,"effective_date":null,"content_sha256_short":"ad2e1957f6b8"}],"text":"State of New Jersey\n                               DEPARTMENT OF BANKING AND INSURANCE\nPHIL MURPHY                         OFFICE OF THE COMMISSIONER\n Governor                                       PO BOX 325\n                                           TRENTON, NJ 08625-0325                           MARLENE CARIDE\n                                                                                             Commissioner\nSHEILA OLIVER                                 TEL (609) 292-7272\n Lt. Governor\n\n                                       BULLETIN NO. 20-07\n TO:            ALL HEALTH INSURANCE COMPANIES, HEALTH MAINTENANCE\n                ORGANIZATIONS, HEALTH SERVICE CORPORATIONS AND ANY\n                OTHER ENTITY ISSUING HEALTH BENEFITS PLANS IN THIS STATE\n\n FROM:          MARLENE CARIDE, COMMISSIONER\n RE:            USE OF TELEMEDICINE AND TELEHEALTH TO RESPOND TO THE\n                COVID-19 PANDEMIC\n\n         On March 9, 2020, Governor Phil Murphy declared a state of emergency and public health\n emergency through the issuance of Executive Order No. 103 (“EO 103”) to contain the spread of\n the Coronavirus (“COVID-19”) pandemic. The Department of Banking and Insurance\n (“Department”) is issuing this Bulletin to provide guidance to all health insurance companies,\n health maintenance organizations, health service corporations and other entities issuing health\n benefits plans in this State (collectively “carriers”) regarding the use of telemedicine and telehealth\n to respond to the COVID-19 pandemic.\n\n         Except as explained below, the terms telemedicine and telehealth are defined as set forth\n in P.L. 2017, c. 117.\n\n         Effective immediately and continuing for the duration of the state of emergency and public\n health emergency declared pursuant to EO 103, the Department is requiring that carriers:\n\n     •   review their telemedicine and telehealth networks to ensure adequacy, given the apparent\n         increased demand, as well as grant any requested in-plan exceptions for individuals to\n         access out-of-network telehealth providers if network telehealth providers are not\n         available, including, but not limited to, mental health and behavioral health providers,\n         physical therapists, occupational therapists, and speech therapists, and any other health\n         providers capable and authorized to provide telehealth or telemedicine services pursuant to\n         State law or other State-issued guidance;\n\n     •   cover, without cost-sharing (i.e., copayments, deductibles, or coinsurance), any healthcare\n         services or supplies delivered or obtained via telemedicine or telehealth as required by P.L.\n         2020, c. 7;\n    •   encourage their network providers to utilize telemedicine or telehealth services wherever\n        possible and clinically appropriate in order to minimize exposure of provider staff and other\n        patients to those who may have the COVID-19 virus;\n\n    •   update their policies to include reimbursement for telehealth services that are provided by\n        a provider in any manner that is practicable, including, if appropriate, and clinically\n        appropriate, by telephone. Carriers should disseminate information on their website, or\n        other reasonable means, to notify individuals of these updates. This would include the use\n        of telephone-only communications to establish a physician-patient relationship and the\n        expanded use of telehealth for the diagnosis, treatment, ordering of tests, and prescribing\n        for all conditions. Carriers are required to update telehealth policies to include telephone-\n        only services within the definition of telehealth;\n\n    •   reimburse providers that deliver covered services to members via telemedicine or telehealth\n        in accordance with P.L. 2020, c.3, and this guidance. Carriers may establish requirements\n        for such telemedicine and/or telehealth services, in accordance with P.L. 2020, c.3, and\n        guidance issued by the Department, including documentation and recordkeeping, but such\n        requirements may not be more restrictive than those for in-person services. Carriers are\n        not permitted to impose any specific requirements on the technologies used to deliver\n        telemedicine and/or telehealth services (including any limitations on audio-only or live\n        video technologies) during the state of emergency and public health emergency declared\n        pursuant to EO 103;\n\n    •   ensure that the rates of payment to in-network providers for services delivered via\n        telemedicine or telehealth are not lower than the rates of payment established by the carrier\n        for services delivered via traditional (i.e., in-person) methods, and carriers must notify\n        providers of any instructions that are necessary to facilitate billing for such telehealth\n        services.\n\n    •   may not impose any restriction on the reimbursement for telehealth or telemedicine that\n        requires that the provider who is delivering the services be licensed in a particular state, so\n        long as the provider is in compliance with P.L. 2020, c.3 and c.4 and this guidance; and\n\n    •   may not impose prior authorization requirements on medically-necessary treatment that is\n        delivered via telemedicine or telehealth.\n        If you have any questions, please contact the Department’s Office of Life and Health at\nlifehealth@dobi.nj.gov.\n\n        3/22/20\nDate                                                           Marlene Caride\n                                                               Commissioner\n\nAV COVID-19 Telemedicine and Telehealth Bulletin\n\n                                                   2","text_length":5760}
{"slug":"ny-cl-1979-21","jurisdiction":"NY","agency":"NYDFS","doc_type":"bulletin","citation":"NY DFS Circular Letter No. 21 (1979)","title":"Summaries of cancellations and non-renewals of product liability insurance.","official_source_url":"https://www.dfs.ny.gov/industry_guidance/circular_letters/cl1979_21","access_class":"source-wants-visibility","access_notes":"NY DFS site grant is non-commercial (gate-zero NY-a); FACTS-MODE: metadata + official link only pending written permission.","first_seen_at":"2026-07-20T02:19:31.928452+00:00","last_checked_at":"2026-07-20T02:19:31.928452+00:00","versions":[{"fetched_at":"2026-07-20T02:19:31.928452+00:00","version_no":1,"text_length":0,"effective_date":"1979-08-02","content_sha256_short":"fe994cc56c8d"}],"text":null,"text_length":0}
{"slug":"ny-cl-1979-25","jurisdiction":"NY","agency":"NYDFS","doc_type":"bulletin","citation":"NY DFS Circular Letter No. 25 (1979)","title":"Waiver of inspection required by Regulation 79 for new automobile physical damage obtained from applicants previously insured with Safeco.","official_source_url":"https://www.dfs.ny.gov/industry_guidance/circular_letters/cl1979_25","access_class":"source-wants-visibility","access_notes":"NY DFS site grant is non-commercial (gate-zero NY-a); FACTS-MODE: metadata + official link only pending written permission.","first_seen_at":"2026-07-20T02:19:31.928452+00:00","last_checked_at":"2026-07-20T02:19:31.928452+00:00","versions":[{"fetched_at":"2026-07-20T02:19:31.928452+00:00","version_no":1,"text_length":0,"effective_date":"1979-10-02","content_sha256_short":"a59f18b33cd8"}],"text":null,"text_length":0}
{"slug":"ny-cl-1979-16","jurisdiction":"NY","agency":"NYDFS","doc_type":"bulletin","citation":"NY DFS Circular Letter No. 16 (1979)","title":"Guidelines for approval of retirement plans of domestic life insurance companies. (See also Addendum to CL 12 (1980) on this listing).","official_source_url":"https://www.dfs.ny.gov/industry_guidance/circular_letters/cl1979_16","access_class":"source-wants-visibility","access_notes":"NY DFS site grant is non-commercial (gate-zero NY-a); FACTS-MODE: metadata + official link only pending written permission.","first_seen_at":"2026-07-20T02:19:31.928452+00:00","last_checked_at":"2026-07-20T02:19:31.928452+00:00","versions":[{"fetched_at":"2026-07-20T02:19:31.928452+00:00","version_no":1,"text_length":0,"effective_date":"1979-10-16","content_sha256_short":"3d07ad108fdf"}],"text":null,"text_length":0}
{"slug":"ny-cl-1979-20","jurisdiction":"NY","agency":"NYDFS","doc_type":"bulletin","citation":"NY DFS Circular Letter No. 20 (1979)","title":"Chapter 250 of the Laws of 1979, in relation to failure to file annual statements or to reply to inquiries and relating to penalties in connection therewith.","official_source_url":"https://www.dfs.ny.gov/industry_guidance/circular_letters/cl1979_20","access_class":"source-wants-visibility","access_notes":"NY DFS site grant is non-commercial (gate-zero NY-a); FACTS-MODE: metadata + official link only pending written permission.","first_seen_at":"2026-07-20T02:19:31.928452+00:00","last_checked_at":"2026-07-20T02:19:31.928452+00:00","versions":[{"fetched_at":"2026-07-20T02:19:31.928452+00:00","version_no":1,"text_length":0,"effective_date":"1979-07-20","content_sha256_short":"9d22c3224054"}],"text":null,"text_length":0}
{"slug":"ny-cl-1979-23","jurisdiction":"NY","agency":"NYDFS","doc_type":"bulletin","citation":"NY DFS Circular Letter No. 23 (1979)","title":"Standard claim forms for accident & health insurance. (See also CL 4 (1978) on this listing).","official_source_url":"https://www.dfs.ny.gov/industry_guidance/circular_letters/cl1979_23","access_class":"source-wants-visibility","access_notes":"NY DFS site grant is non-commercial (gate-zero NY-a); FACTS-MODE: metadata + official link only pending written permission.","first_seen_at":"2026-07-20T02:19:31.928452+00:00","last_checked_at":"2026-07-20T02:19:31.928452+00:00","versions":[{"fetched_at":"2026-07-20T02:19:31.928452+00:00","version_no":1,"text_length":0,"effective_date":"1979-08-01","content_sha256_short":"22d3171aa09c"}],"text":null,"text_length":0}
{"slug":"ny-cl-1979-24","jurisdiction":"NY","agency":"NYDFS","doc_type":"bulletin","citation":"NY DFS Circular Letter No. 24 (1979)","title":"Applicability of Section 4228(g)(7).","official_source_url":"https://www.dfs.ny.gov/industry_guidance/circular_letters/cl1979_24","access_class":"source-wants-visibility","access_notes":"NY DFS site grant is non-commercial (gate-zero NY-a); FACTS-MODE: metadata + official link only pending written permission.","first_seen_at":"2026-07-20T02:19:31.928452+00:00","last_checked_at":"2026-07-20T02:19:31.928452+00:00","versions":[{"fetched_at":"2026-07-20T02:19:31.928452+00:00","version_no":1,"text_length":0,"effective_date":"1979-09-26","content_sha256_short":"c7209c3f0f88"}],"text":null,"text_length":0}
{"slug":"ny-cl-1979-14","jurisdiction":"NY","agency":"NYDFS","doc_type":"bulletin","citation":"NY DFS Circular Letter No. 14 (1979)","title":"Credit for retrospective debits developed pursuant to the provisions of reinsurance agreements. (See also CL 8 (1982) on the Current listing).","official_source_url":"https://www.dfs.ny.gov/industry_guidance/circular_letters/cl1979_14","access_class":"source-wants-visibility","access_notes":"NY DFS site grant is non-commercial (gate-zero NY-a); FACTS-MODE: metadata + official link only pending written permission.","first_seen_at":"2026-07-20T02:19:31.928452+00:00","last_checked_at":"2026-07-20T02:19:31.928452+00:00","versions":[{"fetched_at":"2026-07-20T02:19:31.928452+00:00","version_no":1,"text_length":0,"effective_date":"1979-06-15","content_sha256_short":"c33b69d8eb4c"}],"text":null,"text_length":0}
{"slug":"ny-cl-1979-15","jurisdiction":"NY","agency":"NYDFS","doc_type":"bulletin","citation":"NY DFS Circular Letter No. 15 (1979)","title":"Expenses of officers’ spouses on business trips.","official_source_url":"https://www.dfs.ny.gov/industry_guidance/circular_letters/cl1979_15","access_class":"source-wants-visibility","access_notes":"NY DFS site grant is non-commercial (gate-zero NY-a); FACTS-MODE: metadata + official link only pending written permission.","first_seen_at":"2026-07-20T02:19:31.928452+00:00","last_checked_at":"2026-07-20T02:19:31.928452+00:00","versions":[{"fetched_at":"2026-07-20T02:19:31.928452+00:00","version_no":1,"text_length":0,"effective_date":"1979-06-28","content_sha256_short":"e365f8bf1272"}],"text":null,"text_length":0}
{"slug":"ny-cl-1979-18","jurisdiction":"NY","agency":"NYDFS","doc_type":"bulletin","citation":"NY DFS Circular Letter No. 18 (1979)","title":"National Flood Insurance Program-Homeowners Policies.","official_source_url":"https://www.dfs.ny.gov/industry_guidance/circular_letters/cl1979_18","access_class":"source-wants-visibility","access_notes":"NY DFS site grant is non-commercial (gate-zero NY-a); FACTS-MODE: metadata + official link only pending written permission.","first_seen_at":"2026-07-20T02:19:31.928452+00:00","last_checked_at":"2026-07-20T02:19:31.928452+00:00","versions":[{"fetched_at":"2026-07-20T02:19:31.928452+00:00","version_no":1,"text_length":0,"effective_date":"1979-07-23","content_sha256_short":"c3fd08e304d2"}],"text":null,"text_length":0}
{"slug":"ny-cl-1979-19","jurisdiction":"NY","agency":"NYDFS","doc_type":"bulletin","citation":"NY DFS Circular Letter No. 19 (1979)","title":"Liens against the proceeds of fire insurance policies. (Information Bulletin # 5) (See also CL 9 (1978) on this listing).","official_source_url":"https://www.dfs.ny.gov/industry_guidance/circular_letters/cl1979_19","access_class":"source-wants-visibility","access_notes":"NY DFS site grant is non-commercial (gate-zero NY-a); FACTS-MODE: metadata + official link only pending written permission.","first_seen_at":"2026-07-20T02:19:31.928452+00:00","last_checked_at":"2026-07-20T02:19:31.928452+00:00","versions":[{"fetched_at":"2026-07-20T02:19:31.928452+00:00","version_no":1,"text_length":0,"effective_date":"1979-07-17","content_sha256_short":"b7b1875e24bd"}],"text":null,"text_length":0}
{"slug":"ny-cl-1979-22","jurisdiction":"NY","agency":"NYDFS","doc_type":"bulletin","citation":"NY DFS Circular Letter No. 22 (1979)","title":"Reports of claims for product liability (See also CL 26 (1979) on this listing).","official_source_url":"https://www.dfs.ny.gov/industry_guidance/circular_letters/cl1979_22","access_class":"source-wants-visibility","access_notes":"NY DFS site grant is non-commercial (gate-zero NY-a); FACTS-MODE: metadata + official link only pending written permission.","first_seen_at":"2026-07-20T02:19:31.928452+00:00","last_checked_at":"2026-07-20T02:19:31.928452+00:00","versions":[{"fetched_at":"2026-07-20T02:19:31.928452+00:00","version_no":1,"text_length":0,"effective_date":"1979-08-02","content_sha256_short":"fdf68d122406"}],"text":null,"text_length":0}
{"slug":"ny-cl-1979-26","jurisdiction":"NY","agency":"NYDFS","doc_type":"bulletin","citation":"NY DFS Circular Letter No. 26 (1979)","title":"Amended reporting requirements product liability insurance (See also Addendum to CL 7 (1980) and CL 22 (1979) both on this listing).","official_source_url":"https://www.dfs.ny.gov/industry_guidance/circular_letters/cl1979_26","access_class":"source-wants-visibility","access_notes":"NY DFS site grant is non-commercial (gate-zero NY-a); FACTS-MODE: metadata + official link only pending written permission.","first_seen_at":"2026-07-20T02:19:31.928452+00:00","last_checked_at":"2026-07-20T02:19:31.928452+00:00","versions":[{"fetched_at":"2026-07-20T02:19:31.928452+00:00","version_no":1,"text_length":0,"effective_date":"1979-09-26","content_sha256_short":"8da7690a35c4"}],"text":null,"text_length":0}
{"slug":"oh-bulletin-1988-3","jurisdiction":"OH","agency":"ODI","doc_type":"bulletin","citation":"ODI Bulletin 1988-3","title":"Guarantee Issue Life Insurance Advertising (Substantive)","official_source_url":"https://insurance.ohio.gov/static/Legal/Bulletins/Documents/88-3.pdf","access_class":"source-wants-visibility","access_notes":"insurance.ohio.gov; gate-zero OH-a (no reproduction restriction located; public-records framing). WAF requires browser UA.","first_seen_at":"2026-07-19T21:07:45.550798+00:00","last_checked_at":"2026-07-20T06:30:14.576363+00:00","versions":[{"fetched_at":"2026-07-19T21:07:45.550798+00:00","version_no":1,"text_length":0,"effective_date":"1988-09-20","content_sha256_short":"b4c9cbdf5e74"}],"text":"","text_length":0}
{"slug":"oh-bulletin-1963-36","jurisdiction":"OH","agency":"ODI","doc_type":"bulletin","citation":"ODI Bulletin 1963-36","title":"No Automatic Policy Renewals (Substantive)","official_source_url":"https://insurance.ohio.gov/static/Legal/Bulletins/Documents/36.pdf","access_class":"source-wants-visibility","access_notes":"insurance.ohio.gov; gate-zero OH-a (no reproduction restriction located; public-records framing). WAF requires browser UA.","first_seen_at":"2026-07-19T21:07:45.550798+00:00","last_checked_at":"2026-07-20T06:30:14.576363+00:00","versions":[{"fetched_at":"2026-07-19T21:07:45.550798+00:00","version_no":1,"text_length":0,"effective_date":"1963-12-18","content_sha256_short":"912b0fe33e3f"}],"text":"","text_length":0}
{"slug":"oh-bulletin-1990-6","jurisdiction":"OH","agency":"ODI","doc_type":"bulletin","citation":"ODI Bulletin 1990-6","title":"Payments by Secondary Plan Under Coordination of Benefits (Substantive)","official_source_url":"https://insurance.ohio.gov/static/Legal/Bulletins/Documents/90-6.pdf","access_class":"source-wants-visibility","access_notes":"insurance.ohio.gov; gate-zero OH-a (no reproduction restriction located; public-records framing). WAF requires browser UA.","first_seen_at":"2026-07-19T21:07:45.550798+00:00","last_checked_at":"2026-07-20T06:30:14.576363+00:00","versions":[{"fetched_at":"2026-07-19T21:07:45.550798+00:00","version_no":1,"text_length":0,"effective_date":"1990-11-14","content_sha256_short":"de647ff7c933"}],"text":"","text_length":0}
{"slug":"oh-bulletin-1990-4","jurisdiction":"OH","agency":"ODI","doc_type":"bulletin","citation":"ODI Bulletin 1990-4","title":"Reimbursement of Nurse Mid-Wives (Substantive)","official_source_url":"https://insurance.ohio.gov/static/Legal/Bulletins/Documents/90-4.pdf","access_class":"source-wants-visibility","access_notes":"insurance.ohio.gov; gate-zero OH-a (no reproduction restriction located; public-records framing). WAF requires browser UA.","first_seen_at":"2026-07-19T21:07:45.550798+00:00","last_checked_at":"2026-07-20T06:30:14.576363+00:00","versions":[{"fetched_at":"2026-07-19T21:07:45.550798+00:00","version_no":1,"text_length":0,"effective_date":"1990-10-31","content_sha256_short":"5427c4a093ef"}],"text":"","text_length":0}
{"slug":"oh-bulletin-1995-1","jurisdiction":"OH","agency":"ODI","doc_type":"bulletin","citation":"ODI Bulletin 1995-1","title":"Group Administrative Expense Reimbursement (Substantive)","official_source_url":"https://insurance.ohio.gov/static/Legal/Bulletins/Documents/95-1.pdf","access_class":"source-wants-visibility","access_notes":"insurance.ohio.gov; gate-zero OH-a (no reproduction restriction located; public-records framing). WAF requires browser UA.","first_seen_at":"2026-07-19T21:07:45.550798+00:00","last_checked_at":"2026-07-20T06:30:14.576363+00:00","versions":[{"fetched_at":"2026-07-19T21:07:45.550798+00:00","version_no":1,"text_length":0,"effective_date":"1995-06-22","content_sha256_short":"92bf9561c91d"}],"text":"","text_length":0}
{"slug":"oh-bulletin-1994-2","jurisdiction":"OH","agency":"ODI","doc_type":"bulletin","citation":"ODI Bulletin 1994-2","title":"Section 3737.71 of the Ohio Revised Code --- State Fire Marshal's Tax (Substantive)","official_source_url":"https://insurance.ohio.gov/static/Legal/Bulletins/Documents/94-2.pdf","access_class":"source-wants-visibility","access_notes":"insurance.ohio.gov; gate-zero OH-a (no reproduction restriction located; public-records framing). WAF requires browser UA.","first_seen_at":"2026-07-19T21:07:45.550798+00:00","last_checked_at":"2026-07-20T06:30:14.576363+00:00","versions":[{"fetched_at":"2026-07-19T21:07:45.550798+00:00","version_no":1,"text_length":0,"effective_date":"1994-02-23","content_sha256_short":"e979a7a3187b"}],"text":"","text_length":0}
{"slug":"oh-bulletin-1993-7","jurisdiction":"OH","agency":"ODI","doc_type":"bulletin","citation":"ODI Bulletin 1993-7","title":"Rescission of Bulletin 93-7 (Major Modification Filing as to Dividends) (Rescission)","official_source_url":"https://insurance.ohio.gov/static/Legal/Bulletins/Documents/93-7.pdf","access_class":"source-wants-visibility","access_notes":"insurance.ohio.gov; gate-zero OH-a (no reproduction restriction located; public-records framing). WAF requires browser UA.","first_seen_at":"2026-07-19T21:07:45.550798+00:00","last_checked_at":"2026-07-20T06:30:14.576363+00:00","versions":[{"fetched_at":"2026-07-19T21:07:45.550798+00:00","version_no":1,"text_length":0,"effective_date":"1998-07-09","content_sha256_short":"72f7fedf5ba8"}],"text":"","text_length":0}
{"slug":"oh-bulletin-1992-3","jurisdiction":"OH","agency":"ODI","doc_type":"bulletin","citation":"ODI Bulletin 1992-3","title":"Rescinding Bulletin 90-3 (Insurance Fraud Warning Requirement) (Supersedes Bulletin 90-3; also appears on list of Rescission Bulletins) (Substantive)","official_source_url":"https://insurance.ohio.gov/static/Legal/Bulletins/Documents/92-3.pdf","access_class":"source-wants-visibility","access_notes":"insurance.ohio.gov; gate-zero OH-a (no reproduction restriction located; public-records framing). WAF requires browser UA.","first_seen_at":"2026-07-19T21:07:45.550798+00:00","last_checked_at":"2026-07-20T06:30:14.576363+00:00","versions":[{"fetched_at":"2026-07-19T21:07:45.550798+00:00","version_no":1,"text_length":0,"effective_date":"1992-09-25","content_sha256_short":"b45cf0b453e4"}],"text":"","text_length":0}
{"slug":"oh-bulletin-1991-2","jurisdiction":"OH","agency":"ODI","doc_type":"bulletin","citation":"ODI Bulletin 1991-2","title":"Premium or Franchise Tax Offsets for Guaranty Fund Contributions Under ORC 3901.47 and 3956.20 (Substantive)","official_source_url":"https://insurance.ohio.gov/static/Legal/Bulletins/Documents/91-2.pdf","access_class":"source-wants-visibility","access_notes":"insurance.ohio.gov; gate-zero OH-a (no reproduction restriction located; public-records framing). WAF requires browser UA.","first_seen_at":"2026-07-19T21:07:45.550798+00:00","last_checked_at":"2026-07-20T06:30:14.576363+00:00","versions":[{"fetched_at":"2026-07-19T21:07:45.550798+00:00","version_no":1,"text_length":0,"effective_date":"1991-03-04","content_sha256_short":"e930b461a5b4"}],"text":"","text_length":0}
{"slug":"oh-bulletin-1991-1","jurisdiction":"OH","agency":"ODI","doc_type":"bulletin","citation":"ODI Bulletin 1991-1","title":"Prospective Loss Costs Filing Procedure (Substantive)","official_source_url":"https://insurance.ohio.gov/static/Legal/Bulletins/Documents/91-1.pdf","access_class":"source-wants-visibility","access_notes":"insurance.ohio.gov; gate-zero OH-a (no reproduction restriction located; public-records framing). WAF requires browser UA.","first_seen_at":"2026-07-19T21:07:45.550798+00:00","last_checked_at":"2026-07-20T06:30:14.576363+00:00","versions":[{"fetched_at":"2026-07-19T21:07:45.550798+00:00","version_no":1,"text_length":0,"effective_date":"1991-01-08","content_sha256_short":"c8973242a06e"}],"text":"","text_length":0}
{"slug":"oh-bulletin-1990-8","jurisdiction":"OH","agency":"ODI","doc_type":"bulletin","citation":"ODI Bulletin 1990-8","title":"Rescission of Bulletin 88-2 (Medicare Supplement Advertising Requirements; superseded by Rule 3901-1-41, effective 10/19/1990) (Rescission)","official_source_url":"https://insurance.ohio.gov/static/Legal/Bulletins/Documents/90-8.pdf","access_class":"source-wants-visibility","access_notes":"insurance.ohio.gov; gate-zero OH-a (no reproduction restriction located; public-records framing). WAF requires browser UA.","first_seen_at":"2026-07-19T21:07:45.550798+00:00","last_checked_at":"2026-07-20T06:30:14.576363+00:00","versions":[{"fetched_at":"2026-07-19T21:07:45.550798+00:00","version_no":1,"text_length":0,"effective_date":"1990-12-19","content_sha256_short":"8d1218916310"}],"text":"","text_length":0}
{"slug":"oh-bulletin-1963-35","jurisdiction":"OH","agency":"ODI","doc_type":"bulletin","citation":"ODI Bulletin 1963-35","title":"Policy Cancellations (Substantive)","official_source_url":"https://insurance.ohio.gov/static/Legal/Bulletins/Documents/35.pdf","access_class":"source-wants-visibility","access_notes":"insurance.ohio.gov; gate-zero OH-a (no reproduction restriction located; public-records framing). WAF requires browser UA.","first_seen_at":"2026-07-19T21:07:45.550798+00:00","last_checked_at":"2026-07-20T06:30:14.576363+00:00","versions":[{"fetched_at":"2026-07-19T21:07:45.550798+00:00","version_no":1,"text_length":0,"effective_date":"1963-12-10","content_sha256_short":"13fd60d514d7"}],"text":"","text_length":0}
{"slug":"tx-28tac-5-5-9322","jurisdiction":"TX","agency":"TDI","doc_type":"regulation","citation":"28 TAC §5.9322","title":"Additional Information","official_source_url":"https://texas-sos.appianportalsgov.com/rules-and-meetings?interface=VIEW_TAC_SUMMARY&recordId=196472","access_class":"statutory-public","access_notes":"texas-sos.appianportalsgov.com (state-operated Appian portal; no terms located — gate-zero TX-b); real-browser fetch","first_seen_at":"2026-07-20T17:49:57.213072+00:00","last_checked_at":"2026-07-20T17:49:57.213072+00:00","versions":[{"fetched_at":"2026-07-20T17:49:57.213072+00:00","version_no":1,"text_length":1272,"effective_date":"2019-07-28","content_sha256_short":"eb34fa21772a"}],"text":"(a) When reviewing each filing under this division, TDI may request additional information specific to the filing. This information may include:\n\n(1) related forms or information needed for the review;\n\n(2) a summary of all policy provisions, including a detailed description and explanation of the coverages, limitations, exclusions, and conditions;\n\n(3) a coverage comparison to a similar policy form or endorsement that the Commissioner has approved or adopted containing a detailed explanation of all the differences including any restrictions in coverage, enhancements in coverage, or clarifications to the previously approved policy forms or endorsements.\n\n(4) a coverage evaluation that contains a detailed explanation of the proposed changes including any restrictions in coverage, enhancements in coverage, or clarifications to approved or adopted policy forms or endorsements. The coverage evaluation may be provided in a side-by-side comparison showing any differences between the previously approved or adopted policy forms or endorsements and the proposed policy forms or endorsements.\n\n(b) Filers must provide information requested by TDI under this section.\n\nSource Note: The provisions of this §5.9322 adopted to be effective July 28, 2019, 44 TexReg 3640.","text_length":1272}
{"slug":"tx-28tac-5-5-9313","jurisdiction":"TX","agency":"TDI","doc_type":"regulation","citation":"28 TAC §5.9313","title":"Filing Format Requirements","official_source_url":"https://texas-sos.appianportalsgov.com/rules-and-meetings?interface=VIEW_TAC_SUMMARY&recordId=216191","access_class":"statutory-public","access_notes":"texas-sos.appianportalsgov.com (state-operated Appian portal; no terms located — gate-zero TX-b); real-browser fetch","first_seen_at":"2026-07-20T17:49:57.213072+00:00","last_checked_at":"2026-07-20T17:49:57.213072+00:00","versions":[{"fetched_at":"2026-07-20T17:49:57.213072+00:00","version_no":1,"text_length":770,"effective_date":"2024-01-08","content_sha256_short":"14a9fea9818c"}],"text":"(a) Documents included in filings may not be encrypted or password protected. TDI staff must be able to fully process and review the documents without a password or other decryption process.\n\n(b) The policy forms, endorsements, and form usage tables submitted in a filing under Division 5 of this subchapter (relating to Filings Made Easy - Requirements for Property and Casualty Policy Form and Endorsement Filings) must:\n\n(1) not be scanned documents;\n\n(2) not include any scanned text, or scanned images with text, that will be part of the insurance contract;\n\n(3) be in a format that is selectable and searchable; and\n\n(4) be in portrait, not landscape, orientation.\n\nSource Note: The provisions of this §5.9313 adopted to be effective January 8, 2024, 49 TexReg 41.","text_length":770}
{"slug":"tx-28tac-5-5-9321","jurisdiction":"TX","agency":"TDI","doc_type":"regulation","citation":"28 TAC §5.9321","title":"General Filing Requirements","official_source_url":"https://texas-sos.appianportalsgov.com/rules-and-meetings?interface=VIEW_TAC_SUMMARY&recordId=216198","access_class":"statutory-public","access_notes":"texas-sos.appianportalsgov.com (state-operated Appian portal; no terms located — gate-zero TX-b); real-browser fetch","first_seen_at":"2026-07-20T17:49:57.213072+00:00","last_checked_at":"2026-07-20T17:49:57.213072+00:00","versions":[{"fetched_at":"2026-07-20T17:49:57.213072+00:00","version_no":1,"text_length":2915,"effective_date":"2024-01-08","content_sha256_short":"babfada5eae4"}],"text":"(a) Filings must be submitted for one line of insurance only, except for multi-peril and interline filings.\n\n(b) Filings submitted under this division may not be combined with any other filing types submitted under this subchapter.\n\n(c) Filings must contain the following:\n\n(1) the transmittal information required in §5.9310 of this title (relating to Property and Casualty Transmittal Information and General Filing Requirements);\n\n(2) a copy of the proposed policy forms or endorsements;\n\n(3) a form number for each proposed form;\n\n(4) an edition date for each proposed form, if applicable;\n\n(5) the TDI file number or SERFF tracking number for the previously approved policy to which the proposed form will be attached, if applicable;\n\n(6) a form usage table that includes:\n\n(A) the form name and form number for each proposed form;\n\n(B) information indicating whether each proposed form is optional, mandatory, or conditional mandatory; and\n\n(C) for conditional mandatory forms, an addendum to the form usage table that describes the conditions that make each form mandatory. For filings other than personal automobile, residential property, or personal multi-peril, the filer may describe the conditions elsewhere in the filing;\n\n(7) a memorandum that:\n\n(A) explains in detail the reasons for the filing;\n\n(B) describes each proposed policy form or endorsement; and\n\n(C) details each policy form or endorsement's use, including the type of risk or risks for which the forms or endorsements will be used.\n\n(d) Filings must also meet the following requirements.\n\n(1) Filings must include all provisions required by statute, administrative rule, or Commissioner's order. Filers may add the required provisions to a policy form by including a Texas amendatory endorsement. The filing must include the amendatory endorsement, or the filing may reference an approved amendatory endorsement that applies to the policy forms in the filing.\n\n(2) For amended policy forms or endorsements, copies of the previously approved or adopted policy forms or endorsements indicating the differences between the approved or adopted policy forms or endorsements and the filed policy forms or endorsements must be included. New text must be underlined, and deleted text must be in brackets with a strikethrough. Alternatively, the changes can be indicated by other clearly identified or highlighted editorial notations referencing new and replaced text. The marked changes must be in a separate single document for each filed form.\n\n(e) Unless requested by TDI, filings made by advisory organizations do not need to include:\n\n(1) the proposed effective date specified in §5.9310(c)(9) of this title; or\n\n(2) the form usage table specified in subsection (c)(6) of this section.\n\nSource Note: The provisions of this §5.9321 adopted to be effective July 28, 2019, 44 TexReg 3640; amended to be effective January 8, 2024, 49 TexReg 41.","text_length":2915}
{"slug":"tx-28tac-5-5-9301","jurisdiction":"TX","agency":"TDI","doc_type":"regulation","citation":"28 TAC §5.9301","title":"Commercial Risks Shared by Two or More Insurers","official_source_url":"https://texas-sos.appianportalsgov.com/rules-and-meetings?interface=VIEW_TAC_SUMMARY&recordId=117413","access_class":"statutory-public","access_notes":"texas-sos.appianportalsgov.com (state-operated Appian portal; no terms located — gate-zero TX-b); real-browser fetch","first_seen_at":"2026-07-20T17:49:57.213072+00:00","last_checked_at":"2026-07-20T17:49:57.213072+00:00","versions":[{"fetched_at":"2026-07-20T17:49:57.213072+00:00","version_no":1,"text_length":1818,"effective_date":"1998-04-26","content_sha256_short":"92c1ef1d8f7a"}],"text":"(a) This section applies in the event that the total limit of liability for a single commercial risk or account must be shared by two or more insurers as a result of either a single insurer not having the capacity to provide the total limit of liability for the single risk or account to be shared or as a result of a single insurer being unwilling to accept the total limit of liability for the single risk or account to be shared because it produces a more hazardous exposure.\n\n(b) For purposes of this section, \"lead insurer\" shall mean the insurer providing coverage for the largest percentage of liability for a single commercial risk or account or the insurer designated by the insured as the lead insurer.\n\n(c) The policy forms and endorsements issued to provide coverage on a single commercial risk or account which is shared by two or more insurers must be filed and approved for the lead insurer. Other insurers sharing such coverage on a single commercial risk or account with the lead insurer must use the filed and approved policy forms and endorsements of the lead insurer. These approved policy forms and endorsements may be used by such other insurers sharing such coverage without making a separate filing to the Texas Department of Insurance for approval.\n\n(d) A notice indicating the name of the lead insurer must be placed on each policy of insurance issued to provide coverage on a single commercial risk or account which is shared by two or more insurers. The notice must contain the following or similar language: \"The insurance provided for this (risk or account) is shared by two or more companies. The lead insurer is ___________.\"\n\nSource Note: The provisions of this §5.9301 adopted to be effective September 29, 1993, 18 TexReg 6323; amended to be effective April 26, 1998, 23 TexReg 3835.","text_length":1818}
{"slug":"tx-28tac-5-5-9311","jurisdiction":"TX","agency":"TDI","doc_type":"regulation","citation":"28 TAC §5.9311","title":"Copyright, Public Inspection, and Confidential Filings","official_source_url":"https://texas-sos.appianportalsgov.com/rules-and-meetings?interface=VIEW_TAC_SUMMARY&recordId=196111","access_class":"statutory-public","access_notes":"texas-sos.appianportalsgov.com (state-operated Appian portal; no terms located — gate-zero TX-b); real-browser fetch","first_seen_at":"2026-07-20T17:49:57.213072+00:00","last_checked_at":"2026-07-20T17:49:57.213072+00:00","versions":[{"fetched_at":"2026-07-20T17:49:57.213072+00:00","version_no":1,"text_length":1127,"effective_date":"2019-07-28","content_sha256_short":"4855865b3a04"}],"text":"(a) Copyright. Information included in filings that is marked \"copyright\" may be made available for public disclosure in the same manner as information that is not marked \"copyright.\" Public disclosure methods may include posting filings on TDI's website or making them available for viewing through SERFF.\n\n(b) Public inspection. Each filing submitted under Insurance Code Chapter 2301 or 3502, including any supporting information filed, will be open for public inspection as of the date of the filing. This subsection does not apply to a commercial property insurance filing submitted by a Lloyd's plan or a reciprocal or interinsurance exchange under Chapter 2301. Each filing submitted under Insurance Code Chapter 2053 and 2251, including any supporting information filed, is public information subject to Government Code Chapter 552, including any applicable exception from required disclosure under that chapter.\n\n(c) Confidential filings. If a filer marks its entire filing as confidential, TDI will reject the filing.\n\nSource Note: The provisions of this §5.9311 adopted to be effective July 28, 2019, 44 TexReg 3640.","text_length":1127}
{"slug":"tx-28tac-5-5-9312","jurisdiction":"TX","agency":"TDI","doc_type":"regulation","citation":"28 TAC §5.9312","title":"Personally Identifiable Information","official_source_url":"https://texas-sos.appianportalsgov.com/rules-and-meetings?interface=VIEW_TAC_SUMMARY&recordId=216190","access_class":"statutory-public","access_notes":"texas-sos.appianportalsgov.com (state-operated Appian portal; no terms located — gate-zero TX-b); real-browser fetch","first_seen_at":"2026-07-20T17:49:57.213072+00:00","last_checked_at":"2026-07-20T17:49:57.213072+00:00","versions":[{"fetched_at":"2026-07-20T17:49:57.213072+00:00","version_no":1,"text_length":910,"effective_date":"2024-01-08","content_sha256_short":"b5ddf19140a7"}],"text":"Filings must not include any policyholders' personally identifiable information. Filings that include this type of information may be rejected. As used in this subchapter, personally identifiable information means information that can be used either alone or in combination to distinguish an individual's identity. Examples of personally identifiable information include:\n\n(1) any individual policyholder identification, including name, address, phone number, or email address;\n\n(2) social security numbers;\n\n(3) insurance policy numbers;\n\n(4) drivers' license, identification card, vehicle identification, and license plate numbers;\n\n(5) debit card, credit card, bank account, and routing numbers; and\n\n(6) health information about a specific individual.\n\nSource Note: The provisions of this §5.9312 adopted to be effective July 28, 2019, 44 TexReg 3640; amended to be effective January 8, 2024, 49 TexReg 41.","text_length":910}
{"slug":"tx-28tac-5-5-9303","jurisdiction":"TX","agency":"TDI","doc_type":"regulation","citation":"28 TAC §5.9303","title":"Definition of Catastrophe","official_source_url":"https://texas-sos.appianportalsgov.com/rules-and-meetings?interface=VIEW_TAC_SUMMARY&recordId=185704","access_class":"statutory-public","access_notes":"texas-sos.appianportalsgov.com (state-operated Appian portal; no terms located — gate-zero TX-b); real-browser fetch","first_seen_at":"2026-07-20T17:49:57.213072+00:00","last_checked_at":"2026-07-20T17:49:57.213072+00:00","versions":[{"fetched_at":"2026-07-20T17:49:57.213072+00:00","version_no":1,"text_length":2838,"effective_date":"2017-09-20","content_sha256_short":"ee0023f46f59"}],"text":"(a) An individual insurer or a group of insurers may petition the Texas Department of Insurance for a determination that a weather-related event is a catastrophe or major natural disaster in accordance with Insurance Code §542.059. The Texas Department of Insurance will make a determination within three business days of receipt of a petition, and if the event is determined to be a catastrophe, it will notify all companies, by bulletin issued by the Texas Department of Insurance of the designated catastrophe.\n\n(b) An insurer's petition as specified in subsection (a) of this section must include, but is not limited to, the following information:\n\n(1) type of losses: wind, hail, tornado, hurricane, freeze, or other weather-related losses;\n\n(2) specific lines of insurance affected: property, automobile, inland marine (any lines which may involve a first party claim);\n\n(3) location of the loss: towns, cities, or other specified areas;\n\n(4) specific time period of the event which produced the catastrophe;\n\n(5) the insurer's total estimated dollar losses for insured property, by line of business;\n\n(6) the insurer's total estimated number of claims, by line of insurance;\n\n(7) a statement of the reason claims cannot be processed within the time periods specified under the conditions of the property and casualty policies and Insurance Code §§542.055 - 542.057.\n\n(c) For a weather-related event to be considered a catastrophe or major natural disaster by the Texas Department of Insurance:\n\n(1) The area in which the losses occur must be defined by reasonable boundaries.\n\n(2) For the designated area where the losses occur, either the:\n\n(A) estimated total dollar losses must be $50 million or more in the aggregate for all insurers, and the estimated total number of claims must be 5,000 or more in the aggregate for all insurers; or\n\n(B) estimated total number of claims must be 10,000 or more in the aggregate for all insurers.\n\n(3) The estimated dollar losses and number of claims in paragraph (2) of this subsection may include all lines of insurance listed in subsection (b)(2) of this section.\n\n(d) If the Texas Department of Insurance determines a catastrophe exists, the provisions of Insurance Code §542.059 apply for all affected insurers.\n\n(e) Claims processed in accordance with Insurance Code §542.059 must include all losses arising from the event or events identified in subsection (b)(4) of this section.\n\n(f) In addition to subsections (a) - (c) of this section, the Texas Department of Insurance may use any other criteria it deems appropriate for determining if a catastrophe exists in connection with a weather-related event or natural disaster.\n\nSource Note: The provisions of this §5.9303 adopted to be effective June 29, 1992, 17 TexReg 4255; amended to be effective September 20, 2017, 42 TexReg 4817.","text_length":2838}
{"slug":"tx-28tac-5-5-9320","jurisdiction":"TX","agency":"TDI","doc_type":"regulation","citation":"28 TAC §5.9320","title":"Purpose and Definitions","official_source_url":"https://texas-sos.appianportalsgov.com/rules-and-meetings?interface=VIEW_TAC_SUMMARY&recordId=196471","access_class":"statutory-public","access_notes":"texas-sos.appianportalsgov.com (state-operated Appian portal; no terms located — gate-zero TX-b); real-browser fetch","first_seen_at":"2026-07-20T17:49:57.213072+00:00","last_checked_at":"2026-07-20T17:49:57.213072+00:00","versions":[{"fetched_at":"2026-07-20T17:49:57.213072+00:00","version_no":1,"text_length":613,"effective_date":"2019-07-28","content_sha256_short":"7f4efb453f56"}],"text":"(a) Purpose. The purpose of this division is to specify the filing requirements for property and casualty policy form and endorsement filings submitted under Insurance Code Chapters 2052, 2301, or 3502. All insurer and advisory organization filings must comply with the filing requirements of this division and any other applicable rules.\n\n(b) Definitions. The definitions in §5.9310 of this title (relating to Property and Casualty Transmittal Information and General Filing Requirements) apply to this division.\n\nSource Note: The provisions of this §5.9320 adopted to be effective July 28, 2019, 44 TexReg 3640.","text_length":613}
{"slug":"tx-28tac-5-5-9106","jurisdiction":"TX","agency":"TDI","doc_type":"regulation","citation":"28 TAC §5.9106","title":"Rescindment of Cancellation or Non-Renewal","official_source_url":"https://texas-sos.appianportalsgov.com/rules-and-meetings?interface=VIEW_TAC_SUMMARY&recordId=135996","access_class":"statutory-public","access_notes":"texas-sos.appianportalsgov.com (state-operated Appian portal; no terms located — gate-zero TX-b); real-browser fetch","first_seen_at":"2026-07-20T17:49:57.213072+00:00","last_checked_at":"2026-07-20T17:49:57.213072+00:00","versions":[{"fetched_at":"2026-07-20T17:49:57.213072+00:00","version_no":1,"text_length":1295,"effective_date":"2008-04-09","content_sha256_short":"d360166fa397"}],"text":"(a) An insurer or other entity that rescinds a cancellation or non-renewal noticed to the TCEQ pursuant to the Water Code §26.352(e-1) and §5.9104 of this subchapter (relating to Content of Notice) must send written notice to the TCEQ of such rescindment in accordance with §5.9105(b) of this subchapter (relating to Submission of Notice) not later than the 10th day after the cancellation or non-renewal is rescinded.\n\n(b) The notice of rescindment required in subsection (a) of this section must include:\n\n(1) a copy of the notice under §5.9104 of this subchapter that is being rescinded; or\n\n(2) both of the following:\n\n(A) the policy number or other financial assurance identification number, and\n\n(B) the facility identification number(s) assigned by the TCEQ for the underground storage tank(s) insured or otherwise financially assured.\n\n(c) The notice required by subsection (a) of this section must be accurate and contain all the information required under subsection (b) of this section. It is the sole responsibility of the insurer or other entity providing, holding, or maintaining financial assurance to obtain and maintain the information necessary to complete the required notice.\n\nSource Note: The provisions of this §5.9106 adopted to be effective April 9, 2008, 33 TexReg 2820.","text_length":1295}
{"slug":"tx-28tac-5-5-9107","jurisdiction":"TX","agency":"TDI","doc_type":"regulation","citation":"28 TAC §5.9107","title":"Disciplinary Actions by the Commissioner of Insurance","official_source_url":"https://texas-sos.appianportalsgov.com/rules-and-meetings?interface=VIEW_TAC_SUMMARY&recordId=135994","access_class":"statutory-public","access_notes":"texas-sos.appianportalsgov.com (state-operated Appian portal; no terms located — gate-zero TX-b); real-browser fetch","first_seen_at":"2026-07-20T17:49:57.213072+00:00","last_checked_at":"2026-07-20T17:49:57.213072+00:00","versions":[{"fetched_at":"2026-07-20T17:49:57.213072+00:00","version_no":1,"text_length":452,"effective_date":"2008-04-09","content_sha256_short":"cf4eeed7c86c"}],"text":"The Commissioner of Insurance may, after notice and an opportunity for a hearing, discipline an insurer under the Insurance Code Chapters 82, 83, 84, and 2201 for violations of the requirements of this subchapter and any other applicable law the Commissioner determines the insurer to be in violation of, or with which the insurer has failed to comply.\n\nSource Note: The provisions of this §5.9107 adopted to be effective April 9, 2008, 33 TexReg 2820.","text_length":452}
{"slug":"tx-28tac-5-5-9310","jurisdiction":"TX","agency":"TDI","doc_type":"regulation","citation":"28 TAC §5.9310","title":"Property and Casualty Transmittal Information and General Filing Requirements","official_source_url":"https://texas-sos.appianportalsgov.com/rules-and-meetings?interface=VIEW_TAC_SUMMARY&recordId=216189","access_class":"statutory-public","access_notes":"texas-sos.appianportalsgov.com (state-operated Appian portal; no terms located — gate-zero TX-b); real-browser fetch","first_seen_at":"2026-07-20T17:49:57.213072+00:00","last_checked_at":"2026-07-20T17:49:57.213072+00:00","versions":[{"fetched_at":"2026-07-20T17:49:57.213072+00:00","version_no":1,"text_length":5195,"effective_date":"2024-01-08","content_sha256_short":"a6c92b4615fb"}],"text":"(a) Purpose. The purpose of this division is to specify the transmittal information and general filing requirements for property and casualty form, rate, rule, underwriting guideline, and credit scoring model filings.\n\n(b) Definitions. Terms not defined in this division may be defined in Insurance Code Chapters 2053, concerning Rates for Workers' Compensation Insurance; 2251, concerning Rates; and 2301, concerning Policy Forms and have the same meaning when used in this division. The following terms when used in this division have the following meanings unless the context indicates otherwise:\n\n(1) Interline filing--A filing that may be used for more than one line of insurance submitted for:\n\n(A) a policy jacket, declarations page, signature page, notice of cancellation, disclosure, schedule, general change form, company name change, or policyholder notice filed under Division 5 of this subchapter, relating to Filings Made Easy - Requirements for Property and Casualty Policy Form and Endorsement Filings; or\n\n(B) policy fees, service fees, and other fees that are charged or collected by the insurer under Insurance Code §550.001, concerning Solicitation or Collection of Certain Payments, or §4005.003, concerning Fees, filed under Division 6 of this subchapter (relating to Filings Made Easy - Requirements for Rate and Rule Filings).\n\n(2) Multi-peril insurance--Policies and rates for two or more lines of insurance that are subject to regulation under Insurance Code Chapters 2251 and 2301. This definition does not include a combination of coverages described in:\n\n(A) Insurance Code §2251.002, concerning Definitions, and §2301.002, concerning Definitions, and filed as commercial property insurance; or\n\n(B) Insurance Code §2251.0031, concerning Exceptions for Certain Lines, and §2301.0031, concerning Exceptions for Certain Lines.\n\n(3) NAIC--The National Association of Insurance Commissioners.\n\n(4) Reference filing--A filing that references the use of policy forms, endorsements, rules, loss costs, rating manuals, other supplementary rating information, or credit scoring models that TDI has adopted, approved, or accepted.\n\n(5) SERFF--The NAIC System for Electronic Rate and Form Filing.\n\n(6) TDI--Texas Department of Insurance.\n\n(7) TDI file number--The number TDI assigns to a filing.\n\n(c) Transmittal information. Each filing must contain the following transmittal information:\n\n(1) company name as used for financial reporting to the NAIC and company number assigned by the NAIC;\n\n(2) company group name and group NAIC number;\n\n(3) whether the filing is new, or revises or replaces an existing filing;\n\n(4) TDI file number or SERFF tracking number of the revised or replaced filing;\n\n(5) TDI file number or SERFF tracking number for the previously approved policy that the proposed form will be attached to;\n\n(6) TDI file number or SERFF tracking number of associated or companion filings of other filing types;\n\n(7) line of insurance:\n\n(A) all filings must specify the line of insurance; and\n\n(B) interline filings must specify all lines of insurance to which the filing applies.\n\n(8) type of filing;\n\n(9) proposed effective date; and\n\n(10) contact person, including name, telephone number, and mailing address.\n\n(d) Multi-peril use. A filing submitted for a line of insurance that is subject to regulation under Insurance Code Chapters 2251 and 2301 may also be used in multi-peril insurance.\n\n(e) Filings Made Easy Guide. TDI maintains the Filings Made Easy Guide to help insurers submit filings and comply with statutory requirements. Insurers may obtain this guide from TDI's website at www.tdi.texas.gov.\n\n(f) Letter of authorization. A third party representing an insurer on a filing must provide a letter of authorization signed by the insurer on the insurer's letterhead. A letter of authorization applies only to the filing with which it is submitted.\n\n(g) Submission of filing. Filings under Divisions 5, 6, 7, 8, and 9 of this subchapter (relating to Filings Made Easy - Requirements for Property and Casualty Policy Form and Endorsement Filings; Filings Made Easy - Requirements for Rate and Rule Filings; Filings Made Easy - Requirements for Underwriting Guideline Filings; Filings Made Easy - Requirements for Credit Scoring Model Filings for Personal Insurance; and Filings Made Easy - Reduced Filing Requirements for Certain Insurers) must be submitted through SERFF.\n\n(h) Public disclosure of contact information. To the extent that a filing includes company contact information, by submitting a filing the company affirmatively consents to the release and disclosure of its company contact information, including any email addresses. The filer also certifies that each person associated with an email address that appears in the filing has affirmatively consented to the release and disclosure of that email address.\n\nSource Note: The provisions of this §5.9310 adopted to be effective February 10, 2005, 30 TexReg 548; amended to be effective August 13, 2006, 31 TexReg 6221; amended to be effective November 16, 2014, 39 TexReg 8694; amended to be effective July 28, 2019, 44 TexReg 3640; amended to be effective January 8, 2024, 49 TexReg 41.","text_length":5195}
{"slug":"tx-28tac-5-5-9323","jurisdiction":"TX","agency":"TDI","doc_type":"regulation","citation":"28 TAC §5.9323","title":"Requirements for Reference Filings","official_source_url":"https://texas-sos.appianportalsgov.com/rules-and-meetings?interface=VIEW_TAC_SUMMARY&recordId=216199","access_class":"statutory-public","access_notes":"texas-sos.appianportalsgov.com (state-operated Appian portal; no terms located — gate-zero TX-b); real-browser fetch","first_seen_at":"2026-07-20T17:49:57.213072+00:00","last_checked_at":"2026-07-20T17:49:57.213072+00:00","versions":[{"fetched_at":"2026-07-20T17:49:57.213072+00:00","version_no":1,"text_length":1281,"effective_date":"2024-01-08","content_sha256_short":"c98fb0bbd939"}],"text":"(a) Reference filings for policy forms and endorsements should not include a copy of the referenced material.\n\n(b) In addition to the transmittal information, a reference filing must include:\n\n(1) the name of the insurance company or advisory organization whose filing is being referenced; and\n\n(2) the TDI file number or SERFF tracking number of the filing being referenced.\n\n(c) For personal automobile, residential property, and personal multi-peril insurance, the filing must also include:\n\n(1) a list of each form and endorsement that the insurer will use from each referenced filing; and\n\n(2) a form usage table, as described in §5.9321(c)(6) of this title (relating to General Filing Requirements), that includes each form and endorsement that the insurer will use from each referenced filing.\n\n(d) If a filer wants to change a form or endorsement approved for another insurer or an advisory organization, the filer may not submit the form as a reference filing. The filer must submit the amended form for approval with the information required by §5.9321 and §5.9322 of this title (relating to Additional Information).\n\nSource Note: The provisions of this §5.9323 adopted to be effective July 28, 2019, 44 TexReg 3640; amended to be effective January 8, 2024, 49 TexReg 41.","text_length":1281}
{"slug":"va-14vac5-322","jurisdiction":"VA","agency":"SCC-BOI","doc_type":"regulation","citation":"14 VAC 5-322","title":"Chapter 322. Use of the 2001 CSO Preferred Class Structure Mortality Table in Determining Reserve Liabilities","official_source_url":"https://law.lis.virginia.gov/admincodefull/title14/agency5/chapter322/","access_class":"statutory-public","access_notes":"law.lis.virginia.gov (DLAS self-hosted); gate-zero TOP-20 VA admin code row.","first_seen_at":"2026-07-20T01:49:34.270808+00:00","last_checked_at":"2026-07-20T06:39:10.939479+00:00","versions":[{"fetched_at":"2026-07-20T01:49:34.270808+00:00","version_no":1,"text_length":15581,"effective_date":null,"content_sha256_short":"ab19f643056c"}],"text":"Documents Incorporated by Reference (14VAC5-322)\n\n                      Virginia General Assembly  /\n                      LIS Learning Center  /\n                      Privacy Policy  /\n                      LIS home  /\n                      Register Account  /\n                      Login\n\n                     Session Information\n\n                     Bills & Resolutions\n\n                     State Budget\n\n                     Virginia Law\n\n                     Reports to the General Assembly\n\n                          Virginia Law\n\n                                 Select Search Type\n\n                                     All\n                                     Code of Virginia\n                                     Administrative Code\n                                     Constitution\n                                     Charters\n                                     Authorities\n                                     Compacts\n                                     Uncodified Acts\n\n                  Administrative Code\n                   Table of Contents   »  Title 14. Insurance  »  Agency 5. State Corporation Commission, Bureau of Insurance  »  Chapter 322. Use of the 2001 CSO Preferred Class Structure Mortality Table in Determining Reserve Liabilities\n\n                            Chapter\n\n                          Print\n\n                      Virginia Administrative Code\n\n                      Chapter 322. Use of the 2001 CSO Preferred Class Structure Mortality Table in Determining Reserve Liabilities  14VAC5-322-10. Authority.  This chapter is promulgated by the commission, pursuant to §  38.2-223  of the Code of Virginia and in accordance with §   38.2-1369  of the Code of Virginia and  14VAC5-319-40 , to approve, recognize, permit, and prescribe the use of the 2001 Commissioners Standard Ordinary (CSO) Preferred Class Structure Mortality Table by and for insurers transacting the business of insurance in this Commonwealth.   Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 23, Issue 10 , eff. January 1, 2007; amended, Virginia Register  Volume 31, Issue 9 , eff. January 1, 2015.    14VAC5-322-20. Definitions.  The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:\n "2001 CSO Mortality Table" means that mortality table, consisting of separate rates of mortality for male and female lives, developed by the American Academy of Actuaries CSO Task Force from the Valuation Basic Mortality Table developed by the Society of Actuaries Individual Life Insurance Valuation Mortality Task Force, and adopted by the NAIC in December 2002. The 2001 CSO Mortality Table is included in the Proceedings of the NAIC (2nd Quarter 2002) and supplemented by the 2001 CSO Preferred Class Structure Mortality Table. Unless the context indicates otherwise, the "2001 CSO Mortality Table" includes both the ultimate form of that table and the select and ultimate form of that table and includes both the smoker and nonsmoker mortality tables and the composite mortality tables. It also includes both the age-nearest-birthday and age-last-birthday bases of the mortality tables. The 2001 CSO Mortality Table may be accessed via the  Society of Actuaries' website,   https://mort.soa.org/ . Mortality tables in the 2001 CSO Mortality Table include the following:\n 1. "2001 CSO Mortality Table (F)" means that mortality table consisting of the rates of mortality for female lives from the 2001 CSO Mortality Table.\n 2. "2001 CSO Mortality Table (M)" means that mortality table consisting of the rates of mortality for male lives from the 2001 CSO Mortality Table.\n 3. "Composite mortality tables" means mortality tables with rates of mortality that do not distinguish between smokers and nonsmokers.\n 4. "Smoker and nonsmoker mortality tables" means mortality tables with separate rates of mortality for smokers and nonsmokers.\n "2001 CSO Preferred Class Structure Mortality Table" means mortality tables with separate rates of mortality for Super Preferred Nonsmokers, Preferred Nonsmokers, Residual Standard Nonsmokers, Preferred Smokers, and Residual Standard Smoker splits of the 2001 CSO Nonsmoker and Smoker tables adopted by the NAIC in September 2006. The 2001 CSO Preferred Class Structure Mortality Table is included in the Proceedings of the NAIC (3rd Quarter 2006). Unless the context indicates otherwise, the "2001 CSO Preferred Class Structure Mortality Table" includes both the ultimate form of that table and the select and ultimate form of that table. It includes both the smoker and nonsmoker mortality tables. It includes both the male and female mortality tables and the gender composite mortality tables. It also includes both the age-nearest-birthday and age-last-birthday bases of the mortality table. The 2001 CSO Preferred Class Structure Mortality Table may be accessed via the Society of Actuaries website,   https://www.soa.org/globalassets/assets/files/xls/2001-cso-preferred-class-structure-mortality-tables.xls .\n "Commission" means the State Corporation Commission.\n "Commissioner" means the Commissioner of Insurance in Virginia unless specific reference is made to another state, in which case "commissioner" means the insurance commissioner, director, superintendent or other supervising regulatory official of a given state who is responsible for administering the insurance laws of that state.\n "NAIC" means the National Association of Insurance Commissioners.\n "Statistical agent" means an entity with proven systems for protecting the confidentiality of individual insured and insurer information; demonstrated resources for and history of ongoing electronic communications and data transfer ensuring data integrity with insurers, which are its members or subscribers; and a history of and means for aggregation of data and accurate promulgation of the experience modifications in a timely manner.  Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 23, Issue 10 , eff. January 1, 2007; amended, Virginia Register  Volume 26, Issue 4 , eff. September 30, 2009;  Volume 37, Issue 4 , eff. October 12, 2020.    14VAC5-322-30. 2001 CSO Preferred Class Structure Mortality Table.  At the election of the insurer, for each calendar year of issue, for any one or more specified plans of insurance and subject to satisfying the conditions stated in this chapter, the 2001 CSO Preferred Class Structure Mortality Table may be substituted in place of the 2001 CSO Smoker or Nonsmoker Mortality Table as the minimum valuation standard for policies issued on or after January 1, 2007, or, with the consent of the commissioner and subject to the conditions set forth in  14VAC5-322-40  D,  January 1, 2004. In determining such consent, the commissioner may rely on the consent of the commissioner of the company's state of domicile. No such election shall be made until the insurer demonstrates at least 20% of the business to be valued on this table is in one or more of the preferred classes. A table from the 2001 CSO Preferred Class Structure Mortality Table used in place of a 2001 CSO Mortality Table, pursuant to the requirements of this chapter, will be treated as part of the 2001 CSO Mortality Table only for purposes of reserve valuation pursuant to the requirements of the rules entitled "Use of the 2001 CSO Mortality Table In Determining Minimum Reserve Liabilities And Nonforfeiture Benefits" ( 14VAC5-321 ).   Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 23, Issue 10 , eff. January 1, 2007; amended, Virginia Register  Volume 26, Issue 4 , eff. September 30, 2009.    14VAC5-322-40. Conditions.  A. For each plan of insurance with separate rates for Preferred and Standard Nonsmoker lives, an insurer may use the Super Preferred Nonsmoker, Preferred Nonsmoker, and Residual Standard Nonsmoker tables to substitute for the Nonsmoker mortality table found in the 2001 CSO Mortality Table to determine minimum reserves. At the time of election and annually thereafter, except for business valued under the Residual Standard Nonsmoker Table, the appointed actuary shall certify that:\n 1. The present value of death benefits over the next 10 years after the valuation date, using the anticipated mortality experience without recognition of mortality improvement beyond the valuation date for each class, is less than the present value of death benefits using the valuation basic table corresponding to the valuation table being used for that class.\n 2. The present value of death benefits over the future life of the contracts, using anticipated mortality experience without recognition of mortality improvement beyond the valuation date for each class, is less than the present value of death benefits using the valuation basic table corresponding to the valuation table being used for that class.\n B. For each plan of insurance with separate rates for Preferred and Standard Smoker lives, an insurer may use the Preferred Smoker and Residual Standard Smoker tables to substitute for the Smoker mortality table found in the 2001 CSO Mortality Table to determine minimum reserves. At the time of election and annually thereafter, for business valued under the Preferred Smoker Table, the appointed actuary shall certify that:\n 1. The present value of death benefits over the next 10 years after the valuation date, using the anticipated mortality experience without recognition of mortality improvement beyond the valuation date for each class, is less than the present value of death benefits using the Preferred Smoker valuation basic table corresponding to the valuation table being used for that class.\n 2. The present value of death benefits over the future life of the contracts, using anticipated mortality experience without recognition of mortality improvement beyond the valuation date for each class, is less than the present value of death benefits using the Preferred Smoker valuation basic table.\n C. Unless exempted by the commission, every authorized insurer having elected to substitute the 2001 CSO Preferred Class Structure Mortality Table pursuant to this chapter shall file annually with a statistical agent designated by the NAIC and acceptable to the commission, statistical reports showing mortality and such other information as the commission may deem necessary or expedient for the administration of the provisions of this chapter. The commission shall require the use of a statistical report form established by the NAIC or by a statistical agent designated by the NAIC and acceptable to the commission.\n\n D. The use of the 2001 CSO Preferred Class Structure Mortality Table for the valuation of policies issued prior to January 1, 2007, shall not be permitted in any statutory financial statement in which a company reports, with respect to any policy or portion of a policy coinsured, either of the following:\n 1. In cases where the mode of payment of the reinsurance premium is less frequent than the mode of payment of the policy premium, a reserve credit that exceeds, by more than the amount specified in this subdivision as Y, the gross reserve calculated before reinsurance. Y is the amount of the gross reinsurance premium that (i) provides coverage for the period from the next policy premium due date to the earlier of the end of the policy year and the next reinsurance premium due date, and (ii) would be refunded to the ceding entity upon the termination of the policy.\n 2. In cases where the mode of payment of the reinsurance premium is more frequent than the mode of payment of the policy premium, a reserve credit that is less than the gross reserve, calculated before reinsurance, by an amount that is less than the amount specified in this subdivision as Z. Z is the amount of the gross reinsurance premium that the ceding entity would need to pay the assuming company to provide reinsurance coverage from the period of the next reinsurance premium due date to the next policy premium due date minus any liability established for the proportionate amount not remitted to the reinsurer.\n For purposes of this condition, both the reserve credit and the gross reserve before reinsurance (i) for the mean reserve method shall be defined as the mean reserve minus the deferred premium asset, and (ii) for the mid-terminal reserve method shall include the unearned premium reserve. A company may estimate and adjust its accounting on an aggregate basis in order to meet the conditions to use the 2001 CSO Preferred Class Structure Mortality Table.\n E. This section is effective for valuations on and after December 31, 2008.   Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 23, Issue 10 , eff. January 1, 2007; amended, Virginia Register  Volume 26, Issue 4 , eff. September 30, 2009.    14VAC5-322-50. Severability clause.    If any provision of this chapter or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the chapter and the application of the provision to other persons or circumstances shall not be affected thereby.   Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 23, Issue 10 , eff. January 1, 2007.    Documents Incorporated by Reference (14VAC5-322)  2001 CSO Mortality Table, American Academy of Actuaries, June 2002.\n Preferred Class Structure Mortality Table, Society of Actuaries, January 30, 2006 report, as adopted by NAIC September 2006.\n                     Website addresses provided in the Virginia Administrative Code to documents incorporated by reference are for the reader's convenience only, may not necessarily be active or current, and should not be relied upon. To ensure the information incorporated by reference is accurate, the reader is encouraged to use the source document described in the regulation.\n                     As a service to the public, the Virginia Administrative Code is provided online by the Virginia General Assembly. We are unable to answer legal questions or respond to requests for legal advice, including application of law to specific fact. To understand and protect your legal rights, you should consult an attorney.\n\n\t\t\t\t\t\t\t Code of Virginia\n\n\t\t\t\t\t\t\t Administrative Code\n\n\t\t\t\t\t\t\t View by Agency\n\n\t\t\t\t\t\t\t Emergency Regulations\n\n\t\t\t\t\t\t\t VAC# Look Up\n\n\t\t\t\t\t\t\t\t Go\n\n\t\t\t\t\t\t\t Constitution of Virginia\n\n\t\t\t\t\t\t\t Charters\n\n\t\t\t\t\t\t\t Authorities\n\n\t\t\t\t\t\t\t Compacts\n\n\t\t\t\t\t\t\t Uncodified Acts\n\n                             Sign In\n\n                                 Username: \n\n                                 Password: \n\n                                 Cancel\n\n                                  LIS Home\n                                  Lobbyist-in-a-Box\n                                  Privacy Policy\n\n                                © Copyright Commonwealth of Virginia,\n                                 . All rights reserved. Site developed by the  Division of Legislative Automated Systems (DLAS) .\n                                 Sign In","text_length":15581}
{"slug":"va-14vac5-340","jurisdiction":"VA","agency":"SCC-BOI","doc_type":"regulation","citation":"14 VAC 5-340","title":"Chapter 340. Rules Governing Standards for the Content of Fire Insurance or Fire Insurance in Combination with Other Coverages","official_source_url":"https://law.lis.virginia.gov/admincodefull/title14/agency5/chapter340/","access_class":"statutory-public","access_notes":"law.lis.virginia.gov (DLAS self-hosted); gate-zero TOP-20 VA admin code row.","first_seen_at":"2026-07-20T01:49:34.270808+00:00","last_checked_at":"2026-07-20T06:39:10.939479+00:00","versions":[{"fetched_at":"2026-07-20T01:49:34.270808+00:00","version_no":1,"text_length":5681,"effective_date":null,"content_sha256_short":"931509b02979"}],"text":"14VAC5-340-150:9. (Repealed.)\n\n                      Virginia General Assembly  /\n                      LIS Learning Center  /\n                      Privacy Policy  /\n                      LIS home  /\n                      Register Account  /\n                      Login\n\n                     Session Information\n\n                     Bills & Resolutions\n\n                     State Budget\n\n                     Virginia Law\n\n                     Reports to the General Assembly\n\n                          Virginia Law\n\n                                 Select Search Type\n\n                                     All\n                                     Code of Virginia\n                                     Administrative Code\n                                     Constitution\n                                     Charters\n                                     Authorities\n                                     Compacts\n                                     Uncodified Acts\n\n                  Administrative Code\n                   Table of Contents   »  Title 14. Insurance  »  Agency 5. State Corporation Commission, Bureau of Insurance  »  Chapter 340. Rules Governing Standards for the Content of Fire Insurance or Fire Insurance in Combination with Other Coverages\n\n                            Chapter\n\n                          Print\n\n                      Virginia Administrative Code\n\n                      Chapter 340. Rules Governing Standards for the Content of Fire Insurance or Fire Insurance in Combination with Other Coverages  14VAC5-340-10. (Repealed.)  Historical Notes  Derived from Regulation 17, Case No. INS800067, § 2, eff. February 1, 1982; repealed, Virginia Register  Volume 38, Issue 11 , eff. January 1, 2022.    14VAC5-340-20. (Repealed.)  Historical Notes  Derived from Regulation 17, Case No. INS800067, § 3, eff. February 1, 1982.    14VAC5-340-30. (Repealed.)  Historical Notes  Derived from Regulation 17, Case No. INS800067, § 4, eff. February 1, 1982.    14VAC5-340-40. (Repealed.)  Historical Notes  Derived from Regulation 17, Case No. INS800067, § 5, eff. February 1, 1982.    14VAC5-340-50. (Repealed.)  Historical Notes  Derived from Regulation 17, Case No. INS800067, § 6, eff. February 1, 1982.    14VAC5-340-60. (Repealed.)  Historical Notes  Derived from Regulation 17, Case No. INS800067, § 7, eff. February 1, 1982.    14VAC5-340-70. (Repealed.)  Historical Notes  Derived from Regulation 17, Case No. INS800067, § 8, eff. February 1, 1982.    14VAC5-340-80. (Repealed.)  Historical Notes  Derived from Regulation 17, Case No. INS800067, § 9, eff. February 1, 1982.    14VAC5-340-90. (Repealed.)  Historical Notes  Derived from Regulation 17, Case No. INS800067, § 10, eff. February 1, 1982.    14VAC5-340-100. (Repealed.)  Historical Notes  Derived from Regulation 17, Case No. INS800067, § 11, eff. February 1, 1982. 1982; repealed, Virginia Register  Volume 38, Issue 11 , eff. January 1, 2022.    14VAC5-340-110. (Repealed.)  Historical Notes  Derived from Regulation 17, Case No. INS800067, § 12, eff. February 1, 1982; repealed, Virginia Register  Volume 38, Issue 11 , eff. January 1, 2022.    14VAC5-340-120. (Repealed.)  Historical Notes  Derived from Regulation 17, Case No. INS800067, § 13, eff. February 1, 1982; repealed, Virginia Register  Volume 38, Issue 11 , eff. January 1, 2022.    14VAC5-340-130. (Repealed.)  Historical Notes  Derived from Regulation 17, Case No. INS800067, § 14, eff. February 1, 1982; repealed, Virginia Register  Volume 38, Issue 11 , eff. January 1, 2022.    14VAC5-340-140. (Repealed.)  Historical Notes  Derived from Regulation 17, Case No. INS800067, § 15, eff. February 1, 1982.    14VAC5-340-150. (Repealed.)  Historical Notes  Derived from Regulation 17, Case No. INS800067, § 16, eff. February 1, 1982.    14VAC5-340-150:1. (Repealed.)    14VAC5-340-150:2. (Repealed.)    14VAC5-340-150:3. (Repealed.)    14VAC5-340-150:4. (Repealed.)    14VAC5-340-150:5. (Repealed.)    14VAC5-340-150:6. (Repealed.)    14VAC5-340-150:7. (Repealed.)    14VAC5-340-150:8. (Repealed.)    14VAC5-340-150:9. (Repealed.)\n                     Website addresses provided in the Virginia Administrative Code to documents incorporated by reference are for the reader's convenience only, may not necessarily be active or current, and should not be relied upon. To ensure the information incorporated by reference is accurate, the reader is encouraged to use the source document described in the regulation.\n                     As a service to the public, the Virginia Administrative Code is provided online by the Virginia General Assembly. We are unable to answer legal questions or respond to requests for legal advice, including application of law to specific fact. To understand and protect your legal rights, you should consult an attorney.\n\n\t\t\t\t\t\t\t Code of Virginia\n\n\t\t\t\t\t\t\t Administrative Code\n\n\t\t\t\t\t\t\t View by Agency\n\n\t\t\t\t\t\t\t Emergency Regulations\n\n\t\t\t\t\t\t\t VAC# Look Up\n\n\t\t\t\t\t\t\t\t Go\n\n\t\t\t\t\t\t\t Constitution of Virginia\n\n\t\t\t\t\t\t\t Charters\n\n\t\t\t\t\t\t\t Authorities\n\n\t\t\t\t\t\t\t Compacts\n\n\t\t\t\t\t\t\t Uncodified Acts\n\n                             Sign In\n\n                                 Username: \n\n                                 Password: \n\n                                 Cancel\n\n                                  LIS Home\n                                  Lobbyist-in-a-Box\n                                  Privacy Policy\n\n                                © Copyright Commonwealth of Virginia,\n                                 . All rights reserved. Site developed by the  Division of Legislative Automated Systems (DLAS) .\n                                 Sign In","text_length":5681}
{"slug":"va-14vac5-318","jurisdiction":"VA","agency":"SCC-BOI","doc_type":"regulation","citation":"14 VAC 5-318","title":"Chapter 318. Rules Governing Term and Universal Life Insurance Reserve Financing","official_source_url":"https://law.lis.virginia.gov/admincodefull/title14/agency5/chapter318/","access_class":"statutory-public","access_notes":"law.lis.virginia.gov (DLAS self-hosted); gate-zero TOP-20 VA admin code row.","first_seen_at":"2026-07-20T01:49:34.270808+00:00","last_checked_at":"2026-07-20T06:39:10.939479+00:00","versions":[{"fetched_at":"2026-07-20T01:49:34.270808+00:00","version_no":1,"text_length":29292,"effective_date":null,"content_sha256_short":"441d7f866fa2"}],"text":"14VAC5-318-80. Severability.\n\n                      Virginia General Assembly  /\n                      LIS Learning Center  /\n                      Privacy Policy  /\n                      LIS home  /\n                      Register Account  /\n                      Login\n\n                     Session Information\n\n                     Bills & Resolutions\n\n                     State Budget\n\n                     Virginia Law\n\n                     Reports to the General Assembly\n\n                          Virginia Law\n\n                                 Select Search Type\n\n                                     All\n                                     Code of Virginia\n                                     Administrative Code\n                                     Constitution\n                                     Charters\n                                     Authorities\n                                     Compacts\n                                     Uncodified Acts\n\n                  Administrative Code\n                   Table of Contents   »  Title 14. Insurance  »  Agency 5. State Corporation Commission, Bureau of Insurance  »  Chapter 318. Rules Governing Term and Universal Life Insurance Reserve Financing\n\n                            Chapter\n\n                          Print\n\n                      Virginia Administrative Code\n\n                      Chapter 318. Rules Governing Term and Universal Life Insurance Reserve Financing  14VAC5-318-10. Purpose and scope.  The purpose of this chapter is to set forth rules and procedural requirements to establish uniform, national standards governing reserve financing arrangements pertaining to life insurance policies containing guaranteed nonlevel gross premiums or guaranteed nonlevel benefits and universal life insurance policies with secondary guarantees and to ensure that, with respect to each such financing arrangement, funds consisting of primary security and other security, as defined in  14VAC5-318-30 , are held by or on behalf of ceding insurers in the forms and amounts required in this chapter. In general, reinsurance ceded for reserve financing purposes has one or more of the following characteristics: some or all of the assets used to secure the reinsurance treaty or to capitalize the reinsurer (i) are issued by the ceding insurer or its affiliates; (ii) are not unconditionally available to satisfy the general account obligations of the ceding insurer; or (iii) create a reimbursement, indemnification, or other similar obligation on the part of the ceding insurer or any if its affiliates (other than a payment obligation under a derivative contract acquired in the normal course and used to support and hedge liabilities pertaining to the actual risks in the policies ceded pursuant to the reinsurance treaty).   Statutory Authority  §§  12.1-13 ,  38.2-223 , and  38.2-1316.7  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 34, Issue 9 , eff. January 1, 2018.    14VAC5-318-20. Applicability.  This chapter shall apply to reinsurance treaties that cede liabilities pertaining to covered policies, as that term is defined in  14VAC5-318-30 , issued by any life insurance company domiciled in this Commonwealth. The requirements of this chapter shall pertain to all covered policies in force as of and after January 1, 2018. This chapter and  14VAC5-300  shall both apply to such reinsurance treaties, provided that in the event of a direct conflict between the provisions of this chapter and  14VAC5-300 , the provisions of this chapter shall apply, but only to the extent of the conflict.   Statutory Authority  §§  12.1-13 ,  38.2-223 , and  38.2-1316.7  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 34, Issue 9 , eff. January 1, 2018.    14VAC5-318-30. Definitions.  The following words and terms when used in this chapter shall have the following meanings, unless the context clearly indicates otherwise:\n "Actuarial method" means the methodology used to determine the required level of primary security, as described in  14VAC5-318-50 .\n "Commission" means the State Corporation Commission when acting pursuant to or in accordance with Title 38.2 of the Code of Virginia.\n "Covered policy" means, subject to the exemptions described in  14VAC5-318-40 , those policies, other than grandfathered policies, of the following policy types:\n 1. Life insurance policies with guaranteed nonlevel gross premiums or guaranteed nonlevel benefits, except for flexible premium universal life insurance policies; or\n 2. Flexible premium universal life insurance policies with provisions resulting in the ability of a policyholder to keep a policy in force over a secondary guarantee period.\n "Grandfathered policies" means policies of the types described in the "covered policy" definition that were:\n 1. Issued prior to January 1, 2015; and\n 2. Ceded, as of December 31, 2014, as part of a reinsurance treaty that would not have met one of the exemptions set forth in  14VAC5-318-40  had that section then been in effect.\n "NAIC" means the National Association of Insurance Commissioners.\n "Noncovered policy" means any policy that does not meet the definition of covered policy, including grandfathered policies.\n "Required level of primary security" means the dollar amount determined by applying the actuarial method to the risks ceded with respect to covered policies, but not more than the total reserve ceded.\n "Primary security" means the following forms of security:\n 1. Cash meeting the requirements of subdivision 2 a of §  38.2-1316.4  of the Code of Virginia;\n 2. Securities listed by the Securities Valuation Office meeting the requirements of subdivision 2 b of §  38.2-1316.4  of the Code of Virginia, but excluding any synthetic letter of credit, contingent note, credit-linked note, or other similar security that operates in a manner similar to a letter of credit, and excluding any securities issued by the ceding insurer or any of its affiliates; and\n 3. For security held in connection with funds-withheld and modified coinsurance reinsurance treaties:\n a. Commercial loans in good standing of CM3 quality and higher as calculated for the life risk-based capital report;\n b. Policy loans; and\n c. Derivatives acquired in the normal course and used to support and hedge liabilities pertaining to the actual risks in the policies ceded pursuant to the reinsurance treaty.\n "Other security" means any security acceptable to the commission other than security meeting the definition of primary security.\n "Valuation manual" means the valuation manual adopted by the NAIC as described in subdivision B 1 of §  38.2-1379  of the Code of Virginia, with all amendments adopted by the NAIC that are effective for the financial statement date on which credit for reinsurance is claimed.\n "VM-20" means "requirements for principle-based reserves for life products," including all relevant definitions, from the valuation manual.  Statutory Authority  §§  12.1-13 ,  38.2-223 , and  38.2-1316.7  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 34, Issue 9 , eff. January 1, 2018.    14VAC5-318-40. Exemptions from this chapter.  This chapter does not apply to the situations described in subdivisions 1 through 6 of this section.\n 1. Reinsurance of:\n a. Policies that satisfy the criteria for exemption set forth in  14VAC5-319-50  F or G and that are issued before the later of:\n (1) January 1, 2018; and\n (2) The date on which the ceding insurer begins to apply the provisions of VM-20 to establish the ceded policies' statutory reserves, but in no event later than January 1, 2020;\n b. Portions of policies that satisfy the criteria for exemption set forth in  14VAC5-319-50  E and that are issued before the later of:\n (1) January 1, 2018; and\n (2) The date on which the ceding insurer begins to apply the provisions of VM-20 to establish the ceded policies' statutory reserves, but in no event later than January 1, 2020;\n c. Any universal life policy that meets all of the following requirements:\n (1) Secondary guarantee period, if any, is five years or less;\n (2) Specified premium for the secondary guarantee period is equal to or greater than the net level reserve premium for the secondary guarantee period based on the Commissioners Standard Ordinary (CSO) valuation tables and valuation interest rate applicable to the issue year of the policy; and\n (3) The initial surrender charge is equal to or greater than 100% of the first year annualized specified premium for the secondary guarantee period;\n d. Credit life insurance;\n e. Any variable life insurance policy that provides for life insurance, the amount or duration of which varies according to the investment experience of any separate account or accounts; or\n f. Any group life insurance certificate unless the certificate provides for a stated or implied schedule of maximum gross premiums required in order to continue coverage in force for a period in excess of one year;\n 2. Reinsurance ceded to an assuming insurer that meets the applicable requirements of subdivision C 4 of §  38.2-1316.2  of the Code of Virginia and  14VAC5-300-90  C 1;\n 3. Reinsurance ceded to an assuming insurer that meets the applicable requirements of subdivision C 1, C 2, or C 3 of §  38.2-1316.2  of the Code of Virginia and that in addition:\n a. Prepares statutory financial statements in compliance with §  38.2-1300  of the Code of Virginia, without any departures from NAIC statutory accounting practices and procedures pertaining to the admissibility or valuation of assets or liabilities that increase the assuming insurer's reported surplus and are material enough that they need to be disclosed in the financial statement of the assuming insurer pursuant to Statement of Statutory Accounting Principles No. 1 ("SSAP 1"); and\n b. Is not in a Company Action Level Event, Regulatory Action Level Event, Authorized Control Level Event, or Mandatory Control Level Event as those terms are defined in Chapter 55 (§  38.2-5500  et seq.) of Title 38.2 of the Code of Virginia when its risk-based capital (RBC) is calculated in accordance with §  38.2-5502  of the Code of Virginia;\n 4. Reinsurance ceded to an assuming insurer that meets the applicable requirements of subdivision C 1, C 2, or C 3 of §  38.2-1316.2  of the Code of Virginia and that in addition:\n a. Is not an affiliate, as that term is defined in §  38.2-1322  of the Code of Virginia, of:\n (1) The insurer ceding the business to the assuming insurer; or\n (2) Any insurer that directly or indirectly ceded the business to that ceding insurer;\n b. Prepares statutory financial statements in compliance with the NAIC Accounting Practices and Procedures Manual;\n c. Is both:\n (1) Licensed or accredited in at least 10 states (including its state of domicile); and\n (2) Not licensed in any state as a captive, special purpose vehicle, special purpose financial captive, special purpose life reinsurance company, limited purpose subsidiary, or any other similar licensing regime; and\n d. Is not, or would not be, below 500% of the Authorized Control Level RBC as that term is defined in §  38.2-5501  of the Code of Virginia when its RBC is calculated in accordance with §  38.2-5502  of the Code of Virginia and without recognition of any departures from NAIC statutory accounting practices and procedures pertaining to the admission or valuation of assets or liabilities that increase the assuming insurer's reported surplus;\n 5. Reinsurance ceded to an assuming insurer that meets the requirements of either subdivision B 4 a or B 4 b of §  38.2-1316.7  of the Code of Virginia; or\n 6. Reinsurance not otherwise exempt under subdivisions 1 through 5 of this section if the commission, after consulting with the NAIC Financial Analysis Working Group or other group of regulators designated by the NAIC, as applicable, determines under all the facts and circumstances that all of the following apply:\n a. The risks are clearly outside of the intent and purpose of this chapter, as described in  14VAC5-318-10 ;\n b. The risks are included within the scope of this chapter only as a technicality; and\n c. The application of this chapter to those risks is not necessary to provide appropriate protection to policyholders. The commission shall publicly disclose any decision made pursuant to this subdivision to exempt a reinsurance treaty from this chapter, as well as the general basis therefor (including a summary description of the treaty).   Statutory Authority  §§  12.1-13 ,  38.2-223 , and  38.2-1316.7  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 34, Issue 9 , eff. January 1, 2018.    14VAC5-318-50. The actuarial method.  A. The actuarial method to establish the required level of primary security for each reinsurance treaty subject to this chapter shall be VM-20, applied on a treaty-by-treaty basis, including all relevant definitions, from the Valuation Manual as then in effect, applied as follows:\n 1. For covered policies as provided in subdivision 1 of the definition of "covered policy" in  14VAC5-318-30 , the actuarial method is the greater of the deterministic reserve or the net premium reserve (NPR) regardless of whether the criteria for exemption testing can be met. However, if the covered policies do not meet the requirements of the stochastic reserve exclusion test in the valuation manual, then the actuarial method is the greatest of the deterministic reserve, the stochastic reserve, or the NPR. In addition, if such covered policies are reinsured in a reinsurance treaty that also contains covered policies as provided in subdivision 2 of the definition of "covered policy" in  14VAC5-318-30 , the ceding insurer may elect to instead use subdivision 2 of this subsection as the actuarial method for the entire reinsurance agreement. Whether subdivision 1 or 2 of this subsection is used, the actuarial method must comply with any requirements or restrictions that the valuation manual imposes when aggregating these policy types for purposes of principle-based reserve calculations.\n 2. For covered policies, as that term is defined in subdivision 2 of the definition of "covered policy" of  14VAC5-318-30 , the actuarial method is the greatest of the deterministic reserve, the stochastic reserve, or the NPR regardless of whether the criteria for exemption testing can be met.\n 3. Except as provided in subdivision 4 of this subsection, the actuarial method is to be applied on a gross basis to all risks with respect to the covered policies as originally issued or assumed by the ceding insurer.\n 4. If the reinsurance treaty cedes less than 100% of the risk with respect to the covered policies then the required level of primary security may be reduced as follows:\n a. If a reinsurance treaty cedes only a quota share of some or all of the risks pertaining to the covered policies, the required level of primary security, as well as any adjustment under subdivision A 4 c of this section, may be reduced to a pro rata portion in accordance with the percentage of the risk ceded;\n b. If the reinsurance treaty in a nonexempt arrangement cedes only the risks pertaining to a secondary guarantee, the required level of primary security may be reduced by an amount determined by applying the actuarial method on a gross basis to all risks, other than risks related to the secondary guarantee, pertaining to the covered policies, except that for covered policies for which the ceding insurer did not elect to apply the provisions of VM-20 to establish statutory reserves, the required level of primary security may be reduced by the statutory reserve retained by the ceding insurer on those covered policies, where the retained reserve of those covered policies should be reflective of any reduction pursuant to the cession of mortality risk on a yearly renewable term basis in an exempt arrangement;\n c. If a portion of the covered policy risk is ceded to another reinsurer on a yearly renewable term basis in an exempt arrangement, the required level of primary security may be reduced by the amount resulting by applying the actuarial method including the reinsurance section of VM-20 to the portion of the covered policy risks ceded in the exempt arrangement, except that for covered policies issued prior to January 1, 2017, this adjustment is not to exceed:                        c x                            2(number of reinsurance premiums per year)            where c x  is calculated using the same assumptions used in calculating the NPR; and\n d. For any other treaty ceding a portion of risk to a different reinsurer, including stop loss, excess of loss, and other nonproportional reinsurance treaties, there will be no reduction in the required level of primary security.\n It is possible for any combination of subdivisions A 4 a, b, c, and d of this section to apply. Such adjustments to the required level of primary security will be done in the sequence that accurately reflects the portion of the risk ceded via the treaty. The ceding insurer should document the rationale and steps taken to accomplish the adjustments to the required level of primary security due to the cession of less than 100% of the risk.\n The adjustments for other reinsurance will be made only with respect to reinsurance treaties entered into directly by the ceding insurer. The ceding insurer will make no adjustment as a result of a retrocession treaty entered into by the assuming insurers.\n 5. In no event will the required level of primary security resulting from application of the actuarial method exceed the amount of statutory reserves ceded.\n 6. If the ceding insurer cedes risks with respect to covered policies, including any riders, in more than one reinsurance treaty subject to this chapter, in no event will the aggregate required level of primary security for those reinsurance treaties be less than the required level of primary security calculated using the actuarial method as if all risks ceded in those treaties were ceded in a single treaty subject to this chapter.\n 7. If a reinsurance treaty subject to this chapter cedes risk on both covered and noncovered policies, credit for the ceded reserves shall be determined as follows:\n a. The actuarial method shall be used to determine the required level of primary security for the covered policies, and  14VAC5-318-60  shall be used to determine the reinsurance credit for the covered policy reserves; and\n b. Credit for the noncovered policy reserves shall be granted only to the extent that security, in addition to the security held to satisfy the requirements of subdivision A 7 a of this section, is held by or on behalf of the ceding insurer in accordance with §§  38.2-1316.2  and  38.2-1316.4  of the Code of Virginia,  14VAC5-300-90  C,  14VAC5-300-100 , and  14VAC5-300-150  B and C. Any primary security used to meet the requirements of this subdivision may not be used to satisfy the required level of primary security for the covered policies.\n B. For the purposes of both calculating the required level of primary security pursuant to the actuarial method and determining the amount of primary security and other security, as applicable, held by or on behalf of the ceding insurer, the following shall apply:\n 1. For assets, including any such assets held in trust, that would be admitted under the NAIC Accounting Practices and Procedures Manual if they were held by the ceding insurer, the valuations are to be determined according to statutory accounting procedures as if such assets were held in the ceding insurer's general account and without taking into consideration the effect of any prescribed or permitted practices; and\n 2. For all other assets, the valuations are to be those that were assigned to the assets for the purpose of determining the amount of reserve credit taken. In addition, the asset spread tables and asset default cost tables required by VM-20 shall be included in the actuarial method if adopted by the NAIC Life Actuarial (A) Task Force no later than the December 31st on or immediately preceding the valuation date for which the required level of primary security is being calculated. The tables of asset spreads and asset default costs shall be incorporated into the actuarial method in the manner specified in VM-20.  Statutory Authority  §§  12.1-13 ,  38.2-223 , and  38.2-1316.7  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 34, Issue 9 , eff. January 1, 2018.    14VAC5-318-60. Requirements applicable to covered policies to obtain credit for reinsurance; opportunity for remediation.  A. Subject to the exemptions described in  14VAC5-318-40  and the provisions of subsection B of this section, credit for reinsurance shall be allowed with respect to ceded liabilities pertaining to covered policies pursuant to §  38.2-1316.2  of the Code of Virginia,  14VAC5-300-90  C,  14VAC5-300-100 , and  14VAC5-300-150  B and C, or §  38.2-1316.4  of the Code of Virginia if, and only if, in addition to all other requirements imposed by law or regulation, the following requirements are met on a treaty-by-treaty basis:\n 1. The ceding insurer's statutory policy reserves with respect to the covered policies are established in full and in accordance with the applicable requirements of Article 10 (§  38.2-1365  et seq.) of Chapter 13 of Title 38.2 of the Code of Virginia and related regulations and actuarial guidelines, and credit claimed for any reinsurance treaty subject to this chapter does not exceed the proportionate share of those reserves ceded under the contract;\n 2. The ceding insurer determines the required level of primary security with respect to each reinsurance treaty subject to this chapter and provides support for its calculation as determined to be acceptable to the commission;\n 3. Funds consisting of primary security, in an amount at least equal to the required level of primary security, are held by or on behalf of the ceding insurer, as security under the reinsurance treaty within the meaning of §  38.2-1316.4  of the Code of Virginia, on a funds withheld, trust, or modified coinsurance basis;\n 4. Funds consisting of other security, in an amount at least equal to any portion of the statutory reserves as to which primary security is not held pursuant to subdivision 3 of this subsection, are held by or on behalf of the ceding insurer as security under the reinsurance treaty within the meaning of §  38.2-1316.4  of the Code of Virginia;\n 5. Any trust used to satisfy the requirements of this section shall comply with all of the conditions and qualifications of  14VAC5-300-120 , except that:\n a. Funds consisting of primary security or other security held in trust shall for the purposes identified in  14VAC5-318-50  B be valued according to the valuation rules set forth in  14VAC5-318-50  B, as applicable;\n b. There are no affiliate investment limitations with respect to any security held in such trust if such security is not needed to satisfy the requirements of subdivision 3 of this subsection;\n c. The reinsurance treaty must prohibit withdrawals or substitutions of trust assets that would leave the fair market value of the primary security within the trust when aggregated with primary security outside the trust that is held by or on behalf of the ceding insurer in the manner required by subdivision 3 of this subsection below 102% of the level required by subdivision 3 of this subsection at the time of the withdrawal or substitution; and\n d. The determination of reserve credit under  14VAC5-300-120  D shall be determined according to the valuation rules set forth in  14VAC5-318-50  B, as applicable; and\n 6. The reinsurance treaty has been approved by the commission.\n B. Requirements at inception date and on an on-going basis; remediation.\n 1. The requirements of subsection A of this section must be satisfied as of the date that risks under covered policies are ceded if such date is on or after January 1, 2018, and on an ongoing basis thereafter. Under no circumstances shall a ceding insurer take or consent to any action or series of actions that would result in a deficiency under subdivision A 3 or A 4 of this section with respect to any reinsurance treaty under which covered policies have been ceded, and in the event that a ceding insurer becomes aware at any time that such a deficiency exists, it shall use its best efforts to arrange for the deficiency to be eliminated as expeditiously as possible.\n 2. Prior to the due date of each quarterly or annual statement, each life insurance company that has ceded reinsurance within the scope of  14VAC5-318-20  shall perform an analysis, on a treaty-by-treaty basis, to determine, as to each reinsurance treaty under which covered policies have been ceded, whether as of the end of the immediately preceding calendar quarter (the valuation date) the requirements of subdivision A 3 or A 4 of this section were satisfied. The ceding insurer shall establish a liability equal to the excess of the credit for reinsurance taken over the amount of primary security actually held pursuant to subdivision A 3 of this section, unless either:\n a. The requirements of subdivision A 3 or A 4 of this section were fully satisfied as of the valuation date as to such reinsurance treaty; or\n b. Any deficiency has been eliminated before the due date of the quarterly or annual statement to which the valuation date relates through the addition of primary security or other security, as the case may be, in such amount and in such form as would have caused the requirements of subdivision A 3 or A 4 of this section to be fully satisfied as of the valuation date.\n 3. Nothing in subdivision 2 of this subsection shall be construed to allow a ceding company to maintain any deficiency under subdivision A 3 or A 4 of this section for any period of time longer than is reasonably necessary to eliminate it.   Statutory Authority  §§  12.1-13 ,  38.2-223 , and  38.2-1316.7  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 34, Issue 9 , eff. January 1, 2018.    14VAC5-318-70. Prohibition against avoidance.  No insurer that has covered policies to which this chapter applies, as set forth in  14VAC5-318-20 , shall take any action or series of actions or enter into any transaction, arrangement, or series of transactions or arrangements if the purpose of such action, transaction, arrangement, or series thereof is to avoid the requirements of this chapter or to circumvent its purpose and intent, as set forth in  14VAC5-318-10 .   Statutory Authority  §§  12.1-13 ,  38.2-223 , and  38.2-1316.7  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 34, Issue 9 , eff. January 1, 2018.    14VAC5-318-80. Severability.  If any provision of this chapter or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the chapter and the application of the provision to other persons or circumstances shall not be affected thereby.   Statutory Authority  §§  12.1-13 ,  38.2-223 , and  38.2-1316.7  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 34, Issue 9 , eff. January 1, 2018.\n                     Website addresses provided in the Virginia Administrative Code to documents incorporated by reference are for the reader's convenience only, may not necessarily be active or current, and should not be relied upon. To ensure the information incorporated by reference is accurate, the reader is encouraged to use the source document described in the regulation.\n                     As a service to the public, the Virginia Administrative Code is provided online by the Virginia General Assembly. We are unable to answer legal questions or respond to requests for legal advice, including application of law to specific fact. To understand and protect your legal rights, you should consult an attorney.\n\n\t\t\t\t\t\t\t Code of Virginia\n\n\t\t\t\t\t\t\t Administrative Code\n\n\t\t\t\t\t\t\t View by Agency\n\n\t\t\t\t\t\t\t Emergency Regulations\n\n\t\t\t\t\t\t\t VAC# Look Up\n\n\t\t\t\t\t\t\t\t Go\n\n\t\t\t\t\t\t\t Constitution of Virginia\n\n\t\t\t\t\t\t\t Charters\n\n\t\t\t\t\t\t\t Authorities\n\n\t\t\t\t\t\t\t Compacts\n\n\t\t\t\t\t\t\t Uncodified Acts\n\n                             Sign In\n\n                                 Username: \n\n                                 Password: \n\n                                 Cancel\n\n                                  LIS Home\n                                  Lobbyist-in-a-Box\n                                  Privacy Policy\n\n                                © Copyright Commonwealth of Virginia,\n                                 . All rights reserved. Site developed by the  Division of Legislative Automated Systems (DLAS) .\n                                 Sign In","text_length":29292}
{"slug":"va-14vac5-321","jurisdiction":"VA","agency":"SCC-BOI","doc_type":"regulation","citation":"14 VAC 5-321","title":"Chapter 321. Use of the 2001 CSO Mortality Table in Determining Reserve Liabilities and Nonforfeiture Benefits","official_source_url":"https://law.lis.virginia.gov/admincodefull/title14/agency5/chapter321/","access_class":"statutory-public","access_notes":"law.lis.virginia.gov (DLAS self-hosted); gate-zero TOP-20 VA admin code row.","first_seen_at":"2026-07-20T01:49:34.270808+00:00","last_checked_at":"2026-07-20T06:39:10.939479+00:00","versions":[{"fetched_at":"2026-07-20T01:49:34.270808+00:00","version_no":1,"text_length":14588,"effective_date":null,"content_sha256_short":"0903d4289da2"}],"text":"Documents Incorporated by Reference (14VAC5-321)\n\n                      Virginia General Assembly  /\n                      LIS Learning Center  /\n                      Privacy Policy  /\n                      LIS home  /\n                      Register Account  /\n                      Login\n\n                     Session Information\n\n                     Bills & Resolutions\n\n                     State Budget\n\n                     Virginia Law\n\n                     Reports to the General Assembly\n\n                          Virginia Law\n\n                                 Select Search Type\n\n                                     All\n                                     Code of Virginia\n                                     Administrative Code\n                                     Constitution\n                                     Charters\n                                     Authorities\n                                     Compacts\n                                     Uncodified Acts\n\n                  Administrative Code\n                   Table of Contents   »  Title 14. Insurance  »  Agency 5. State Corporation Commission, Bureau of Insurance  »  Chapter 321. Use of the 2001 CSO Mortality Table in Determining Reserve Liabilities and Nonforfeiture Benefits\n\n                            Chapter\n\n                          Print\n\n                      Virginia Administrative Code\n\n                      Chapter 321. Use of the 2001 CSO Mortality Table in Determining Reserve Liabilities and Nonforfeiture Benefits  14VAC5-321-10. Authority.  This chapter is promulgated by the commission, pursuant to §  38.2-223  of the Code of Virginia and in accordance with §§   38.2-1369 ,  38.2-3206  through  38.2-3209 , and  38.2-4120  of the Code of Virginia and  14VAC5-319-40 , to approve, recognize, permit, and prescribe the use of the 2001 Commissioners Standard Ordinary (CSO) Mortality Table by and for insurers transacting the business of insurance in this Commonwealth.   Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 20, Issue 16 , eff. July 1, 2004; amended, Virginia Register  Volume 23, Issue 10 , eff. January 1, 2007;  Volume 31, Issue 9 , eff. January 1, 2015.    14VAC5-321-20. Definitions.  The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:\n "2001 CSO Mortality Table" means that mortality table, which is included in the Proceedings of the NAIC (2nd Quarter 2002), consisting of separate rates of mortality for male and female lives, developed by the American Academy of Actuaries CSO Task Force from the Valuation Basic Mortality Table developed by the Society of Actuaries Individual Life Insurance Valuation Mortality Task Force, and adopted by the NAIC in December 2002. Unless the context indicates otherwise, the "2001 CSO Mortality Table" includes both the ultimate form of that table and the select and ultimate form of that table and includes both the smoker and nonsmoker mortality tables and the composite mortality tables. It also includes both the age-nearest-birthday and age-last-birthday bases of the mortality tables. The 2001 CSO Mortality Table may be accessed via the  Society of Actuaries' website,   https://mort.soa.org/ .\n "2001 CSO Mortality Table (F)" means that mortality table consisting of the rates of mortality for female lives from the 2001 CSO Mortality Table.\n "2001 CSO Mortality Table (M)" means that mortality table consisting of the rates of mortality for male lives from the 2001 CSO Mortality Table.\n "Commission" means the State Corporation Commission.\n "Composite mortality tables" means mortality tables with rates of mortality that do not distinguish between smokers and nonsmokers.\n "NAIC" means the National Association of Insurance Commissioners.\n "Smoker and nonsmoker mortality tables" means mortality tables with separate rates of mortality for smokers and nonsmokers.   Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 20, Issue 16 , eff. July 1, 2004; amended, Virginia Register  Volume 23, Issue 10 , eff. January 1, 2007;  Volume 37, Issue 4 , eff. October 12, 2020.    14VAC5-321-30. 2001 CSO Mortality Table.  A. At the election of the insurer for any one or more specified plans of insurance and subject to the conditions stated in this chapter, the 2001 CSO Mortality Table may be used as the minimum standard for policies issued on or after January 1, 2004, and before the date specified in subsection B of this section to which subdivision 1 of §  38.2-1369  and §  38.2-3209  of the Code of Virginia are applicable. If the insurer elects to use the 2001 CSO Mortality Table, it shall do so for both valuation and nonforfeiture purposes.\n B. Subject to the conditions stated in this chapter, the 2001 CSO Mortality Table shall be used in determining minimum standards for policies issued on and after January 1, 2009, to which subdivision 1 of §  38.2-1369  and §  38.2-3209  of the Code of Virginia are applicable.\n C. A table from the 2001 CSO Preferred Class Structure Mortality Table used in place of a 2001 CSO Mortality Table, pursuant to the requirements of  14VAC5-322 , will be treated as part of the 2001 CSO Mortality Table only for purposes of reserve valuation pursuant to the requirements of this chapter.  Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 20, Issue 16 , eff. July 1, 2004; amended, Virginia Register  Volume 23, Issue 10 , eff. January 1, 2007;  Volume 26, Issue 9 , eff. December 31, 2009;  Volume 31, Issue 9 , eff. January 1, 2015.    14VAC5-321-40. Conditions.  A. For policies issued on or after July 1, 2004, with each plan of insurance with separate rates for smokers and nonsmokers an insurer may use:\n 1. Composite mortality tables to determine minimum reserve liabilities and minimum cash surrender values and amounts of paid-up nonforfeiture benefits;\n 2. Smoker and nonsmoker mortality tables to determine the valuation net premiums and additional minimum reserves, if any, required by §   38.2-1376  of the Code of Virginia and use composite mortality tables to determine the basic minimum reserves, minimum cash surrender values, and amounts of paid-up nonforfeiture benefits; or\n 3. Smoker and nonsmoker mortality tables to determine minimum reserve liabilities and minimum cash surrender values and amounts of paid-up nonforfeiture benefits.\n B. For policies issued on or after July 1, 2004, with plans of insurance without separate rates for smokers and nonsmokers the composite mortality tables shall be used.\n C. For the purpose of determining minimum reserve liabilities and minimum cash surrender values and amounts of paid-up nonforfeiture benefits, the 2001 CSO Mortality Table may, at the option of the insurer for each such plan of insurance, be used in its ultimate or select and ultimate form, subject to the restrictions of  14VAC5-321-50  and  14VAC5-319  relative to use of the select and ultimate form.\n D. When the 2001 CSO Mortality Table is the minimum reserve standard for any plan for an insurer, any actuarial opinion in the annual statement filed with the commission shall be based on an asset adequacy analysis that meets the standards and satisfies requirements for an asset adequacy analysis performed pursuant to subdivision A 2 of §   38.2-1367  of the Code of Virginia and rules governing actuarial opinions and memoranda at  14VAC5-310 .   Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 20, Issue 16 , eff. July 1, 2004;  amended, Virginia Register  Volume 31, Issue 9 , eff. January 1, 2015.    14VAC5-321-50. Applicability of the 2001 CSO Mortality Table to 14VAC5-319.  A. The 2001 CSO Mortality Table may be used in applying rules at  14VAC5-319 , concerning life insurance reserves, in the following manner, subject to the transition dates for use of the 2001 CSO Mortality Table in  14VAC5-321-30 .\n 1. When applying  14VAC5-319-30  B 2, the net level reserve premium is based on the ultimate mortality rates in the 2001 CSO Mortality Table.\n 2. When determining "contract segmentation method" as defined by  14VAC5-319-10 , all calculations are made using the 2001 CSO mortality rate, and, if elected, the optional minimum mortality standard for deficiency reserves stipulated in subdivision 4 of this subsection. The value of "q x+k+t-1 " is the valuation mortality rate for deficiency reserves in policy year k+t, but using the unmodified select mortality rates if modified select mortality rates are used in the computation of deficiency reserves.\n 3. When applying  14VAC5-319-40  A, the 2001 CSO Mortality Table is the minimum standard for basic reserves.\n 4. When applying  14VAC5-319-40  B, the 2001 CSO Mortality Table is the minimum standard for deficiency reserves. If select mortality rates are used, they may be multiplied by X percent for durations in the first segment, subject to the conditions specified in subdivisions 1 c, 1 d, 2, and 3 of  14VAC5-319-40  B. In demonstrating compliance with those conditions, the demonstrations may not combine the results of tests that utilize the 1980 CSO Mortality Table with those tests that utilize the 2001 CSO Mortality Table, unless the combination is explicitly required by regulation or necessary to be in compliance with relevant Actuarial Standards of Practice.\n 5. When applying  14VAC5-319-50  C, the valuation mortality table used in determining the tabular cost of insurance shall be the ultimate mortality rates in the 2001 CSO Mortality Table.\n 6. When applying  14VAC5-319-50  E 4, the calculations specified in  14VAC5-319-50  E shall use the ultimate mortality rates in the 2001 CSO Mortality Table.\n 7. When applying  14VAC5-319-50  F 4, the calculations specified in  14VAC5-319-50  F shall use the ultimate mortality rates in the 2001 CSO Mortality Table.\n 8. When applying  14VAC5-319-50  G 2, the calculations specified in  14VAC5-319-50  G shall use the ultimate mortality rates in the 2001 CSO Mortality Table.\n 9. When applying  14VAC5-319-60  A 1 b, the one-year valuation premium shall be calculated using the ultimate mortality rates in the 2001 CSO Mortality Table.\n B. Nothing in this section shall be construed to expand the applicability of  14VAC5-319  to include life insurance policies excepted from regulation pursuant to  14VAC5-319-30  B.   Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 20, Issue 16 , eff. July 1, 2004.    14VAC5-321-60. Gender-blended tables.    A. For any ordinary life insurance policy delivered or issued for delivery in this Commonwealth on and after July 1, 2004, that utilizes the same premium rates and charges for male and female lives or is issued in circumstances where applicable law does not permit distinctions on the basis of gender, a mortality table that is a blend of the 2001 CSO Mortality Table (M) and the 2001 CSO Mortality Table (F) may, at the option of the insurer for each plan of insurance, be substituted for the 2001 CSO Mortality Table for use in determining minimum cash surrender values and amounts of paid-up nonforfeiture benefits.  No change in minimum valuation standards is implied by this subsection.     B. When applying subsection A of this section, the insurer may choose from among the blended tables developed by the American Academy of Actuaries CSO Task Force and adopted by the NAIC in December 2002.     C. It shall not, in and of itself, be a violation of §  38.2-508  or §  38.2-508.2  of the Code of Virginia concerning respectively, unfair discrimination and discrimination prohibited, for an insurer to issue the same kind of policy of life insurance on both a sex-distinct and sex-neutral basis.   Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 20, Issue 16 , eff. July 1, 2004.    14VAC5-321-70. Severability clause.    If any provision of this chapter or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the chapter and the application of the provision to other persons or circumstances shall not be affected thereby.   Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 23, Issue 10 , eff. January 1, 2007.    Documents Incorporated by Reference (14VAC5-321)   2001 CSO Mortality Table, American Academy of Actuaries, June 2002.\n                     Website addresses provided in the Virginia Administrative Code to documents incorporated by reference are for the reader's convenience only, may not necessarily be active or current, and should not be relied upon. To ensure the information incorporated by reference is accurate, the reader is encouraged to use the source document described in the regulation.\n                     As a service to the public, the Virginia Administrative Code is provided online by the Virginia General Assembly. We are unable to answer legal questions or respond to requests for legal advice, including application of law to specific fact. To understand and protect your legal rights, you should consult an attorney.\n\n\t\t\t\t\t\t\t Code of Virginia\n\n\t\t\t\t\t\t\t Administrative Code\n\n\t\t\t\t\t\t\t View by Agency\n\n\t\t\t\t\t\t\t Emergency Regulations\n\n\t\t\t\t\t\t\t VAC# Look Up\n\n\t\t\t\t\t\t\t\t Go\n\n\t\t\t\t\t\t\t Constitution of Virginia\n\n\t\t\t\t\t\t\t Charters\n\n\t\t\t\t\t\t\t Authorities\n\n\t\t\t\t\t\t\t Compacts\n\n\t\t\t\t\t\t\t Uncodified Acts\n\n                             Sign In\n\n                                 Username: \n\n                                 Password: \n\n                                 Cancel\n\n                                  LIS Home\n                                  Lobbyist-in-a-Box\n                                  Privacy Policy\n\n                                © Copyright Commonwealth of Virginia,\n                                 . All rights reserved. Site developed by the  Division of Legislative Automated Systems (DLAS) .\n                                 Sign In","text_length":14588}
{"slug":"va-14vac5-330","jurisdiction":"VA","agency":"SCC-BOI","doc_type":"regulation","citation":"14 VAC 5-330","title":"Chapter 330. Reporting of Salvage and Subrogation Recoveries [Repealed]","official_source_url":"https://law.lis.virginia.gov/admincodefull/title14/agency5/chapter330/","access_class":"statutory-public","access_notes":"law.lis.virginia.gov (DLAS self-hosted); gate-zero TOP-20 VA admin code row.","first_seen_at":"2026-07-20T01:49:34.270808+00:00","last_checked_at":"2026-07-20T06:39:10.939479+00:00","versions":[{"fetched_at":"2026-07-20T01:49:34.270808+00:00","version_no":1,"text_length":3180,"effective_date":null,"content_sha256_short":"26bbf859c060"}],"text":"14VAC5-330-10. (Repealed.)\n\n                      Virginia General Assembly  /\n                      LIS Learning Center  /\n                      Privacy Policy  /\n                      LIS home  /\n                      Register Account  /\n                      Login\n\n                     Session Information\n\n                     Bills & Resolutions\n\n                     State Budget\n\n                     Virginia Law\n\n                     Reports to the General Assembly\n\n                          Virginia Law\n\n                                 Select Search Type\n\n                                     All\n                                     Code of Virginia\n                                     Administrative Code\n                                     Constitution\n                                     Charters\n                                     Authorities\n                                     Compacts\n                                     Uncodified Acts\n\n                  Administrative Code\n                   Table of Contents   »  Title 14. Insurance  »  Agency 5. State Corporation Commission, Bureau of Insurance  »  Chapter 330. Reporting of Salvage and Subrogation Recoveries [Repealed]\n\n                            Chapter\n\n                          Print\n\n                      Virginia Administrative Code\n\n                      Chapter 330. Reporting of Salvage and Subrogation Recoveries [Repealed]  14VAC5-330-10. (Repealed.)    Historical Notes     Derived from Regulation 11, Case No. 19948, eff. February 7, 1978; repealed, Virginia Register Volume 18, Issue 3, eff. December 31, 2001.\n                     Website addresses provided in the Virginia Administrative Code to documents incorporated by reference are for the reader's convenience only, may not necessarily be active or current, and should not be relied upon. To ensure the information incorporated by reference is accurate, the reader is encouraged to use the source document described in the regulation.\n                     As a service to the public, the Virginia Administrative Code is provided online by the Virginia General Assembly. We are unable to answer legal questions or respond to requests for legal advice, including application of law to specific fact. To understand and protect your legal rights, you should consult an attorney.\n\n\t\t\t\t\t\t\t Code of Virginia\n\n\t\t\t\t\t\t\t Administrative Code\n\n\t\t\t\t\t\t\t View by Agency\n\n\t\t\t\t\t\t\t Emergency Regulations\n\n\t\t\t\t\t\t\t VAC# Look Up\n\n\t\t\t\t\t\t\t\t Go\n\n\t\t\t\t\t\t\t Constitution of Virginia\n\n\t\t\t\t\t\t\t Charters\n\n\t\t\t\t\t\t\t Authorities\n\n\t\t\t\t\t\t\t Compacts\n\n\t\t\t\t\t\t\t Uncodified Acts\n\n                             Sign In\n\n                                 Username: \n\n                                 Password: \n\n                                 Cancel\n\n                                  LIS Home\n                                  Lobbyist-in-a-Box\n                                  Privacy Policy\n\n                                © Copyright Commonwealth of Virginia,\n                                 . All rights reserved. Site developed by the  Division of Legislative Automated Systems (DLAS) .\n                                 Sign In","text_length":3180}
{"slug":"va-14vac5-335","jurisdiction":"VA","agency":"SCC-BOI","doc_type":"regulation","citation":"14 VAC 5-335","title":"Chapter 335. Rules Governing Claims-Made Liability Insurance Policies","official_source_url":"https://law.lis.virginia.gov/admincodefull/title14/agency5/chapter335/","access_class":"statutory-public","access_notes":"law.lis.virginia.gov (DLAS self-hosted); gate-zero TOP-20 VA admin code row.","first_seen_at":"2026-07-20T01:49:34.270808+00:00","last_checked_at":"2026-07-20T06:39:10.939479+00:00","versions":[{"fetched_at":"2026-07-20T01:49:34.270808+00:00","version_no":1,"text_length":13807,"effective_date":null,"content_sha256_short":"238af51ef191"}],"text":"14VAC5-335-60. Severability.\n\n                      Virginia General Assembly  /\n                      LIS Learning Center  /\n                      Privacy Policy  /\n                      LIS home  /\n                      Register Account  /\n                      Login\n\n                     Session Information\n\n                     Bills & Resolutions\n\n                     State Budget\n\n                     Virginia Law\n\n                     Reports to the General Assembly\n\n                          Virginia Law\n\n                                 Select Search Type\n\n                                     All\n                                     Code of Virginia\n                                     Administrative Code\n                                     Constitution\n                                     Charters\n                                     Authorities\n                                     Compacts\n                                     Uncodified Acts\n\n                  Administrative Code\n                   Table of Contents   »  Title 14. Insurance  »  Agency 5. State Corporation Commission, Bureau of Insurance  »  Chapter 335. Rules Governing Claims-Made Liability Insurance Policies\n\n                            Chapter\n\n                          Print\n\n                      Virginia Administrative Code\n\n                      Chapter 335. Rules Governing Claims-Made Liability Insurance Policies  14VAC5-335-10. Scope.  The provisions of this chapter shall apply to all policies of liability insurance, as defined in §§  38.2-117 ,  38.2-118 , and subsection B of §  38.2-111  of the Code of Virginia, that limit the time allowed for reporting claims arising out of injury, damage, or wrongful act or omission covered by the policy. Any such policy shall be deemed to be a claims-made liability insurance policy for purposes of this chapter. The provisions of this chapter shall apply to  claims-made liability insurance policies delivered or issued for delivery in the Commonwealth by an admitted insurer to become effective on or after   October 1, 2018.\n This chapter shall not apply to incidental claims-made liability insurance.   Statutory Authority  §§  12.1-13  and  38.2-223   of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 20, Issue 21 , eff. January 1, 2005; amended, Virginia Register  Volume 34, Issue 16 , eff. October 1, 2018.    14VAC5-335-20. Definitions.  The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:\n "Admitted insurer" means an insurer licensed in the Commonwealth to engage in the business of insurance. An admitted insurer does not include any surplus lines insurer.\n "Basic extended reporting period" means an  automatic extended reporting period provided at no additional premium charge.\n "Claims-made liability insurance" means an insurance policy  providing coverage for the insured's liability for injury, damage, or wrongful act or omission occurring prior to the termination of coverage but subsequent to any applicable retroactive date, provided the claim for such injury, damage, or wrongful act or omission is first made during the policy period or any extended reporting period.\n "Extended reporting period" means an extension of the time allowed for reporting claims, after termination of any claims-made liability  policy for injury, damage, or wrongful act or omission that occurred prior to termination of the  policy and that, except for the requirement to report claims during the policy period, was otherwise covered by the policy.\n "Incidental claims-made liability insurance" means any claims-made liability  coverage contained in  or attached to a policy  providing liability insurance on other than a claims-made basis.\n "Medical  professional liability insurance" means insurance coverage against the legal liability of the insured and against loss, damage, or expense incident to a claim arising out of the death or injury of any person as the result of actual or alleged negligence in rendering or failing to render professional service by any provider of health care.\n "Policy" means a coverage part, form, or endorsement that is contained in a contract of insurance.\n "Retroactive date" means the date on or after which injury, damage, or wrongful act or omission may occur and be covered under a claims-made liability insurance policy.\n "Supplemental extended reporting period" means an extended reporting period that is available for the insured to purchase.\n "Unimpaired limit of liability" means a limit equal to the dollar amount shown as the aggregate limit in the declarations (i) at the inception of the policy period or (ii) as amended in the policy thereafter, and in force at the time of the termination of the policy.   Statutory Authority  §§  12.1-13  and  38.2-223   of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 20, Issue 21 , eff. January 1, 2005; amended, Virginia Register  Volume 34, Issue 16 , eff. October 1, 2018.    14VAC5-335-23. Required notice.  The following notice, or a notice that is substantially similar, shall be provided in writing with each new and renewal claims-made liability insurance policy:\n You have purchased claims-made liability insurance. When this insurance terminates, the insurer will send an offer with the available options for purchasing the supplemental extended reporting period. You may be entitled to receive information on claims under this policy. If you have any questions regarding your claims-made coverage or the importance of purchasing the supplemental extended reporting period, please contact your insurance company or your insurance agent.  Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 34, Issue 16 , eff. October 1, 2018.    14VAC5-335-27. Standards for basic extended reporting period.  An insurer may offer a basic extended reporting period. If a basic extended reporting period is offered, it shall be included in the policy.  Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 34, Issue 16 , eff. October 1, 2018.    14VAC5-335-30. Requirement to offer supplemental extended reporting period.  A. Every claims-made liability insurance policy  shall include a provision  that the named insured  may purchase a supplemental extended reporting period in accordance with the provisions of  14VAC5-335-40  upon policy termination. To the extent that policy limits apply separately to each named insured, each named insured shall be separately entitled to purchase  a supplemental extended reporting period.  Policy termination of claims-made coverage shall include:\n 1. Cancellation or nonrenewal of the policy by the insurer or the insured;\n 2. Advancement of any applicable retroactive date; or\n 3. Renewal of the  policy on other than a claims-made basis.\n\n  B. No offer of a supplemental extended reporting period  is required if cancellation or nonrenewal of a claims-made liability insurance policy is due to:\n 1. Nonpayment of premium;\n 2. Failure to comply with terms or conditions of the policy; or\n 3. Fraud.\n C. Each claims-made liability insurance policy shall contain provisions that clearly state when the supplemental extended reporting period will and will not be offered.\n D.  Upon a policy termination  as set forth in subsection A of this section, the insurer shall offer in writing to the named insured a supplemental extended reporting period. The offer shall include the duration and premium of the  required supplemental extended reporting period coverage in  14VAC5-335-40  and  any other available duration and premium options. The offer shall be sent no earlier than the date of notification of termination of the policy and not later than 15 days after the termination of the policy. The named insured shall have a minimum of 30 days from  policy termination to purchase the supplemental extended reporting period.\n\n    Statutory Authority  §§  12.1-13  and  38.2-223   of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 20, Issue 21 , eff. January 1, 2005; amended, Virginia Register  Volume 34, Issue 16 , eff. October 1, 2018.    14VAC5-335-40. Supplemental extended reporting period requirements.  A. Each insurer shall offer a supplemental extended reporting period to allow an extension of the time  to report claims as follows:\n 1. For medical professional liability  insurance, an unlimited supplemental extended reporting period shall be offered with unimpaired limits of liability and shall be effective the same day as the termination of the policy; or\n 2. For all other claims-made liability insurance policies, a   supplemental extended reporting period of at least one year shall be offered.\n  In addition, the insurer  may also  offer greater or more limited extensions of time in which to report claims.\n B.   A supplemental extended reporting period purchased with unimpaired limits of liability in whole or in part  shall be effective the same day as the termination of the policy. In all other instances, the policy provisions shall establish the effective date of the supplemental extended reporting period as (i) the same day as the termination of the policy if no basic extended reporting period applies, or (ii) the same day the basic extended reporting period expires if a basic extended reporting period applies.\n   Statutory Authority  §§  12.1-13  and  38.2-223   of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 20, Issue 21 , eff. January 1, 2005; amended, Virginia Register  Volume 34, Issue 16 , eff. October 1, 2018.    14VAC5-335-45. Requirement to provide loss information.  A. If the policy is issued with an aggregate limit:\n 1. The insurer shall provide loss information to the named insured with the notice of cancellation or nonrenewal of the  policy; or\n 2. The named insured may request loss information within 120 days from the date of policy renewal. The insurer shall provide such loss information within 15 calendar days of the insured's request.\n B. The loss information shall  be sufficient to inform the named insured regarding the remaining or potentially remaining limits of coverage available under the terminating policy.\n C. This section shall apply to medical professional liability insurance only if the insurer offers an extended reporting period with other than unimpaired limits of liability.  Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 34, Issue 16 , eff. October 1, 2018.    14VAC5-335-50. Prohibitions.  A.  The supplemental extended reporting period coverage shall not be  canceled by the insurer without the consent of the insured except for nonpayment of premium or fraud.\n B.  No insurer shall deny coverage under a supplemental extended reporting period  on the basis that other applicable insurance coverage is in effect.  An insurer  may apply the supplemental extended reporting period coverage as excess over  other insurance.   Statutory Authority  §§  12.1-13  and  38.2-223   of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 20, Issue 21 , eff. January 1, 2005; amended, Virginia Register  Volume 34, Issue 16 , eff. October 1, 2018.    14VAC5-335-60. Severability.  If any provision of this chapter or  its application  to any person or circumstance is for any reason held to be invalid by a court, the remainder of  this chapter and the application of  the provisions to other persons or circumstances shall not be affected.   Statutory Authority  §§  12.1-13  and  38.2-223   of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 20, Issue 21 , eff. January 1, 2005; amended, Virginia Register  Volume 34, Issue 16 , eff. October 1, 2018.\n                     Website addresses provided in the Virginia Administrative Code to documents incorporated by reference are for the reader's convenience only, may not necessarily be active or current, and should not be relied upon. To ensure the information incorporated by reference is accurate, the reader is encouraged to use the source document described in the regulation.\n                     As a service to the public, the Virginia Administrative Code is provided online by the Virginia General Assembly. We are unable to answer legal questions or respond to requests for legal advice, including application of law to specific fact. To understand and protect your legal rights, you should consult an attorney.\n\n\t\t\t\t\t\t\t Code of Virginia\n\n\t\t\t\t\t\t\t Administrative Code\n\n\t\t\t\t\t\t\t View by Agency\n\n\t\t\t\t\t\t\t Emergency Regulations\n\n\t\t\t\t\t\t\t VAC# Look Up\n\n\t\t\t\t\t\t\t\t Go\n\n\t\t\t\t\t\t\t Constitution of Virginia\n\n\t\t\t\t\t\t\t Charters\n\n\t\t\t\t\t\t\t Authorities\n\n\t\t\t\t\t\t\t Compacts\n\n\t\t\t\t\t\t\t Uncodified Acts\n\n                             Sign In\n\n                                 Username: \n\n                                 Password: \n\n                                 Cancel\n\n                                  LIS Home\n                                  Lobbyist-in-a-Box\n                                  Privacy Policy\n\n                                © Copyright Commonwealth of Virginia,\n                                 . All rights reserved. Site developed by the  Division of Legislative Automated Systems (DLAS) .\n                                 Sign In","text_length":13807}
{"slug":"va-14vac5-300","jurisdiction":"VA","agency":"SCC-BOI","doc_type":"regulation","citation":"14 VAC 5-300","title":"Chapter 300. Rules Governing Credit for Reinsurance","official_source_url":"https://law.lis.virginia.gov/admincodefull/title14/agency5/chapter300/","access_class":"statutory-public","access_notes":"law.lis.virginia.gov (DLAS self-hosted); gate-zero TOP-20 VA admin code row.","first_seen_at":"2026-07-20T01:49:34.270808+00:00","last_checked_at":"2026-07-20T06:39:10.939479+00:00","versions":[{"fetched_at":"2026-07-20T01:49:34.270808+00:00","version_no":1,"text_length":107876,"effective_date":null,"content_sha256_short":"46557c913f43"}],"text":"Documents Incorporated by Reference (14VAC5-300)\n\n                      Virginia General Assembly  /\n                      LIS Learning Center  /\n                      Privacy Policy  /\n                      LIS home  /\n                      Register Account  /\n                      Login\n\n                     Session Information\n\n                     Bills & Resolutions\n\n                     State Budget\n\n                     Virginia Law\n\n                     Reports to the General Assembly\n\n                          Virginia Law\n\n                                 Select Search Type\n\n                                     All\n                                     Code of Virginia\n                                     Administrative Code\n                                     Constitution\n                                     Charters\n                                     Authorities\n                                     Compacts\n                                     Uncodified Acts\n\n                  Administrative Code\n                   Table of Contents   »  Title 14. Insurance  »  Agency 5. State Corporation Commission, Bureau of Insurance  »  Chapter 300. Rules Governing Credit for Reinsurance\n\n                            Chapter\n\n                          Print\n\n                      Virginia Administrative Code\n\n                      Chapter 300. Rules Governing Credit for Reinsurance  14VAC5-300-10. Purpose.  The purpose of this chapter  is to set forth rules and procedural requirements which the  commission has determined are necessary to carry out the provisions of Article 3.1 (§  38.2-1316.1  et seq.) of Chapter 13 of Title 38.2 of the Code of Virginia.   Statutory Authority  §§  38.2-223 ,  38.2-1316.7  and  12.1-13  of the Code of Virginia.  Historical Notes  Derived from Regulation 43, Case No. INS910307, § 2, eff. March 1, 1992; amended, Virginia Register  Volume 29, Issue 4 , eff. January 1, 2013.    14VAC5-300-20. (Repealed.)    Historical Notes  Derived from Regulation 43, Case No. INS910307, § 3, eff. March 1, 1992; repealed, Virginia Register  Volume 29, Issue 4 , eff. January 1, 2013.    14VAC5-300-30. Applicability and scope.  This chapter  shall apply to all insurers taking credit for reinsurance under the provisions of Article 3.1 (§  38.2-1316.1  et seq.) of Chapter 13 of Title 38.2 of the Code of Virginia.   Statutory Authority  §§  38.2-223 ,  38.2-1316.7  and  12.1-13  of the Code of Virginia.  Historical Notes  Derived from Regulation 43, Case No. INS910307, § 4, eff. March 1, 1992; amended, Virginia Register  Volume 29, Issue 4 , eff. January 1, 2013.    14VAC5-300-40. Definitions.  The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:\n "The Act" means the provisions concerning reinsurance set forth in Article 3.1 (§  38.2-1316.1  et seq.) of Chapter 13 of Title 38.2 of the Code of Virginia.\n "Beneficiary" means the entity for whose sole benefit the trust described in  14VAC5-300-120 , or the letter of credit described in  14VAC5-300-130 , has been established and any successor of the beneficiary by operation of law, including, without limitation, any receiver, conservator, rehabilitator or liquidator.\n "Certified reinsurer" has the meaning set forth in §  38.2-1316.1  of the Code of Virginia.\n "Grantor" means the entity that has established a trust for the sole benefit of the beneficiary. However, when such a trust is established in conjunction with a reinsurance agreement that qualifies for credit under  14VAC5-300-120 , the grantor shall not be an assuming insurer for which credit can be taken under §  38.2-1316.2  of the Code of Virginia.\n "Mortgage-related security" means an obligation that is rated AA or higher (or the equivalent) by a securities rating agency recognized by the Securities Valuation Office of the NAIC and that either:\n 1. Represents ownership of one or more promissory notes or certificates of interest or participation in the notes (including any rights designed to assure servicing of, or the receipt or timeliness of receipt by the holders of the notes, certificates, or participation of amounts payable under, the notes, certificates or participation), that:\n a. Are directly secured by a first lien on a single parcel of real estate, including stock allocated to a dwelling unit in a residential cooperative housing corporation, upon which is located a dwelling or mixed residential and commercial structure, or on a residential manufactured home as defined in 42 USCA § 5402(6), whether the manufactured home is considered real or personal property under the laws of the state in which it is located; and\n b. Were originated by a savings and loan association, savings bank, commercial bank, credit union, insurance company, or similar institution that is supervised and examined by a federal or state housing authority, or by a mortgagee approved by the Secretary of Housing and Urban Development pursuant to 12 USCA §§ 1709 and 1715-b, or, where the notes involve a lien on the manufactured home, by an institution or by a financial institution approved for insurance by the Secretary of Housing and Urban Development pursuant to 12 USCA § 1703; or\n 2. Is secured by one or more promissory notes or certificates of deposit or participations in the notes (with or without recourse to the insurer of the notes) and, by its terms, provides for payments of principal in relation to payments, or reasonable projections of payments, or notes meeting the requirements of items 1 a and b of this definition.\n "NAIC" means the National Association of Insurance Commissioners.\n "Obligations", as used in  14VAC5-300-120  A 11, means:\n 1. Reinsured losses and allocated loss expenses paid by the ceding company, but not recovered from the assuming insurer;\n 2. Reserves for reinsured losses reported and outstanding;\n 3. Reserves for reinsured losses incurred but not reported; and\n 4. Reserves for allocated reinsured loss expenses and unearned premiums.\n "Promissory note" means, when used in connection with a manufactured home, a loan, advance or credit sale as evidenced by a retail installment sales contract or other instrument.\n "Qualified United States financial institutions" has the meanings set forth in §  38.2-1316.1  of the Code of Virginia.\n "Solvent scheme of arrangement" means a foreign or alien statutory or regulatory compromise procedure subject to requisite majority creditor approval and judicial sanction in the assuming insurer's home jurisdiction either to finally commute liabilities of duly noticed classed members or creditors of a solvent debtor or to reorganize or restructure the debts and obligations of a solvent debtor on a final basis and that may be subject to judicial recognition and enforcement of the arrangement by a governing authority outside the ceding insurer's home jurisdiction.   Statutory Authority  §§   12.1-13  and  38.2-1316.2  of the Code of Virginia.  Historical Notes  Derived from Regulation 43, Case No. INS910307, § 5, eff. March 1, 1992; amended, Virginia Register  Volume 29, Issue 4 , eff. January 1, 2013;  Volume 36, Issue 23 , eff. July 1, 2020.    14VAC5-300-50. (Repealed.)\n\n   Historical Notes  Derived from Regulation 43, Case No. INS910307, § 6, eff. March 1, 1992; repealed, Virginia Register  Volume 29, Issue 4 , eff. January 1, 2013.    14VAC5-300-60. Credit for reinsurance; reinsurer licensed in this Commonwealth.  Pursuant to §  38.2-1316.2   C 1 of the Act, the commission shall allow credit when reinsurance is ceded to an assuming insurer which is licensed to transact insurance in this Commonwealth. For purposes of this section, an insurer shall not be considered so "licensed" unless it is fully authorized to actively solicit and conduct its business in this Commonwealth and in its domiciliary state.   Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Regulation 43, Case No. INS910307, § 7, eff. March 1, 1992; amended, Virginia Register  Volume 29, Issue 4 , eff. January 1, 2013;  Volume 35, Issue 5 , eff. November 1, 2018.    14VAC5-300-70. Credit for reinsurance; accredited reinsurers.  A. Pursuant to §  38.2-1316.2   C 2 of the Act, the commission shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer that is accredited as a reinsurer in this Commonwealth as of the date on which statutory financial statement credit for reinsurance is claimed. An accredited reinsurer shall:\n 1. File a properly executed Certificate of Assuming Insurer as evidence of its submission to this Commonwealth's jurisdiction and to this Commonwealth's authority to examine its books and records;\n 2. File with the commission a certified copy of a certificate of authority or other acceptable evidence that it is licensed to transact insurance or reinsurance in at least one state, or, in the case of a United States branch of an alien assuming insurer, is entered through and licensed to transact insurance or reinsurance in at least one state;\n 3. File annually with the commission an electronic copy of its annual statement filed with the insurance department of its state of domicile or, in the case of an alien assuming insurer, with the state through which it is entered and in which it is licensed to transact insurance or reinsurance, and a copy of its most recent audited financial statement; and\n 4. Maintain a surplus as regards policyholders in an amount not less than $20 million, or obtain the affirmative approval of the commission upon a finding that it has adequate financial capacity to meet its reinsurance obligations and is otherwise qualified to assume reinsurance from domestic insurers.\n B. If the commission determines that the assuming insurer has failed to meet or maintain any of these qualifications, the commission may upon written notice and opportunity for hearing, suspend, or revoke the accreditation. Credit shall not be allowed a domestic ceding insurer under this section if the assuming insurer's accreditation has been revoked by the commission, or if the reinsurance was ceded while the assuming insurer's accreditation was under suspension by the commission.  Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Regulation 43, Case No. INS910307, § 8, eff. March 1, 1992; amended, Virginia Register  Volume 29, Issue 4 , eff. January 1, 2013;  Volume 35, Issue 5 , eff. November 1, 2018.    14VAC5-300-80. Credit for reinsurance; reinsurer domiciled and licensed in another state, and neither licensed nor accredited in Virginia.  A. Pursuant to the provisions of §  38.2-1316.2   C 3 of the Act, the commission shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer that as of any date on which statutory financial statement credit for reinsurance is claimed:\n 1. Is domiciled in  or, in the case of a United States branch of an alien assuming insurer, is entered  through a state that employs standards regarding credit for reinsurance substantially similar to those applicable under the Act and this chapter;\n 2. Maintains a surplus as regards policyholders in an amount not less than $20 million; and\n 3. Files a properly executed Certificate of Assuming Insurer with the commission as evidence of its submission to this Commonwealth's authority to examine its books and records.\n B. The provisions of this section relating to surplus as regards policyholders shall not apply to reinsurance ceded and assumed pursuant to pooling arrangements among insurers in the same holding company system. As used in this section, "substantially similar" standards means credit for reinsurance standards that the commission determines equal or exceed the standards of the Act and this chapter.  Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Regulation 43, Case No. INS910307, § 9, eff. March 1, 1992; amended, Virginia Register  Volume 29, Issue 4 , eff. January 1, 2013;  Volume 35, Issue 5 , eff November 1, 2018.    14VAC5-300-90. Credit for reinsurance; reinsurers maintaining trust funds.  A. Pursuant to §  38.2-1316.2  C 4 of the Act, the commission shall allow credit for reinsurance ceded to a trusteed assuming insurer which, as of the date of the ceding insurer's statutory financial statement:\n 1. Maintains a trust fund and trusteed surplus that complies with the provisions of §  38.2-1316.2  C 4;\n 2. Complies with the requirements set forth in subsections B, C, and D of this section; and\n 3. Reports annually to the commission on or before June 1 of each year in which a ceding insurer seeks reserve credit under the Act substantially the same information as that required to be reported on the NAIC annual statement form by licensed insurers, to enable the commission to determine the sufficiency of the trust fund. The accounting shall, among other things, set forth the balance to the trust and list the trust's investments as of the preceding year end and shall certify the date of termination of the trust, if so planned, or certify that the trust shall not expire prior to the next following December 31.\n B. The following requirements apply to the following categories of assuming insurer:\n 1. The trust fund for a single assuming insurer shall consist of funds in trust in an amount not less than the assuming insurer's liabilities attributable to reinsurance ceded by United States domiciled insurers, and in addition, the assuming insurer shall maintain a trusteed surplus of not less than $20 million, except as provided in subdivision 2 of this subsection.\n 2. At any time after the assuming insurer has permanently discontinued underwriting new business secured by the trust for at least three full years, the commissioner with principal regulatory oversight of the trust may authorize a reduction in the required trusteed surplus, but only after a finding, based on an assessment of the risk, that the new required surplus level is adequate for the protection of United States ceding insurers, policyholders, and claimants in light of reasonably foreseeable adverse loss development. The risk assessment may involve an actuarial review, including an independent analysis of reserves and cash flows, and shall consider all material risk factors, including when applicable the lines of business involved, the stability of the incurred loss estimates, and the effect of the surplus requirements on the assuming insurer's liquidity or solvency. The minimum required trusteed surplus may not be reduced to an amount less than 30% of the assuming insurer's liabilities attributable to reinsurance ceded by United States ceding insurers covered by the trust.\n 3. a. The trust fund for a group including incorporated and individual unincorporated underwriters shall consist of:\n (1) For reinsurance ceded under reinsurance agreements with an inception, amendment, or renewal date on or after January 1, 1993, funds in trust in an amount not less than the respective underwriters' several liabilities attributable to business ceded by United States domiciled ceding insurers to any underwriter of the group;\n (2) For reinsurance ceded under reinsurance agreements with an inception date on or before December 31, 1992, and not amended or renewed after that date, notwithstanding the other provisions of this chapter, funds in trust in an amount not less than the respective underwriters' several insurance and reinsurance liabilities attributable to business written in the United States; and\n (3) In addition to these trusts, the group shall maintain a trusteed surplus of which $100 million shall be held jointly for the benefit of the United States domiciled ceding insurers of any member of the group for all the years of account.\n b. The incorporated members of the group shall not be engaged in any business other than underwriting as a member of the group and shall be subject to the same level of regulation and solvency control by the group's domiciliary regulator as are the unincorporated members. The group shall, within 90 days after its financial statements are due to be filed with the group's domiciliary regulator, provide to the commission:\n (1) An annual certification by the group's domiciliary regulator of the solvency of each underwriter member of the group; or\n (2) If a certification is unavailable, a financial statement prepared by independent public accountants of each underwriter member of the group.\n 4. a. The trust fund for a group of incorporated insurers under common administration, whose members possess aggregate policyholders surplus of $10 billion (calculated and reported in substantially the same manner as prescribed by the NAIC Annual Statement Instructions and the NAIC Accounting Practices and Procedures Manual) and which has continuously transacted an insurance business outside the United States for at least three years immediately prior to making application for accreditation, shall:\n (1) Consist of funds in trust in an amount not less than the assuming insurers' several liabilities attributable to business ceded by United States domiciled ceding insurers to any members of the group pursuant to reinsurance contracts issued in the name of such group;\n (2) Maintain a joint trusteed surplus of which $100 million shall be held jointly for the benefit of United States domiciled ceding insurers of any member of the group; and\n (3) File a properly executed Certificate of Assuming Insurer as evidence of the submission to this Commonwealth's authority to examine the books and records of any of its members and shall certify that any member examined will bear the expense of any such examination.\n b. Within 90 days after the statements are due to be filed with the group's domiciliary regulator, the group shall file with the commission an annual certification of each underwriter member's solvency by the member's domiciliary regulators, and financial statements, prepared by independent public accountants, of each underwriter member of the group.\n C. 1. Credit for reinsurance shall not be granted unless the form of the trust and any amendments to the trust have been approved by either the commissioner of the state where the trust is domiciled or the commissioner of another state who, pursuant to the terms of the trust instrument, has accepted responsibility for regulatory oversight of the trust. The form of the trust and any trust amendments also shall be filed with the commissioner of every state in which the ceding insurer beneficiaries of the trust are domiciled. The trust instrument shall provide that:\n a. Contested claims shall be valid and enforceable out of funds in trust to the extent remaining unsatisfied 30 days after entry of the final order of any court of competent jurisdiction in the United States;\n b. Legal title to the assets of the trust shall be vested in the trustee for the benefit of the grantor's United States policyholders and ceding insurers, their assigns and successors in interest;\n c. The trust and the assuming insurer shall be subject to examination as determined by the commission;\n d. The trust shall remain in effect for as long as the assuming insurer, or any member or former member of a group of insurers, shall have outstanding obligations under reinsurance agreements subject to the trust; and\n e. No later than February 28 of each year the trustees of the trust (i) shall report to the commission in writing setting forth the balance in the trust and listing the trust's investments at the preceding year end and (ii) shall certify the date of termination of the trust, if so planned, or certify that the trust shall not expire prior to the next December 31.\n 2. a. Notwithstanding any other provisions in the trust instrument, if the trust fund is inadequate because it contains an amount less than the amount required by this subsection or if the grantor of the trust has been declared insolvent or placed into receivership, rehabilitation, liquidation, or similar proceedings under the laws of its state or country of domicile, the trustee shall comply with an order of the commissioner with regulatory oversight over the trust or with an order of a court of competent jurisdiction directing the trustee to transfer to the commissioner with regulatory oversight over the trust or other designated receiver all of the assets of the trust fund.\n b. The assets shall be distributed by and claims shall be filed with and valued by the commissioner with regulatory oversight over the trust in accordance with the laws of the state in which the trust is domiciled applicable to the liquidation of domestic insurance companies.\n c. If the commissioner with regulatory oversight over the trust determines that the assets of the trust fund or any part thereof are not necessary to satisfy the claims of the United States beneficiaries of the trust, the commissioner with regulatory oversight over the trust shall return the assets, or any part thereof, to the trustee for distribution in accordance with the trust agreement.\n d. The grantor shall waive any right otherwise available to it under United States law that is inconsistent with this provision.\n D. For purposes of this section, the term "liabilities" shall mean the assuming insurer's gross liabilities attributable to reinsurance ceded by United States domiciled insurers, excluding liabilities that are otherwise secured by acceptable means, and shall include:\n 1. For business ceded by domestic insurers authorized to write accident and health, and property and casualty insurance:\n a. Losses and allocated loss expenses paid by the ceding insurer, recoverable from the assuming insurer;\n b. Reserves for losses reported and outstanding;\n c. Reserves for losses incurred but not reported;\n d. Reserves for allocated loss expenses; and\n e. Unearned premiums.\n 2. For business ceded by domestic insurers authorized to write life, health, and annuity insurance:\n a. Aggregate reserves for life policies and contracts net of policy loans and net due and deferred premiums;\n b. Aggregate reserves for accident and health policies;\n c. Deposit funds and other liabilities without life or disability contingencies; and\n d. Liabilities for policy and contract claims.\n E. Assets deposited in trusts established pursuant to §  38.2-1316.2  of the Act and this section shall be valued according to their current fair market value and shall consist only of cash in United States dollars, certificates of deposit issued by a United States financial institution as defined in §  38.2-1316.1  of the Act, clean, irrevocable, unconditional, and "evergreen" letters of credit issued or confirmed by a qualified United States financial institution, as defined in §  38.2-1316.1 , and investments of the type specified in this subsection, but investments in or issued by an entity controlling, controlled by or under common control with either the grantor or beneficiary of the trust shall not exceed 5.0% of total investments. No more than 20% of the total of the investments in the trust may be foreign investments authorized under  subdivision 1 e, 3, 5 b, or 6 of this subsection, and no more than 10% of the total of the investments in the trust may be securities denominated in foreign currencies. For purposes of applying the preceding sentence, a depository receipt denominated in United States dollars and representing rights conferred by a foreign security shall be classified as a foreign investment denominated in a foreign currency. The assets of a trust established to satisfy the requirements of §  38.2-1316.2  shall be invested only as follows:\n 1. Government obligations that are not in default as to principal or interest, that are valid and legally authorized and that are issued, assumed, or guaranteed by:\n a. The United States or by any agency or instrumentality of the United States;\n b. A state of the United States;\n c. A territory, possession, or other governmental unit of the United States;\n d. An agency or instrumentality of a governmental unit referred to in subdivisions 1 b and c of this subsection if the obligations shall be by law (statutory or otherwise) payable, as to both principal and interest, from taxes levied or by law required to be levied or from adequate special revenues pledged or otherwise appropriated or by law required to be provided for making these payments, but shall not be obligations eligible for investment under this subsection if payable solely out of special assessments on properties benefited by local improvements; or\n e. The government of any other country that is a member of the Organization for Economic Cooperation and Development and whose government obligations are rated A or higher, or the equivalent, by a rating agency recognized by the Securities Valuation Office of the NAIC;\n 2. Obligations that are issued in the United States, or that are dollar denominated and issued in a non-United States market, by a solvent United States institution (other than an insurance company) or that are assumed or guaranteed by a solvent United States institution (other than an insurance company) and that are not in default as to principal or interest if the obligations:\n a. Are rated A or higher (or the equivalent) by a securities rating agency recognized by the Securities Valuation Office of the NAIC, or if not so rated, are similar in structure and other material respects to other obligations of the same institution that are so rated;\n b. Are insured by at least one authorized insurer (other than the investing insurer or a parent, subsidiary or affiliate of the investing insurer) licensed to insure obligations in this Commonwealth and, after considering the insurance, are rated AAA (or the equivalent) by a securities rating agency recognized by the Securities Valuation Office of the NAIC; or\n c. Have been designated as Class One or Class Two by the Securities Valuation Office of the NAIC;\n 3. Obligations issued, assumed or guaranteed by a solvent non-United States institution chartered in a country that is a member of the Organization for Economic Cooperation and Development or obligations of United States corporations issued in a non-United States currency, provided that in either case the obligations are rated A or higher, or the equivalent, by a rating agency recognized by the Securities Valuation Office of the NAIC;\n 4. An investment made pursuant to the provisions of subdivision 1, 2, or 3 of this subsection shall be subject to the following additional limitations:\n a. An investment in or loan upon the obligations of an institution other than an institution that issues mortgage-related securities shall not exceed 5.0% of the assets of the trust;\n b. An investment in any one mortgage-related security shall not exceed 5.0% of the assets of the trust;\n c. The aggregate total investment in mortgage-related securities shall not exceed 25% of the assets of the trust; and\n d. Preferred or guaranteed shares issued or guaranteed by a solvent United States institution are permissible investments if all of the institution's obligations are eligible as investments under subdivisions 2 a and 2 c of this subsection, but shall not exceed 2.0% of the assets of the trust;\n 5. Equity interests.\n a. Investments in common shares or partnership interests of a solvent United States institution are permissible if:\n (1) Its obligations and preferred shares, if any, are eligible as investments under this subsection; and\n (2) The equity interests of the institution (except an insurance company) are registered on a national securities exchange as provided in the Securities Exchange Act of 1934, 15 USC §§ 78 a to 78 kk or otherwise registered pursuant to that Act, and if otherwise registered, price quotations for them are furnished through a nationwide automated quotations system approved by the Financial Industry Regulatory Authority, or successor organization. A trust shall not invest in equity interests under this subdivision an amount exceeding 1.0% of the assets of the trust even though the equity interests are not so registered and are not issued by an insurance company;\n b. Investments in common shares of a solvent institution organized under the laws of a country that is a member of the Organization for Economic Cooperation and Development if:\n (1) All its obligations are rated A or higher, or the equivalent, by a rating agency recognized by the Securities Valuation Office of the NAIC; and\n (2) The equity interests of the institution are registered on a securities exchange regulated by the government of a country that is a member of the Organization for Economic Cooperation and Development;\n c. An investment in or loan upon any one institution's outstanding equity interests shall not exceed 1.0% of the assets of the trust. The cost of an investment in equity interests made pursuant to this subdivision, when added to the aggregate cost of other investments in equity interests then held pursuant to this subdivision, shall not exceed 10% of the assets in the trust;\n 6. Obligations issued, assumed, or guaranteed by a multinational development bank, provided the obligations are rated A or higher, or the equivalent, by a rating agency recognized by the Securities Valuation Office of the NAIC.\n 7. Investment companies.\n a. Securities of an investment company registered pursuant to the Investment Company Act of 1940, 15 USC § 80 a, are permissible investments if the investment company:\n (1) Invests at least 90% of its assets in the types of securities that qualify as an investment under subdivision 1, 2, or 3 of this subsection or invests in securities that are determined by the commission to be substantively similar to the types of securities set forth in subdivision 1, 2, or 3 of this subsection; or\n (2) Invests at least 90% of its assets in the types of equity interests that qualify as an investment under subdivision 5 a of this subsection;\n b. Investments made by a trust in investment companies under this subdivision shall not exceed the following limitations:\n (1) An investment in an investment company qualifying under subdivision 7 a (1) of this subsection shall not exceed 10% of the assets in the trust and the aggregate amount of investment in qualifying investment companies shall not exceed 25% of the assets in the trust; and\n (2) Investments in an investment company qualifying under subdivision 7 a (2) of this subsection shall not exceed 5.0% of the assets in the trust and the aggregate amount of investment in qualifying investment companies shall be included when calculating the permissible aggregate value of equity interests pursuant to subdivision 5 a of this subsection.\n 8. Letters of credit.\n a. In order for a letter of credit to qualify as an asset of the trust, the trustee shall have the right and the obligation pursuant to the deed of trust or some other binding agreement (as duly approved by the commission) to immediately draw down the full amount of the letter of credit and hold the proceeds in trust for the beneficiaries of the trust if the letter of credit will otherwise expire without being renewed or replaced.\n b. The trust agreement shall provide that the trustee shall be liable for its negligence, willful misconduct, or lack of good faith. The failure of the trustee to draw against the letter of credit in circumstances where such draw would be required shall be deemed to be negligence and/or willful misconduct.\n F. A specific security provided to a ceding insurer by an assuming insurer pursuant to   14VAC5-300-110  shall be applied, until exhausted, to the payment of liabilities of the assuming insurer to the ceding insurer holding the specific security prior to, and as a condition precedent for, presentation of a claim by the ceding insurer for payment by a trustee of a trust established by the assuming insurer pursuant to this section.   Statutory Authority  §§  12.1-13  and   38.2-1316.2  of the Code of Virginia.  Historical Notes  Derived from Regulation 43, Case No. INS910307, § 10, eff. March 1, 1992; amended, Virginia Register  Volume 17, Issue 22 , eff. August 1, 2001;  Volume 29, Issue 4 , eff. January 1, 2013;  Volume 35, Issue 5 , November 1, 2018;  Volume 36, Issue 23 , eff. July 1, 2020.    14VAC5-300-95. Credit for reinsurance; certified reinsurers.  A. Pursuant to §  38.2-1316.2  D of the Act, the commission shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer that has been certified as a reinsurer in this Commonwealth at all times for which statutory financial statement credit for reinsurance is claimed under this section. The credit allowed shall be based upon the security held by or on behalf of the ceding insurer in accordance with a rating assigned to the certified reinsurer by the commission. The security shall be in a form consistent with the provisions of §  38.2-1316.2  D and   14VAC5-300-120 ,  14VAC5-300-130 , or  14VAC5-300-140 . The amount of security required in order for full credit to be allowed shall correspond with the following requirements:              1. Ratings          Security Required                           Secure – 1          0.0%                            Secure – 2           10%                            Secure – 3           20%                            Secure – 4           50%                            Secure – 5           75%                            Vulnerable – 6           100%             2. Affiliated reinsurance transactions shall receive the same opportunity for reduced security requirements as all other reinsurance transactions.\n 3. The commission shall require the certified reinsurer to post 100%, for the benefit of the ceding insurer or its estate, security upon the entry of an order of rehabilitation, liquidation, or conservation against the ceding insurer.\n 4. In order to facilitate the prompt payment of claims, a certified reinsurer shall not be required to post security for catastrophe recoverables for a period of one year from the date of the first instance of a liability reserve entry by the ceding company as a result of a loss from a catastrophic occurrence that is likely to result in significant insured losses, as recognized by the commission. The one year deferral period is contingent upon the certified reinsurer continuing to pay claims in a timely manner. Reinsurance recoverables for only the following lines of business as reported on the NAIC annual financial statement related specifically to the catastrophic occurrence will be included in the deferral:\n a. Line 1: Fire\n b. Line 2: Allied Lines\n c. Line 3: Farmowners multiple peril\n d. Line 4: Homeowners multiple peril\n e. Line 5: Commercial multiple peril\n f. Line 9: Inland marine\n g. Line 12: Earthquake\n h. Line 21: Auto physical damage\n 5. Credit for reinsurance under this section shall apply only to reinsurance contracts entered into or renewed on or after the effective date of the certification of the assuming insurer. Any reinsurance contract entered into prior to the effective date of the certification of the assuming insurer that is subsequently amended by mutual agreement of the parties to the reinsurance contract after the effective date of the certification of the assuming insurer, or a new reinsurance contract, covering any risk for which collateral was provided previously, shall only be subject to this section with respect to losses incurred and reserves reported from and after the effective date of the amendment or new contract.\n 6. Nothing in this section shall prohibit the parties to a reinsurance agreement from agreeing to provisions establishing security requirements that exceed the minimum security requirements established for certified reinsurers under this section.\n B. Certification procedure.\n 1. The commission shall post notice on the Bureau of Insurance's website promptly upon receipt of any application for certification, including instructions on how members of the public may respond to the application. The commission may not take final action on the application until at least 30 days after posting the notice required by this subdivision.\n 2. The commission shall issue written notice to an assuming insurer that has made application and been approved as a certified reinsurer. Included in such notice shall be the rating assigned the certified reinsurer in accordance with subsection A of this section. The commission shall publish a list of all certified reinsurers and their ratings.\n 3. In order to be eligible for certification, the assuming insurer shall meet the following requirements:\n a. The assuming insurer shall be domiciled and licensed to transact insurance or reinsurance in a qualified jurisdiction, as determined by the commission pursuant to subsection C of this section.\n b. The assuming insurer shall maintain capital and surplus, or its equivalent, of no less than $250 million calculated in accordance with subdivision 4 h of this subsection. This requirement may also be satisfied by an association including incorporated and individual unincorporated underwriters having minimum capital and surplus equivalents (net of liabilities) of at least $250 million and a central fund containing a balance of at least $250 million.\n c. The assuming insurer shall maintain financial strength ratings from two or more rating agencies deemed acceptable by the commission. These ratings shall be based on interactive communication between the rating agency and the assuming insurer and shall not be based solely on publicly available information. These financial strength ratings will be one factor used by the commission in determining the rating that is assigned to the assuming insurer. Acceptable rating agencies include the following:\n (1) Standard & Poor's;\n (2) Moody's Investors Service;\n (3) Fitch Ratings;\n (4) A.M. Best Company; or\n (5) Any other nationally recognized statistical rating organization.\n d. The certified reinsurer shall comply with any other requirements reasonably imposed by the commission.\n 4. Each certified reinsurer shall be rated on a legal entity basis, with due consideration being given to the group rating where appropriate, except that an association including incorporated and individual unincorporated underwriters that has been approved to do business as a single certified reinsurer may be evaluated on the basis of its group rating. Factors that may be considered as part of the evaluation process include, but are not limited to, the following:\n a. The certified reinsurer's financial strength rating from an acceptable rating agency. The maximum rating that a certified reinsurer may be assigned will correspond to its financial strength rating as outlined in the table below. The commission shall use the lowest financial strength rating received from an approved rating agency in establishing the maximum rating of a certified reinsurer. A failure to obtain or maintain at least two financial strength ratings from acceptable rating agencies will result in loss of eligibility for certification:              Ratings          Best          S&P          Moody's          Fitch                Secure – 1          A++          AAA          Aaa          AAA                Secure – 2          A+          AA+, AA, AA-          Aa1, Aa2, Aa3          AA+, AA, AA-                Secure – 3          A          A+, A          A1, A2          A+, A                Secure – 4          A­-          A­-          A3          A-                Secure – 5          B++, B+          BBB+, BBB, BBB-­          Baa1, Baa2, Baa3          BBB+, BBB, BBB-                Vulnerable – 6          B, B-, C++, C+, C, C-, D, E, F          BB+, BB, BB-, B+, B, B-, CCC, CC, C, D, R          Ba1, Ba2, Ba3, B1, B2, B3, Caa, Ca, C          BB+, BB, BB-, B+, B, B-, CCC+, CC, CCC-, DD            b. The business practices of the certified reinsurer in dealing with its ceding insurers, including its record of compliance with reinsurance contractual terms and obligations;\n c. For certified reinsurers domiciled in the United States, a review of the most recent applicable NAIC annual statement blank, either Schedule F (for property/casualty reinsurers) or Schedule S (for life and health reinsurers);\n d. For certified reinsurers not domiciled in the United States, a review annually of the Assumed Reinsurance Form CR-F (for property/casualty reinsurers) or the Reinsurance Assumed Life Insurance, Annuities, Deposit Funds and Other Liabilities Form CR-S (for life and health reinsurers) of this chapter;\n e. The reputation of the certified reinsurer for prompt payment of claims under reinsurance agreements, based on an analysis of ceding insurers' Schedule F reporting of overdue reinsurance recoverables, including the proportion of obligations that are more than 90 days past due or are in dispute, with specific attention given to obligations payable to companies that are in administrative supervision or receivership;\n f. Regulatory actions against the certified reinsurer;\n g. The report of the independent auditor on the financial statements of the insurance enterprise, on the basis described in subdivision 4 h of this subsection;\n h. For certified reinsurers not domiciled in the United States, audited financial statements, regulatory filings, and actuarial opinion (as filed with the non-United States jurisdiction  supervisor with a translation into English). Upon the initial application for certification, the commission will consider audited financial statements for the last  two years filed with its non-United States jurisdiction supervisor;\n i. The liquidation priority of obligations to a ceding insurer in the certified reinsurer's domiciliary jurisdiction in the context of an insolvency proceeding;\n j. A certified reinsurer's participation in any solvent scheme of arrangement, or similar procedure, which involves United States ceding insurers. The commission shall receive prior notice from a certified reinsurer that proposes participation by the certified reinsurer in a solvent scheme of arrangement; and\n k. Any other information deemed relevant by the commission.\n 5. Based on the analysis conducted under subdivision 4 e of this subsection of a certified reinsurer's reputation for prompt payment of claims, the commission may make appropriate adjustments in the security the certified reinsurer is required to post to protect its liabilities to United States ceding insurers, provided that the commission shall, at a minimum, increase the security the certified reinsurer is required to post by one rating level under subdivision 4 a of this subsection if the commission finds that:\n a. More than 15% of the certified reinsurer's ceding insurance clients have overdue reinsurance recoverables on paid losses of 90 days or more that are not in dispute and that exceed $100,000 for each cedent; or\n b. The aggregate amount of reinsurance recoverables on paid losses that are not in dispute that are overdue by 90 days or more exceeds $50 million.\n 6. The assuming insurer shall submit a properly executed Certificate of Certified Reinsurer as evidence of its submission to the jurisdiction of this Commonwealth, appointment of the commission as an agent for service of process in this Commonwealth, and agreement to provide security for 100% of the assuming insurer's liabilities attributable to reinsurance ceded by United States ceding insurers if it resists enforcement of a final United States judgment. The commission shall not certify any assuming insurer that is domiciled in a jurisdiction that the commission has determined does not adequately and promptly enforce final United States judgments or arbitration awards.\n 7. The certified reinsurer shall agree to meet applicable information filing requirements as determined by the commission, both with respect to an initial application for certification and on an ongoing basis. All information submitted by certified reinsurers that are not otherwise public information subject to disclosure shall be exempted from disclosure under §§  38.2-221.3  and  38.2-1306.1  of the  Code of Virginia and shall be withheld from public disclosure. The applicable information filing requirements are as follows:\n a. Notification within 10 days of any regulatory actions taken against the certified reinsurer, any change in the provisions of its domiciliary license, or any change in rating by an approved rating agency, including a statement describing such changes and the reasons therefore;\n b. Annually, Form CR-F or CR-S, as applicable;\n c. Annually, the report of the independent auditor on the financial statements of the insurance enterprise, on the basis described in subdivision 7 d of this subsection;\n d. Annually, the most recent audited financial statements, regulatory filings, and actuarial opinion (as filed with the certified reinsurer's  supervisor with a translation into English). Upon the initial certification, audited financial statements for the last  two years filed with the certified reinsurer's supervisor;\n e. At least annually, an updated list of all disputed and overdue reinsurance claims regarding reinsurance assumed from United States domestic ceding insurers;\n f. A certification from the certified reinsurer's domestic regulator that the certified reinsurer is in good standing and maintains capital in excess of the jurisdiction's highest regulatory action level; and\n g. Any other information that the commission may reasonably require.\n 8. Change in rating or revocation of certification.\n a. In the case of a downgrade by a rating agency or other disqualifying circumstance, the commission shall upon written notice assign a new rating to the certified reinsurer in accordance with the requirements of subdivision 4 a of this subsection.\n b. The commission shall have the authority to suspend, revoke, or otherwise modify a certified reinsurer's certification at any time if the certified reinsurer fails to meet its obligations or security requirements under this section, or if other financial or operating results of the certified reinsurer, or documented significant delays in payment by the certified reinsurer, lead the commission to reconsider the certified reinsurer's ability or willingness to meet its contractual obligations.\n c. If the rating of a certified reinsurer is upgraded by the commission, the certified reinsurer may meet the security requirements applicable to its new rating on a prospective basis, but the commission shall require the certified reinsurer to post security under the previously applicable security requirements as to all contracts in force on or before the effective date of the upgraded rating. If the rating of a certified reinsurer is downgraded by the commission, the commission shall require the certified reinsurer to meet the security requirements applicable to its new rating for all business it has assumed as a certified reinsurer.\n d. Upon revocation of the certification of a certified reinsurer by the commission, the assuming insurer shall be required to post security in accordance with  14VAC5-300-110  in order for the ceding insurer to continue to take credit for reinsurance ceded to the assuming insurer. If funds continue to be held in trust in accordance with  14VAC5-300-90 , the commission may allow additional credit equal to the ceding insurer's pro rata share of such funds, discounted to reflect the risk of uncollectibility and anticipated expenses of trust administration. Notwithstanding the change of a certified reinsurer's rating or revocation of its certification, a domestic insurer that has ceded reinsurance to that certified reinsurer may not be denied credit for reinsurance for a period of three months for all reinsurance ceded to that certified reinsurer, unless the reinsurance is found by the commission to be at high risk of uncollectibility.\n C. Qualified jurisdictions.\n 1. If, upon conducting an evaluation under this section with respect to the reinsurance supervisory system of any non-United States assuming insurer, the commission determines that the jurisdiction qualifies to be recognized as a qualified jurisdiction, the commission shall publish notice and evidence of such recognition in an appropriate manner. The commission may establish a procedure to withdraw recognition of those jurisdictions that are no longer qualified.\n 2. In order to determine whether the domiciliary jurisdiction of a non-United States assuming insurer is eligible to be recognized as a qualified jurisdiction, the commission shall evaluate the reinsurance supervisory system of the non-United States jurisdiction, both initially and on an ongoing basis, and consider the rights, benefits, and the extent of reciprocal recognition afforded by the non-United States jurisdiction to reinsurers licensed and domiciled in the United States. The commission shall determine the appropriate approach for evaluating the qualifications of such jurisdictions, and create and publish a list of jurisdictions whose reinsurers may be approved by the commission as eligible for certification. A qualified jurisdiction shall agree to share information and cooperate with the commission with respect to all certified reinsurers domiciled within that jurisdiction. Additional factors to be considered in determining whether to recognize a qualified jurisdiction, in the discretion of the commission, include but are not limited to the following:\n a. The framework under which the assuming insurer is regulated.\n b. The structure and authority of the domiciliary regulator with regard to solvency regulation requirements and financial surveillance.\n c. The substance of financial and operating standards for assuming insurers in the domiciliary jurisdiction.\n d. The form and substance of financial reports required to be filed or made publicly available by reinsurers in the domiciliary jurisdiction and the accounting principles used.\n e. The domiciliary regulator's willingness to cooperate with United States regulators in general and the commission in particular.\n f. The history of performance by assuming insurers in the domiciliary jurisdiction.\n g. Any documented evidence of substantial problems with the enforcement of final United States judgments in the domiciliary jurisdiction. A jurisdiction will not be considered to be a qualified jurisdiction if the commission has determined that it does not adequately and promptly enforce final United States judgments or arbitration awards.\n h. Any relevant international standards or guidance with respect to mutual recognition of reinsurance supervision adopted by the International Association of Insurance Supervisors or successor organization.\n i. Any other matters deemed relevant by the commission.\n 3. A list of qualified jurisdictions shall be published through the NAIC committee process. The commission shall consider this list in determining qualified jurisdictions. If the commission approves a jurisdiction as qualified that does not appear on the list of qualified jurisdictions, the commission shall provide thoroughly documented justification with respect to the criteria provided under subdivisions 2 a through i of this subsection.\n 4. United States jurisdictions that meet the requirements for accreditation under the NAIC financial standards and accreditation program shall be recognized as qualified jurisdictions.\n D. Recognition of certification issued by an NAIC accredited jurisdiction.\n 1. If an applicant for certification has been certified as a reinsurer in an NAIC accredited jurisdiction, the commission has the discretion to defer to that jurisdiction's certification, and to defer to the rating assigned by that jurisdiction, if the assuming insurer submits a properly executed Certificate of Certified Reinsurer and such additional information as the commission requires. The assuming insurer shall be considered to be a certified reinsurer in this Commonwealth.\n 2. Any change in the certified reinsurer's status or rating in the other jurisdiction shall apply automatically in this Commonwealth as of the date it takes effect in the other jurisdiction. The certified reinsurer shall notify the commission of any change in its status or rating within 10 days after receiving notice of the change.\n 3. The commission may withdraw recognition of the other jurisdiction's rating at any time and assign a new rating in accordance with subdivision B 8 a of this section.\n 4. The commission may withdraw recognition of the other jurisdiction's certification at any time, with written notice to the certified reinsurer. Unless the commission suspends or revokes the certified reinsurer's certification in accordance with subdivision B 8 b of this section, the certified reinsurer's certification shall remain in good standing in this Commonwealth for a period of three months, which shall be extended if additional time is necessary to consider the assuming insurer's application for certification in this Commonwealth.\n E. Mandatory funding clause. In addition to the clauses required under  14VAC5-300-150 , reinsurance contracts entered into or renewed under this section shall include a proper funding clause, which requires the certified reinsurer to provide and maintain security in an amount sufficient to avoid the imposition of any financial statement penalty on the ceding insurer under this section for reinsurance ceded to the certified reinsurer.\n F. The commission shall comply with all reporting and notification requirements that may be established by the NAIC with respect to certified reinsurers and qualified jurisdictions.  Statutory Authority  §§  12.1-13  and   38.2-1316.2  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 29, Issue 4 , eff. January 1, 2013; amended, Virginia Register  Volume 35, Issue 5 , eff. November 1, 2018;  Volume 36, Issue 23 , eff. July 1, 2020.    14VAC5-300-97. Credit for reinsurance; reciprocal jurisdictions.  A. Pursuant to §  38.2-1316.2  E of the Act, the commission shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer that is licensed to write reinsurance by, and has its head office or is domiciled in a reciprocal jurisdiction and that meets the other requirements of this chapter.\n B. A "reciprocal jurisdiction" is a jurisdiction, as designated by the commission pursuant to subsection D of this section, that meets one of the following:\n 1. A non-United States jurisdiction that is subject to an in-force covered agreement with the United States, each within its legal authority or, in the case of a covered agreement between the United States and the European Union, is a member state of the European Union. For purposes of this subsection, a "covered agreement" is an agreement entered into pursuant to the Dodd-Frank Wall Street Reform and Consumer Protection Act (31 USC §§ 313 and 314) that is currently in effect or in a period of provisional application and addresses the elimination, under specified conditions, of collateral requirements as a condition for entering into any reinsurance agreement with a ceding insurer domiciled in this Commonwealth or for allowing the ceding insurer to recognize credit for reinsurance;\n 2. A United States jurisdiction that meets the requirements for accreditation under the NAIC financial standards and accreditation program; or\n 3. A qualified jurisdiction, as determined by the commission pursuant to §  38.2-1316.2  D of the Code of Virginia and  14VAC5-300-95  C, that is not otherwise described in subdivision 1 or 2 of this subsection and that the commission determines meets all of the following additional requirements:\n a. Provides that an insurer that has its head office or is domiciled in such qualified jurisdiction shall receive credit for reinsurance ceded to a United States-domiciled assuming insurer in the same manner as credit for reinsurance is received for reinsurance assumed by insurers domiciled in such qualified jurisdiction;\n b. Does not require a United States-domiciled assuming insurer to establish or maintain a local presence as a condition for entering into a reinsurance agreement with any ceding insurer subject to regulation by the non-United States jurisdiction or as a condition to allow the ceding insurer to recognize credit for such reinsurance;\n c. Recognizes the United States state regulatory approach to group supervision and group capital by providing written confirmation by a competent regulatory authority in such qualified jurisdiction that insurers and insurance groups that are domiciled or maintain their headquarters in this Commonwealth or another jurisdiction accredited by the NAIC shall be subject only to worldwide prudential insurance group supervision, including worldwide group governance, solvency and capital, and reporting, as applicable, by the commission or the commissioner of the domiciliary state and will not be subject to group supervision at the level of the worldwide parent undertaking of the insurance or reinsurance group by the qualified jurisdiction; and\n d. Provides written confirmation by a competent regulatory authority in such qualified jurisdiction that information regarding insurers and the insurers' parent, subsidiary, or affiliated entities, if applicable, shall be provided to the commission in accordance with a memorandum of understanding or similar document between the commission and such qualified jurisdiction, including to the International Association of Insurance Supervisors Multilateral Memorandum of Understanding or other multilateral memoranda of understanding coordinated by the NAIC.\n C. Credit shall be allowed when the reinsurance is ceded from an insurer domiciled in this Commonwealth to an assuming insurer meeting each of the conditions set forth in this subsection.\n 1. The assuming insurer must be licensed to transact reinsurance by and have its head office or be domiciled in a reciprocal jurisdiction.\n 2. The assuming insurer must have and maintain on an ongoing basis minimum capital and surplus, or its equivalent, calculated on at least an annual basis as of the preceding December 31 or at the annual date otherwise statutorily reported to the reciprocal jurisdiction and confirmed as set forth in subdivision C 7 of this subsection according to the methodology of its domiciliary jurisdiction, in the following amounts:\n a. No less than $250 million; or\n b. If the assuming insurer is an association, including incorporated and individual unincorporated underwriters:\n (1) Minimum capital and surplus equivalents (net of liabilities) or own funds of the equivalent of at least $250 million; and\n (2) A central fund containing a balance of the equivalent of at least $250 million.\n 3. The assuming insurer must have and maintain on an ongoing basis a minimum solvency or capital ratio, as applicable, as follows:\n a. If the assuming insurer has its head office or is domiciled in a reciprocal jurisdiction as defined in subdivision B 1 of this section, the ratio specified in the applicable covered agreement;\n b. If the assuming insurer is domiciled in a reciprocal jurisdiction as defined in subdivision B 2 of this section, a risk-based capital (RBC) ratio of 300% of the authorized control level, calculated in accordance with the formula developed by the NAIC; or\n c. If the assuming insurer is domiciled in a reciprocal jurisdiction as defined in subdivision B 3 of this section, after consultation with the reciprocal jurisdiction and considering any recommendations published through the NAIC Committee Process, such solvency or capital ratio as the commission determines to be an effective measure of solvency.\n 4. The assuming insurer must agree to and provide adequate assurance, in the form of a properly executed Certificate of Reinsurer Domiciled in Reciprocal Jurisdiction Form RJ-1 of this chapter, of its agreement to the following:\n a. The assuming insurer must agree to provide prompt written notice and explanation to the commission if it falls below the minimum requirements set forth in subdivision 2 or 3 of this subsection or if any regulatory action is taken against it for serious noncompliance with applicable law.\n b. The assuming insurer must consent in writing to the jurisdiction of the courts of this Commonwealth and to the appointment of the commission as agent for service of process.\n (1) The commission may also require that such consent be provided and included in each reinsurance agreement under the commission's jurisdiction.\n (2) Nothing in this provision shall limit or in any way alter the capacity of parties to a reinsurance agreement to agree to alternative dispute resolution mechanisms, except to the extent such agreements are unenforceable under applicable insolvency or delinquency laws.\n c. The assuming insurer must consent in writing to pay all final judgments, wherever enforcement is sought, obtained by a ceding insurer that have been declared enforceable in the territory where the judgment was obtained.\n d. Each reinsurance agreement must include a provision requiring the assuming insurer to provide security in an amount equal to 100% of the assuming insurer's liabilities attributable to reinsurance ceded pursuant to that agreement if the assuming insurer resists enforcement of a final judgment that is enforceable under the law of the jurisdiction in which it was obtained or a properly enforceable arbitration award, whether obtained by the ceding insurer or by its legal successor on behalf of its estate, if applicable.\n e. The assuming insurer must confirm that it is not presently participating in any solvent scheme of arrangement, which involves this Commonwealth's ceding insurers, and agrees to notify the ceding insurer and the commission and to provide 100% security to the ceding insurer consistent with the terms of the scheme, should the assuming insurer enter into such a solvent scheme of arrangement. Such security shall be in a form consistent with the provisions of subsection D of §  38.2-1316.2  and subdivision 2 of §  38.2-1316.4  of the Code of Virginia and  14VAC5-300-120 ,  14VAC5-300-130 , or  14VAC5-300-140 .\n f. The assuming insurer must agree in writing to meet the applicable information filing requirements as set forth in subdivision 5 of this subsection.\n 5. The assuming insurer or its legal successor must provide, if requested by the commission, on behalf of itself and any legal predecessors, the following documentation to the commission:\n a. For the two years preceding entry into the reinsurance agreement and on an annual basis thereafter, the assuming insurer's annual audited financial statements in accordance with the applicable law of the jurisdiction of its head office or domiciliary jurisdiction, as applicable, including the external audit report;\n b. For the two years preceding entry into the reinsurance agreement, the solvency and financial condition report or actuarial opinion if filed with the assuming insurer's supervisor;\n c. Prior to entry into the reinsurance agreement and not more than semi-annually thereafter, an updated list of all disputed and overdue reinsurance claims outstanding for 90 days or more, regarding reinsurance assumed from ceding insurers domiciled in the United States; and\n d. Prior to entry into the reinsurance agreement and not more than semi-annually thereafter, information regarding the assuming insurer's assumed reinsurance by ceding insurer, ceded reinsurance by the assuming insurer, and reinsurance recoverable on paid and unpaid losses by the assuming insurer to allow for the evaluation of the criteria set forth in subdivision 6 of this subsection.\n 6. The assuming insurer must maintain a practice of prompt payment of claims under reinsurance agreements. The lack of prompt payment will be evidenced if any of the following criteria is met:\n a. More than 15% of the reinsurance recoverables from the assuming insurer are overdue and in dispute as reported to the commission;\n b. More than 15% of the assuming insurer's ceding insurers or reinsurers have overdue reinsurance recoverable on paid losses of 90 days or more that are not in dispute and that exceed for each ceding insurer $100,000, or as otherwise specified in a covered agreement; or\n c. The aggregate amount of reinsurance recoverable on paid losses that are not in dispute, but are overdue by 90 days or more, exceeds $50 million, or as otherwise specified in a covered agreement.\n 7. The assuming insurer's supervisory authority must confirm to the commission on an annual basis that the assuming insurer complies with the requirements set forth in subdivisions 2 and 3 of this subsection.\n 8. Nothing in this provision precludes an assuming insurer from providing the commissioner with information on a voluntary basis.\n D. The commissioner shall timely create and publish a list of reciprocal jurisdictions.\n 1. A list of reciprocal jurisdictions is published through the NAIC Committee Process. The commission's list shall include any reciprocal jurisdiction as defined under subdivisions B 1 and B 2 of this section and shall consider any other reciprocal jurisdiction included on the NAIC list. The commission may approve a jurisdiction that does not appear on the NAIC list of reciprocal jurisdictions as provided by applicable law or regulation or in accordance with criteria published through the NAIC Committee Process.\n 2. The commission may remove a jurisdiction from the list of reciprocal jurisdictions upon a determination that the jurisdiction no longer meets one or more of the requirements of a reciprocal jurisdiction, as provided by applicable law or regulation or in accordance with a process published through the NAIC Committee Process, except that the commission shall not remove from the list a reciprocal jurisdiction as defined under subdivisions B 1 and B 2 of this section. Upon removal of a reciprocal jurisdiction from this list credit for reinsurance ceded to an assuming insurer domiciled in that jurisdiction shall be allowed if otherwise allowed pursuant to Article 3.1 (§  38.2-1316.1  et seq.) of Chapter 13 of Title 38.2 of the Code of Virginia or this chapter.\n E. The commission shall timely create and publish a list of assuming insurers that have satisfied the conditions set forth in this section and to which cessions shall be granted credit in accordance with this section.\n 1. If an NAIC accredited jurisdiction has determined that the conditions set forth in subsection C of this section have been met, the commission has the discretion to defer to that jurisdiction's determination and add such assuming insurer to the list of assuming insurers to which cessions shall be granted credit in accordance with this subsection. The commission may accept financial documentation filed with another NAIC accredited jurisdiction or with the NAIC in satisfaction of the requirements of subsection C of this section.\n 2. When requesting that the commission defer to another NAIC accredited jurisdiction's determination, an assuming insurer must submit a properly executed Form RJ-1 and additional information as the commission may require. A state that has received such a request will notify other states through the NAIC Committee Process and provide relevant information with respect to the determination of eligibility.\n F. If the commission determines that an assuming insurer no longer meets one or more of the requirements under this section, the commission may revoke or suspend the eligibility of the assuming insurer for recognition under this section.\n 1. While an assuming insurer's eligibility is suspended, no reinsurance agreement issued, amended, or renewed after the effective date of the suspension qualifies for credit except to the extent that the assuming insurer's obligations under the contract are secured in accordance with  14VAC5-300-110 .\n 2. If an assuming insurer's eligibility is revoked, no credit for reinsurance may be granted after the effective date of the revocation with respect to any reinsurance agreements entered into by the assuming insurer, including reinsurance agreements entered into prior to the date of revocation, except to the extent that the assuming insurer's obligations under the contract are secured in a form acceptable to the commission and consistent with the provisions of  14VAC5-300-110 .\n G. Before denying statement credit or imposing a requirement to post security with respect to subsection F of this section or adopting any similar requirement that will have substantially the same regulatory impact as security, the commission shall:\n 1. Communicate with the ceding insurer, the assuming insurer, and the assuming insurer's supervisory authority that the assuming insurer no longer satisfies one of the conditions listed in subsection C of this section;\n 2. Provide the assuming insurer with 30 days from the initial communication to submit a plan to remedy the defect and 90 days from the initial communication to remedy the defect, except in exceptional circumstances in which a shorter period is necessary for policyholder and other consumer protection;\n 3. After the expiration of the 90-day or shorter period to remedy the defect, as set out in subdivision 2 of this subsection, if the commission determines that no or insufficient action was taken by the assuming insurer, the commission may impose any of the requirements as set out in this subsection; and\n 4. Provide a written explanation to the assuming insurer of any of the requirements set out in this subsection.\n H. If subject to a legal process of rehabilitation, liquidation, or conservation, as applicable, the ceding insurer or its representative may seek and, if determined appropriate by the court in which the proceedings are pending, may obtain an order requiring that the assuming insurer post security for all outstanding liabilities.  Statutory Authority  §§  12.1-13  and  38.2-1316.2  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 36, Issue 23 , eff. July 1, 2020.    14VAC5-300-100. Credit for reinsurance required by law.  When an assuming insurer fails to meet the requirements of §  38.2-1316.2   of the Act, the ceding insurer may take credit pursuant to subdivision 1 of §  38.2-1316.4  of the Act but only with respect to the insurance of risks located in jurisdictions where such reinsurance is required by the applicable law or regulation of that jurisdiction. As used in this section, "jurisdiction" means any state, district or territory of the United States and any lawful national government.   Statutory Authority  §§  38.2-223 ,  38.2-1316.7  and  12.1-13  of the Code of Virginia.  Historical Notes  Derived from Regulation 43, Case No. INS910307, § 11, eff. March 1, 1992; amended, Virginia Register  Volume 29, Issue 4 , eff. January 1, 2013.    14VAC5-300-110. Asset or reduction from liability for reinsurance ceded to an assuming insurer not meeting the requirements of 14VAC5-300-60 through 14VAC5-300-100.  A. Pursuant to §  38.2-1316.4  of the Act, the commission shall allow a reduction from liability for reinsurance ceded by a domestic insurer to an assuming insurer not meeting the requirements of §  38.2-1316.2  of the Act in an amount not exceeding the liabilities carried by the ceding insurer. The reduction shall be in the amount of funds held by or on behalf of the ceding insurer, including funds held in trust for the exclusive benefit of the ceding insurer, under a reinsurance contract with such assuming insurer as security for the payment of obligations under the reinsurance contract. The security shall be held in the United States subject to withdrawal solely by, and under the exclusive control of, the ceding insurer or, in the case of a trust, held in a qualified United States financial institution as defined in §  38.2-1316.1  of the Act. This security may be in the form of any of the following:\n  1. Cash;\n  2. Securities listed by the Securities Valuation Office of the NAIC, including those deemed exempt from filing as defined by the Purposes and Procedures Manual of the NAIC  Investment Analysis Office, and qualifying as admitted assets;\n  3. Clean, irrevocable, unconditional, and "evergreen" letters of credit issued or confirmed by a qualified United States institution, as defined in §  38.2-1316.1  of the Act, effective no later than December 31 of the year for which filing is being made, and in the possession of, or in trust for, the ceding insurer on or before the filing date of its annual statement. Letters of credit meeting applicable standards of issuer acceptability as of the dates of their issuance (or confirmation) shall, notwithstanding the issuing (or confirming) institution's subsequent failure to meet applicable standards of issuer acceptability, continue to be acceptable as security until their expiration, extension, renewal, modification or amendment, whichever first occurs; or\n  4. Any other form of security acceptable to the commission.\n B. An admitted asset or a reduction from liability for reinsurance ceded to an unauthorized assuming insurer pursuant to this section shall be allowed only when the requirements of  14VAC5-300-150  and the applicable portions of  14VAC5-300-120 ,  14VAC5-300-130 , or  14VAC5-300-140  of this chapter have been satisfied.  Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Regulation 43, Case No. INS910307, § 12, eff. March 1, 1992; amended, Virginia Register  Volume 29, Issue 4 , eff. January 1, 2013;  Volume 35, Issue 5 , eff. November 1, 2018.    14VAC5-300-120. Trust agreements qualified under 14VAC5-300-110 and subdivision 2 of § 38.2-1316.4 of the Act.  A. When a ceding insurer takes credit pursuant to subdivision 2 of §  38.2-1316.4  of the Act for reinsurance transactions secured by funds held in trust, the underlying trust agreement shall meet the following conditions:\n 1. The trust agreement shall be entered into between the beneficiary, the grantor and a trustee which shall be a qualified United States financial institution, as those terms are defined in this chapter.\n 2. The trust agreement shall create a trust account into which assets shall be deposited.\n 3. All assets in the trust account shall be held by the trustee at the trustee's office in the United States.\n 4. The trust agreement shall provide that:\n a. The beneficiary shall have the right to withdraw assets from the trust account at any time, without notice to the grantor, subject only to written notice from the beneficiary to the trustee;\n b. No other statement or document is required to be presented in order to withdraw assets, except that the beneficiary may be required to acknowledge receipt of withdrawn assets;\n c. It is not subject to any conditions or qualifications outside of the trust agreement; and\n d. It shall not contain references to any other agreements or documents except as provided for under  subdivisions 11 and 12 of this subsection.\n\n 5. The trust agreement shall be established for the sole benefit of the beneficiary.\n 6. The trust agreement shall require the trustee to:\n a. Receive assets and hold all assets in a safe place;\n b. Determine that all assets are in such form that the beneficiary, or the trustee upon direction by the beneficiary, may whenever necessary negotiate any such assets, without consent or signature from the grantor or any other person or entity;\n c. Furnish to the grantor and the beneficiary a statement of all assets in the trust account upon its inception and at intervals no less frequent than the end of each calendar quarter;\n d. Notify the grantor and the beneficiary, within 10 days, of any deposits to or withdrawals from the trust account;\n e. Upon written demand of the beneficiary, immediately take any and all steps necessary to transfer absolutely and unequivocally all right, title and interest in the assets held in the trust account to the beneficiary and deliver physical custody of such assets to such beneficiary; and\n f. Allow no substitutions or withdrawals of assets from the trust account, except on written instructions from the beneficiary, except that the trustee may, without the consent of but with notice to the beneficiary, upon call or maturity of any trust asset, withdraw such asset upon condition that the proceeds are paid into the trust account.\n 7. The trust agreement shall provide that at least 30 days, but not more than 45 days, prior to termination of the trust account, written notification of termination shall be delivered by the trustee to the beneficiary.\n 8. The trust agreement shall be made subject to and governed by the laws of the state in which the trust is established.\n  9. The trust agreement shall prohibit invasion of the trust corpus for the purpose of paying compensation to, or reimbursing the expenses of, the trustee. In order for a letter of credit to qualify as an asset of the trust, the trustee shall have the right and the obligation pursuant to the deed of trust or some other binding agreement (as duly approved by the commission), to immediately draw down the full amount of the letter of credit and hold the proceeds in trust for the beneficiaries of the trust if the letter of credit will otherwise expire without being renewed or replaced.\n\n 10. The trust agreement shall provide that the trustee shall be liable for its negligence, willful misconduct, or lack of good faith. The failure of the trustee to draw against the letter of credit in circumstances where such draw would be required shall be deemed to be negligence or willful misconduct, or both.\n 11. Notwithstanding other provisions of this chapter, when a trust agreement is established in conjunction with a reinsurance agreement covering risks other than life, annuities, and accident and health, where it is customary practice to provide a trust agreement for a specific purpose, the trust agreement may provide that the ceding insurer shall undertake to use and apply amounts drawn upon the trust account, without diminution because of the insolvency of the ceding insurer or the assuming insurer, only for the following purposes:\n a. To pay or reimburse the ceding insurer for the assuming insurer's share under the specific reinsurance agreement regarding any losses and allocated loss expenses paid by the ceding insurer, but not recovered from the assuming insurer, or for unearned premiums due to the ceding insurer if not otherwise paid by the assuming insurer;\n b. To make payment to the assuming insurer of any amounts held in the trust account that exceed 102% of the actual amount required to fund the assuming insurer's obligations under the specific reinsurance agreement; or\n c. Where the ceding insurer has received notification of termination of the trust account and where the assuming insurer's entire obligations under the specific reinsurance agreement remain unliquidated and undischarged 10 days prior to the termination date, to withdraw amounts equal to the obligations and deposit those amounts in a separate account, in the name of the ceding insurer in any qualified United States financial institution as defined in §  38.2-1316.1  of the Act apart from its general assets, in trust for such uses and purposes specified in subdivisions 11 a and b of this subsection as may remain executory after such withdrawal and for any period after the termination date.\n 12. Notwithstanding other provisions of this chapter, when a trust agreement is established to meet the requirements of  14VAC5-300-110  in conjunction with a reinsurance agreement covering life, annuities or accident and health risks, where it is customary to provide a trust agreement for a specific purpose, the trust agreement may provide that the ceding insurer shall undertake to use and apply amounts drawn upon the trust account, without diminution because of the insolvency of the ceding insurer or the assuming insurer, only for the following purposes:\n a. To pay or reimburse the ceding insurer for:\n (1) The assuming insurer's share under the specific reinsurance agreement of premiums returned, but not yet recovered from the assuming insurer, to the owners of policies reinsured under the reinsurance agreement on account of cancellations of the policies; and\n (2) The assuming insurer's share under the specific reinsurance agreement of surrenders and benefits or losses paid by the ceding insurer, but not yet recovered from the assuming insurer, under the terms and provisions of the policies reinsured under the reinsurance agreement;\n b. To pay to the assuming insurer amounts held in the trust account in excess of the amount necessary to secure the credit or reduction from liability for reinsurance taken by the ceding insurer; or\n c. Where the ceding insurer has received notification of termination of the trust and where the assuming insurer's entire obligations under the specific reinsurance agreement remain unliquidated and undischarged 10 days prior to the termination date, to withdraw amounts equal to the assuming insurer's share of liabilities, to the extent that the liabilities have not yet been funded by the assuming insurer, and deposit those amounts in a separate account, in the name of the ceding insurer in any qualified United States financial institution apart from its general assets, in trust for the uses and purposes specified in subdivisions 12 a and b of this subsection as may remain executory after withdrawal and for any period after the termination date.\n 13. Either the reinsurance agreement or the trust agreement shall stipulate that assets deposited in the trust account shall be valued according to their current fair market value and shall consist only of cash in United States dollars, certificates of deposit issued by a United States bank and payable in United States dollars, and investments permitted by the Code of Virginia or any combination of the above, provided investments in or issued by an entity controlling, controlled by or under common control with either the grantor or the beneficiary of the trust shall not exceed 5.0% of total investments. The agreement may further specify the types of investments to be deposited. If the reinsurance agreement covers life, annuities or accident and health risks, then the provisions required by this subdivision shall be included in the reinsurance agreement.\n B. When a ceding insurer seeks credit pursuant to subdivision 2 of §  38.2-1316.4   for reinsurance transactions secured by funds held in trust, the underlying trust agreement may contain the following provisions subject to all conditions set forth:\n 1. The trust agreement may provide that the trustee may resign upon delivery of a written notice of resignation, effective not less than 90 days after receipt by the beneficiary and grantor of the notice and that the trustee may be removed by the grantor by delivery to the trustee and the beneficiary of a written notice of removal, effective not less than 90 days after receipt by the trustee and the beneficiary of the notice, provided that no such resignation or removal shall be effective until a successor trustee has been duly appointed and approved by the beneficiary and the grantor and all assets in the trust have been duly transferred to the new trustee.\n 2. The grantor may have the full and unqualified right to vote any shares of stock in the trust account and to receive from time to time payments of any dividends or interest upon any shares of stock or obligations included in the trust account. Any such interest or dividends shall be either forwarded promptly upon receipt to the grantor or deposited in a separate account established in the grantor's name.\n 3. The trustee may be given authority to invest, and accept substitutes of, any funds in the account, provided that no investment or substitution shall be made without prior approval of the beneficiary, unless the trust agreement specifies categories of investments acceptable to the beneficiary and authorizes the trustee to invest such funds and to accept such substitutions which the trustee determines are at least equal in current fair market value to the assets withdrawn and that are consistent with the restrictions in subdivision C 1 b of this section.\n 4. The trust agreement may provide that the beneficiary may at any time designate a party to which all or part of the trust assets are to be transferred. Such transfer may be conditioned upon the trustee receiving, prior to or simultaneously, other specified assets.\n 5. The trust agreement may provide that, upon termination of the trust account, all assets not previously withdrawn by the beneficiary shall, with written approval by the beneficiary, be delivered over to the grantor.\n\n C. Conditions applicable to reinsurance agreements entered into by a ceding insurer which takes credit pursuant to subdivision 2 of §  38.2-1316.4   for reinsurance transactions secured by funds held in trust.\n 1. The reinsurance agreement may contain provisions that:\n a. Require the assuming insurer to enter into a trust agreement and to establish a trust account for the benefit of the ceding insurer, and specifying what such agreement is to cover;\n\n  b. Require the assuming insurer, prior to depositing assets with the trustee, to execute assignments or endorsements in blank, or to transfer legal title to the trustee of all shares, obligations or any other assets requiring assignments, in order that the ceding insurer, or the trustee upon the direction of the ceding insurer, may whenever necessary negotiate any such assets without consent or signature from the assuming insurer or any other entity;\n  c. Require that all settlements of account between the ceding insurer and the assuming insurer be made in cash or its equivalent; and\n  d. Stipulate that the assuming insurer and the ceding insurer agree that the assets in the trust account, established pursuant to the provisions of the reinsurance agreement, may be withdrawn by the ceding insurer at any time, notwithstanding any other provisions in the reinsurance agreement, and shall be utilized and applied by the ceding insurer or its successors in interest by operation of law, including without limitations any liquidator, rehabilitator, receiver or conservator of such company, without diminution because of insolvency on the part of the ceding insurer or the assuming insurer, only for the following purposes:\n (1) To pay or reimburse the ceding insurer for:\n (a) The assuming insurer's share under the specific reinsurance agreement of premiums returned, but not yet recovered from the assuming insurer, to the owners of policies reinsured under the reinsurance agreement because of cancellations of such policies;\n  (b) The assuming insurer's share of surrenders and benefits or losses paid by the ceding insurer pursuant to the provisions of the policies reinsured under the reinsurance agreement; and\n\n  (c) Any other amounts necessary to secure the credit or reduction from liability for reinsurance taken by the ceding insurer; or\n (2) To make payment to the assuming insurer of amounts held in the trust account in excess of the amount necessary to secure the credit or reduction from liability for reinsurance taken by the ceding insurer.\n 2. The reinsurance agreement also may contain provisions that:\n  a. Give the assuming insurer the right to seek approval (which shall not be unreasonably or arbitrarily withheld) from the ceding insurer to withdraw from the trust account all or any part of the trust assets and transfer such assets to the assuming insurer, provided:\n (1) The assuming insurer shall, at the time of such withdrawal, replace the withdrawn assets with other qualified assets having a current fair market value equal to the market value of the assets withdrawn so as to maintain at all times the deposit in the required amount, or\n (2) After such withdrawal and transfer, the current fair market value of the trust account is no less than 102% of the required amount.\n  b. Provide for the return of any amount withdrawn in excess of the actual amounts required for  subdivision C 1 d of this section, and for interest payments, at a rate not in excess of the prime rate of interest on  such amounts.\n  c. Permit the award by any arbitration panel or court of competent jurisdiction of:\n (1) Interest at a rate different from that provided in subdivision  2 b of this subsection;\n (2) Court or arbitration costs;\n (3) Attorney's fees; and\n (4) Any other reasonable expenses.\n  D. With regard to financial reporting, a trust agreement may be used to reduce any liability for reinsurance ceded to an unauthorized assuming insurer in financial statements required to be filed with the  commission in compliance with the provisions of this chapter when established on or before the date of filing of the financial statement of the ceding insurer. Further, the reduction for the existence of an acceptable trust account may be up to the current fair market value of acceptable assets available to be withdrawn from the trust account at that time, but such reduction shall be no greater than the specific obligations, as defined in this chapter, under the reinsurance agreement that the trust account was established to secure.\n  E. With regard to existing agreements and notwithstanding the effective date of this chapter, any trust agreement or underlying reinsurance agreement in existence prior to  July 1, 2012, will continue to be acceptable until  January 1, 2013, at which time the agreements will have to be in full compliance with this chapter for the trust agreement to be acceptable.\n  F. The failure of any trust agreement to specifically identify the beneficiary as defined in  14VAC5-300-40   shall not be construed to affect any actions or rights which the  commission may take or possess pursuant to the provisions of the laws of this Commonwealth.   Statutory Authority  §§  38.2-223 ,  38.2-1316.7  and  12.1-13  of the Code of Virginia.  Historical Notes  Derived from Regulation 43, Case No. INS910307, § 13, eff. March 1, 1992; amended, Virginia Register  Volume 29, Issue 4 , eff. January 1, 2013.    14VAC5-300-130. Letters of credit qualifying for § 38.2-1316.4 credit under 14VAC5-300-110.  A. The letter of credit  shall be clean, irrevocable, unconditional and issued or confirmed by a qualified United States financial institution as defined in §  38.2-1316.1  of the Act. The letter of credit shall contain an issue date and expiration date and shall stipulate that the beneficiary need only draw a sight draft under the letter of credit and present it to obtain funds and that no other document need be presented. The letter of credit also shall indicate that it is not subject to any condition or qualifications outside of the letter of credit. In addition, the letter of credit itself shall not contain reference to any other agreements, documents or entities, except as provided in subdivision H 1 of this section. As used in this section, "beneficiary" means the domestic insurer for whose benefit the letter of credit has been established and any successor of the beneficiary by operation of law. If a court of law appoints a successor in interest to the named beneficiary, then the named beneficiary includes and is limited to the court appointed domiciliary receiver (including conservator, rehabilitator or liquidator).\n\n  B. The heading of the letter of credit may include a boxed section which contains the name of the applicant and other appropriate notations to provide a reference for such letter of credit. The boxed section shall be clearly marked to indicate that such information is for internal identification purposes only.\n  C. The letter of credit shall contain a statement to the effect that the obligation of the qualified United States financial institution under the letter of credit is in no way contingent upon reimbursement with respect thereto.\n  D. The term of the letter of credit shall be for at least one year and shall contain an "evergreen clause"  that prevents the expiration of the letter of credit without due notice from the issuer. The "evergreen clause" shall provide for a period of no less than 30 days notice prior to  expiration date for nonrenewal.\n  E. The letter of credit shall state whether it is subject to and governed by the laws of this Commonwealth, the ceding insurer's state of domicile or the Uniform Customs and Practice for Documentary Credits of the International Chamber of Commerce  Publication 600 (UCP 600) or International Standby Practices ISP98 of the International Chamber of Commerce, Publication 590, or any successor publication, and all drafts drawn thereunder shall be presentable at an office in the United States of a qualified United States financial institution.\n  F. If the letter of credit is made subject to the Uniform Customs and Practice for Documentary Credits of the International Chamber of Commerce (Publication 500), or any successor publication, then the letter of credit shall specifically address and  provide for an extension of time to draw against the letter of credit in the event that one or more of the occurrences specified in Article 17 of Publication 500, or any successor publication, occur.\n\n  G. If the letter of credit is issued by a financial institution  authorized to issue letters of credit,  other than a qualified United States financial institution as described in subsection  A of this section, then the following additional requirements shall be met:\n 1. The issuing financial institution shall formally designate the confirming qualified United States financial institution as its agent for the receipt and payment of the drafts; and\n 2. The "evergreen clause" shall provide for  30  days notice prior to  the expiration date for nonrenewal.\n  H. Reinsurance agreement provisions.\n 1. The reinsurance agreement in conjunction with which the letter of credit is obtained may contain provisions which:\n a. Require the assuming insurer to provide letters of credit to the ceding insurer and specify what they are to cover;\n b. Stipulate that the assuming insurer and ceding insurer agree that the letter of credit provided by the assuming insurer pursuant to the provisions of the reinsurance agreement may be drawn upon at any time, notwithstanding any other  provisions in  the agreement, and shall be utilized by the ceding insurer or its successors in interest only for one or more of the following reasons:\n (1) To pay or reimburse the ceding insurer for:\n (a) The assuming insurer's share under the specific reinsurance agreement of premiums returned, but not yet recovered from the assuming insurers, to the owners of policies reinsured under the reinsurance agreement on account of cancellations of such policies;\n  (b) The assuming insurer's share under the specific reinsurance agreement, of surrenders and benefits or losses paid by the ceding insurer, but not yet recovered from the assuming insurers, under the terms and provisions of the policies reinsured under the reinsurance agreement; and\n\n  (c) Any other amounts necessary to secure the credit or reduction from liability for reinsurance taken by the ceding insurer;\n (2) Where the letter of credit will expire without renewal or be reduced or replaced by a letter of credit for a reduced amount and where the assuming insurer's entire obligations under the reinsurance agreement remain unliquidated and undischarged 10 days prior to the termination date, to withdraw amounts equal to the assuming insurer's share of the liabilities, to the extent that the liabilities have not yet been funded by the assuming insurer and exceed the amount of any reduced or replacement letter of credit, and deposit those amounts in a separate account in the name of the ceding insurer in a qualified United States financial institution apart from its general assets, in trust for such uses and purposes specified in subdivision 1 b (1) of this subsection as may remain after withdrawal and for any period after the termination date.\n c. All of the foregoing provisions of subdivision 1 of this subsection should be applied without diminution because of insolvency on the part of the ceding insurer or assuming insurer.\n 2. Nothing contained in subdivision 1 of this subsection shall preclude the ceding insurer and assuming insurer from providing for:\n a. An interest payment, at a rate not in excess of the prime rate of interest, on the amounts held pursuant to subdivision 1 b  of this subsection;  or\n b. The return of any amounts drawn down on the letters of credit in excess of the actual amounts required for the above or any amounts that are subsequently determined not to be due.\n\n    Statutory Authority  §§  38.2-223 ,  38.2-1316.7 , and  12.1-13  of the Code of Virginia.  Historical Notes  Derived from Regulation 43, Case No. INS910307, § 14, eff. March 1, 1992; amended, Virginia Register  Volume 17, Issue 16 , eff. May 1, 2001;  Volume 29, Issue 4 , eff. January 1, 2013.    14VAC5-300-140. Other security.  The  commission may allow credit pursuant to subdivision 2 d of §  38.2-1316.4  of the Act for unencumbered funds withheld by the ceding insurer in the United States subject to withdrawal solely by the ceding insurer and under its exclusive control.   Statutory Authority  §§  38.2-223 ,  38.2-1316.7  and  12.1-13  of the Code of Virginia.  Historical Notes  Derived from Regulation 43, Case No. INS910307, § 15, eff. March 1, 1992; amended, Virginia Register  Volume 29, Issue 4 , eff. January 1, 2013.    14VAC5-300-150. Reinsurance contract.  A. Credit will not be granted, nor an asset or reduction from liability allowed, to a ceding insurer for reinsurance effected with assuming insurers meeting the requirements of  14VAC5-300-60 ,  14VAC5-300-70 ,  14VAC5-300-80 ,  14VAC5-300-90 ,  14VAC5-300-95 ,  14VAC5-300-97 , or   14VAC5-300-110  or otherwise in compliance with §  38.2-1316.2  of the Act unless the reinsurance agreement:\n 1. Includes a proper insolvency clause that stipulates that reinsurance is payable directly to the liquidator or successor without diminution regardless of the status of the ceding company;\n 2. Includes a provision whereby the assuming insurer, if an unauthorized assuming insurer, has submitted to the jurisdiction of an alternative dispute resolution panel or court of competent jurisdiction within the United States, has agreed to comply with all requirements necessary to give such court or panel jurisdiction, has designated an agent upon whom service of process may be effected, and has agreed to abide by the final decisions of such court or panel; and\n 3. Includes a proper reinsurance intermediary clause, if applicable, that stipulates that the credit risk for the intermediary is carried by the assuming insurer.\n B. If the assuming insurer is not licensed, accredited, or certified to transact insurance or reinsurance in this Commonwealth, the credit permitted pursuant to §  38.2-1316.2  C 3, C 4, and  H shall not be allowed unless the assuming insurer agrees in the reinsurance agreements:\n 1. a. That in the event of the failure of the assuming insurer to perform its obligations under the terms of the reinsurance agreement, the assuming insurer, at the request of the ceding insurer, shall submit to the jurisdiction of any court of competent jurisdiction in any state of the United States, will comply with all requirements necessary to give the court jurisdiction, and will abide by the final decision of the court or of any appellate court in the event of an appeal; and\n b. To designate the commission or a designated attorney as its true and lawful attorney upon whom may be served any lawful process in any action, suit, or proceeding instituted by or on behalf of the ceding insurer.\n 2. This subsection is not intended to conflict with or override the obligation of the parties to a reinsurance agreement to arbitrate their disputes, if this obligation is created in the agreement.\n C. If the assuming insurer does not meet the requirements of §  38.2-1316.2  C 1, 2, or 3, the credit permitted by §  38.2-1316.2  C 4 or D shall not be allowed unless the assuming insurer agrees in the trust agreements to the following conditions:\n 1. Notwithstanding any other provisions in the trust instrument, if the trust fund is inadequate because it contains an amount less than the amount required by §  38.2-1316.2  C 4, or if the grantor of the trust has been declared insolvent or placed into receivership, rehabilitation, liquidation, or similar proceedings under the laws of its state or country of domicile, the trustee shall comply with an order of the commissioner with regulatory oversight over the trust or with an order of a court of competent jurisdiction directing the trustee to transfer to the commissioner with regulatory oversight all of the assets of the trust fund.\n 2. The assets shall be distributed by and claims shall be filed with and valued by the commissioner with regulatory oversight in accordance with the laws of the state in which the trust is domiciled that are applicable to the liquidation of domestic insurance companies.\n 3. If the commissioner with regulatory oversight determines that the assets of the trust fund or any part thereof are not necessary to satisfy the claims of the United States ceding insurers of the grantor of the trust, the assets or part thereof shall be returned by the commissioner with regulatory oversight to the trustee for distribution in accordance with the trust agreement.\n 4. The grantor shall waive any right otherwise available to it under United States law that is inconsistent with this provision.   Statutory Authority  §§  12.1-13  and   38.2-1316.2  of the Code of Virginia.  Historical Notes  Derived from Regulation 43, Case No. INS910307, § 16, eff. March 1, 1992; amended, Virginia Register  Volume 29, Issue 4 , eff. January 1, 2013;  Volume 35, Issue 5 , eff. November 1, 2018;  Volume 36, Issue 23 , eff. July 1, 2020.    14VAC5-300-160. Contracts affected.  All new and renewal reinsurance transactions entered into after December 31,  2012, shall conform to the requirements of the Act and this chapter if credit is to be given to the ceding insurer for such reinsurance. Unless otherwise provided in this chapter, credits for cessions under reinsurance agreements in force on July 1, 2012, or commenced within six months thereafter, shall be governed by the requirements for such credits in effect on June 30, 2012.  Statutory Authority  §§  38.2-223 ,  38.2-1316.7  and  12.1-13  of the Code of Virginia.  Historical Notes  Derived from Regulation 43, Case No. INS910307, § 17, eff. March 1, 1992; amended, Virginia Register  Volume 29, Issue 4 , eff. January 1, 2013.    14VAC5-300-170. Severability.  If any provision in this chapter or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the chapter and the application of the provision to other persons or circumstances shall not be affected thereby.   Statutory Authority  §§  38.2-223 ,  38.2-1316.7  and  12.1-13  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 29, Issue 4 , eff. January 1, 2013.    Forms (14VAC5-300)   Certificate of Assuming Insurer - Year Ended December 31, 2017, R05 (05/18) (eff. 5/2018)\n\n  Certificate of Certified Reinsurer - Year Ended December 31, ____, R15 (11/19) (eff. 11/2019)\n  Schedule S, Part 1 - Part 7, 1994‑2017 National Association of Insurance Commissioners, Annual Statement Blank, Life, Accident & Health (eff. 1/2018)\n  Schedule F, Part 1 - Part 9, 1994‑2017 National Association of Insurance Commissioners, Annual Statement Blank, Property/Casualty (eff. 1/2018)\n  Form CR-F - Part 1 - Part 2, 2011 National Association of Insurance Commissioners (eff. 1/2013)\n  Form CR-S - Part 1 - Part 3, 2011 National Association of Insurance Commissioners (eff. 1/2013)\n  Certificate of Reinsurer Domiciled in Reciprocal Jurisdiction - Year Ended December 31, ____, RJ-1 (07/20) (eff. 7/2020)     Documents Incorporated by Reference (14VAC5-300)\n  NAIC Policy Statement on Financial Regulation Standards, 2018, National Association of Insurance Commissioners\n NAIC Annual Statement Instructions,  2017 Life Annual Statement Instructions, September  1, 2017, National Association of Insurance Commissioners and the Center for Insurance Policy and Research.\n NAIC Annual Statement Instructions,  2017 Property/Casualty Annual Statement Instructions, September  1, 2017, National Association of Insurance Commissioners and the Center for Insurance Policy and Research.\n NAIC Accounting Practices & Procedures Manual, Volumes I, II,  March  2018, National Association of Insurance Commissioners.\n ICC Uniform Customs and Practice for Documentary Credits (UCP 500), 1993, International Chamber of Commerce.\n ICC Uniform Customs and Practice for Documentary Credits (UCP 600), 2007, International Chamber of Commerce.\n International Standby Practices ISP98, 1999, The Institute of International Banking Law and Practice, Inc.\n Purposes and Procedures Manual of the NAIC  Investment Analysis Office - Effective for Statements Ending December 31,  2017, Volume/Issue  17/01, 2017, National Association of Insurance Commissioners.\n                     Website addresses provided in the Virginia Administrative Code to documents incorporated by reference are for the reader's convenience only, may not necessarily be active or current, and should not be relied upon. To ensure the information incorporated by reference is accurate, the reader is encouraged to use the source document described in the regulation.\n                     As a service to the public, the Virginia Administrative Code is provided online by the Virginia General Assembly. We are unable to answer legal questions or respond to requests for legal advice, including application of law to specific fact. To understand and protect your legal rights, you should consult an attorney.\n\n\t\t\t\t\t\t\t Code of Virginia\n\n\t\t\t\t\t\t\t Administrative Code\n\n\t\t\t\t\t\t\t View by Agency\n\n\t\t\t\t\t\t\t Emergency Regulations\n\n\t\t\t\t\t\t\t VAC# Look Up\n\n\t\t\t\t\t\t\t\t Go\n\n\t\t\t\t\t\t\t Constitution of Virginia\n\n\t\t\t\t\t\t\t Charters\n\n\t\t\t\t\t\t\t Authorities\n\n\t\t\t\t\t\t\t Compacts\n\n\t\t\t\t\t\t\t Uncodified Acts\n\n                             Sign In\n\n                                 Username: \n\n                                 Password: \n\n                                 Cancel\n\n                                  LIS Home\n                                  Lobbyist-in-a-Box\n                                  Privacy Policy\n\n                                © Copyright Commonwealth of Virginia,\n                                 . All rights reserved. Site developed by the  Division of Legislative Automated Systems (DLAS) .\n                                 Sign In","text_length":107876}
{"slug":"va-14vac5-310","jurisdiction":"VA","agency":"SCC-BOI","doc_type":"regulation","citation":"14 VAC 5-310","title":"Chapter 310. Rules Governing Actuarial Opinions and Memoranda","official_source_url":"https://law.lis.virginia.gov/admincodefull/title14/agency5/chapter310/","access_class":"statutory-public","access_notes":"law.lis.virginia.gov (DLAS self-hosted); gate-zero TOP-20 VA admin code row.","first_seen_at":"2026-07-20T01:49:34.270808+00:00","last_checked_at":"2026-07-20T06:39:10.939479+00:00","versions":[{"fetched_at":"2026-07-20T01:49:34.270808+00:00","version_no":1,"text_length":45159,"effective_date":null,"content_sha256_short":"d5a4be5d037d"}],"text":"14VAC5-310-120. Severability.\n\n                      Virginia General Assembly  /\n                      LIS Learning Center  /\n                      Privacy Policy  /\n                      LIS home  /\n                      Register Account  /\n                      Login\n\n                     Session Information\n\n                     Bills & Resolutions\n\n                     State Budget\n\n                     Virginia Law\n\n                     Reports to the General Assembly\n\n                          Virginia Law\n\n                                 Select Search Type\n\n                                     All\n                                     Code of Virginia\n                                     Administrative Code\n                                     Constitution\n                                     Charters\n                                     Authorities\n                                     Compacts\n                                     Uncodified Acts\n\n                  Administrative Code\n                   Table of Contents   »  Title 14. Insurance  »  Agency 5. State Corporation Commission, Bureau of Insurance  »  Chapter 310. Rules Governing Actuarial Opinions and Memoranda\n\n                            Chapter\n\n                          Print\n\n                      Virginia Administrative Code\n\n                      Chapter 310. Rules Governing Actuarial Opinions and Memoranda  14VAC5-310-10. Purpose.  The purpose of this chapter ( 14VAC5-310 ) is to prescribe:\n 1. Requirements for statements of actuarial opinion that are to be submitted in accordance with §  38.2-1367  of the Code of Virginia, and for memoranda in support thereof;\n 2. Rules applicable to the appointment of an appointed actuary; and\n 3. Guidance as to the meaning of "adequacy of reserves."   Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Regulation 45, Case No. INS920377, § 1, eff. December 15, 1992; amended, Virginia Register  Volume 20, Issue 5 , eff. December 31, 2003;  Volume 31, Issue 9 , eff. January 1, 2015.    14VAC5-310-20. Authority; effective date.  This chapter ( 14VAC5-310 ) is adopted and promulgated by the commission pursuant to §§  12.1-13 ,  38.2-223 , and   38.2-1367  of the Code of Virginia. This chapter will take effect for annual statements for the year-ending December 31, 1992. Except as otherwise specifically provided, revisions to this chapter shall be effective upon adoption by the commission and applicable as to annual statements and actuarial opinions, memoranda, and statements of reserves filed with the commission for periods ending on or after December 31 of the year in which the revision is adopted.   Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Regulation 45, Case No. INS920377, § 2, eff. December 15, 1992; amended, Virginia Register  Volume 20, Issue 5 , eff. December 31, 2003;  Volume 31, Issue 9 , eff. January 1, 2015.    14VAC5-310-30. Scope.  A. This chapter ( 14VAC5-310 ) shall apply to all companies subject to the provisions of §  38.2-1367  of the Code of Virginia, including fraternal benefit societies licensed under Chapter 41 (§  38.2-4100  et seq.) of Title 38.2 and all other companies licensed under Title 38.2 of the Code of Virginia to write and reinsure policies or agreements providing any form of life, life insurance, or annuity benefits as those terms are defined in §§  38.2-102  through  38.2-107.1  of the Code of Virginia and also to any life insurer authorized to write or reinsure accident and sickness insurance as defined in §  38.2-109  of the Code of Virginia.\n B. This chapter shall be applied in a manner that allows the appointed actuary to utilize professional judgment in performing the asset analysis and developing the actuarial opinion and supporting memoranda, consistent with relevant actuarial standards of practice unless the commission determines particular specifications are necessary for an acceptable opinion to be rendered relative to the adequacy of reserves and related items. Particular specifications, including specific methods of actuarial analysis and actuarial assumptions, may be promulgated by rule or order of the commission or by an administrative letter issued by the Commissioner of Insurance.\n C. This chapter, as reflected in rules adopted by the commission by order entered November 5, 1992, in Case No. INS920377, shall be applicable to all annual statements filed with the commission on or after December 15, 1992, and before December 31, 2003. On and after December 31, 2003, a statement of opinion on the adequacy of the reserves and related actuarial items based on an asset adequacy analysis in accordance with  14VAC5-310-80 , and a memorandum in support thereof in accordance with  14VAC5-310-90 , shall be required each year in accordance with rules as revised and adopted by order of the commission entered in Case No. INS-2003-00165.   Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Regulation 45, Case No. INS920377, § 3, eff. December 15, 1992; amended, Virginia Register  Volume 20, Issue 5 , eff. December 31, 2003;  Volume 31, Issue 9 , eff. January 1, 2015.    14VAC5-310-40. Definitions.  As used in this chapter unless the context clearly indicates otherwise:\n "Actuarial opinion" means the opinion of an appointed actuary regarding the adequacy of reserves and related actuarial items based on an asset adequacy analysis in accordance with  14VAC5-310-80  and with applicable Actuarial Standards of Practice.\n "Actuarial Standards Board" means the board established by the American Academy of Actuaries to develop and promulgate standards of actuarial practice.\n "Annual statement" means that statement required by §  38.2-1300  of the Code of Virginia to be filed by the company with the commission annually.\n "Appointed actuary" means any individual who is appointed or retained in accordance with the requirements set forth in  14VAC5-310-50  C to provide the actuarial opinion and supporting memorandum as required by §   38.2-1367  of the Code of Virginia.\n "Asset adequacy analysis" means an analysis that meets the standards and other requirements referred to in  14VAC5-310-50  D.\n "Commission" means the Virginia State Corporation Commission.\n "Commissioner" means the Commissioner of Insurance in Virginia unless specific reference is made to another state, in which case "commissioner" means the Insurance Commissioner, Director, Superintendent or other supervising regulatory official of a given state who is responsible for administering the insurance laws of that state.\n "Company" means a life insurer, company or fraternal benefit society subject to the provisions of this chapter.\n "NAIC" means the National Association of Insurance Commissioners.\n "Qualified actuary" means any individual who meets the requirements set forth in  14VAC5-310-50  B.   Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Regulation 45, Case No. INS920377, § 4, eff. December 15, 1992; amended, Virginia Register  Volume 20, Issue 5 , eff. December 31, 2003;  Volume 31, Issue 9 , eff. January 1, 2015.    14VAC5-310-50. General requirements for actuarial opinions.  A. The following requirements apply to all companies submitting a statement of actuarial opinion in compliance with §   38.2-1367  of the Code of Virginia.\n 1. There is to be included on or attached to page 1 of the annual statement for each year ending on or after December 31, 1992, the statement of an appointed actuary, entitled "Statement of Actuarial Opinion," setting forth an opinion relating to reserves and related actuarial items held in support of policies and contracts, in accordance with  14VAC5-310-80 .\n 2. Upon written request by the company, the commission may grant an extension of the date for submission of the statement of actuarial opinion.\n B. A "qualified actuary" is an individual who:\n 1. Is a member in good standing of the American Academy of Actuaries;\n 2. Is qualified to sign statements of actuarial opinion for life and health insurance company annual statements in accordance with the American Academy of Actuaries qualification standards for actuaries signing such statements;\n 3. Is familiar with the valuation requirements applicable to life and health insurance companies;\n 4. Has not been found by the commission (or if so found has subsequently been reinstated as a qualified actuary), following appropriate notice and hearing, to have:\n a. Violated any provision of, or any obligation imposed by Title 38.2 of the Code of Virginia or other law in the course of his dealings as a qualified actuary;\n b. Been found guilty of fraudulent or dishonest practices;\n c. Demonstrated his incompetency, lack of cooperation, or untrustworthiness to act as a qualified actuary;\n d. Submitted to the commission during the past five years, pursuant to this chapter, an actuarial opinion or memorandum that the commission rejected because it did not meet the provisions of this chapter, including standards set by the Actuarial Standards Board; or\n e. Resigned or been removed as an actuary within the past five years as a result of acts or omissions indicated in any adverse report on examination or as a result of failure to adhere to generally acceptable actuarial standards; and\n 5. Has not failed to notify the commission of any action taken by the commissioner of any other state similar to that under subdivision 4 of this subsection.\n C. An "appointed actuary" is a qualified actuary who is appointed or retained to prepare the statement of actuarial opinion required by this chapter, either directly by or by the authority of the board of directors through an executive officer of the company other than the qualified actuary. The company shall give the commission timely written notice of the name, title (and, in the case of a consulting actuary, the name of the firm) and manner of appointment or retention of each person appointed or retained by the company as an appointed actuary and shall state in such notice that the person meets the requirements set forth in  14VAC5-310-50  B. Once notice is furnished, no further notice is required with respect to this person, provided that the company shall give the commission timely written notice in the event the actuary ceases to be appointed or retained as an appointed actuary or to meet the requirements set forth in  14VAC5-310-50  B. If any person appointed or retained as an appointed actuary replaces a previously appointed actuary, the notice shall so state and give the reasons for replacement.\n D. The asset adequacy analysis required by this chapter shall:\n 1. Conform to the Actuarial Standards of Practice as promulgated from time to time by the Actuarial Standards Board and on any additional standards under this chapter, which standards are to form the basis of the statement of actuarial opinion in accordance with  this chapter; and\n 2. Be based on methods of analysis as are deemed appropriate for such purposes by the Actuarial Standards Board.\n E. Liabilities shall be covered in conformity with the following:\n 1. Under authority of §   38.2-1367  of the Code of Virginia, the statement of actuarial opinion shall apply to all in-force business on the statement date, whether directly issued or assumed, regardless of when or where issued (e.g., reserves reportable for 2002 in Exhibits 5, 5A, 6, and 7 of the NAIC annual statement for life insurers; claim liabilities reported in Exhibit 8 (2002) in Part I of the life insurer's annual statement, and equivalent items in any separate account statement, or other annual financial statements filed pursuant to §  38.2-1300 ,  38.2-1301  or  38.2-4126  of the Code of Virginia).\n 2. If the appointed actuary determines as the result of asset adequacy analysis that a reserve should be held in addition to the aggregate reserve held by the company and calculated in accordance with methods set forth in §  38.2-1311 ,  38.2-3923 ,  38.2-4010 ,  38.2-4011 , or §  38.2-4125  of the Code of Virginia; Article  10 (§  38.2-1365  et seq.) of Chapter  13 of Title 38.2 of the Code of Virginia; a rule or regulation of the commission applicable to the company; or any additional or further guidance provided by the NAIC Accounting Practices and Procedures Manual, whether in a Statement of Statutory Accounting Principle or in an actuarial guideline or other appendix, the company shall establish the additional reserve.\n 3. Additional reserves established under subdivision 2 of this subsection and deemed not necessary in subsequent years may be released. Any amounts released shall be disclosed in the actuarial opinion for the applicable year. The release of such reserves would not be deemed an adoption of a lower standard of valuation.   Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Regulation 45, Case No. INS920377, § 5, eff. December 15, 1992; amended, Virginia Register  Volume 20, Issue 5 , eff. December 31, 2003;  Volume 31, Issue 9 , eff. January 1, 2015.    14VAC5-310-60. (Repealed.)    Historical Notes     Derived from Regulation 45, Case No. INS920377, §§ 6, 7, eff. December 15, 1992; repealed, Virginia Register Volume 20, Issue 5, eff. December 31, 2003.     14VAC5-310-80. Statement of actuarial opinion based on an asset adequacy analysis.  A. The statement of actuarial opinion submitted in accordance with this section shall consist of:\n 1. A paragraph identifying the appointed actuary and his qualifications (and complying with the requirements of subdivision B 1 of this section;\n 2. A scope paragraph identifying the subjects on which an opinion is to be expressed and describing the scope of the appointed actuary's work, including a tabulation delineating the reserves and related actuarial items that have been analyzed for asset adequacy and the method of analysis, and identifying the reserves and related actuarial items covered by the opinion that have not been so analyzed (see subdivision B 2 of this section);\n 3. A reliance paragraph describing those areas, if any, where the appointed actuary has deferred to other experts in developing data, procedures or assumptions, (e.g., anticipated cash flows from currently owned assets, including variation in cash flows according to economic scenarios (see subdivision B 3 of this section)), supported by a statement of each such expert in the form prescribed by subsection E of this section;\n 4. An opinion paragraph expressing the appointed actuary's opinion with respect to the adequacy of the supporting assets to mature the liabilities (see subdivision B 6 of this section); and\n 5. One or more additional paragraphs, which will be needed in individual company cases to address matters such as the following:\n a. If the appointed actuary considers it necessary to state a qualification of the opinion;\n b. If the appointed actuary must disclose an inconsistency in the method of analysis or basis of asset allocation used at the prior opinion date with that used for this opinion;\n c. If the appointed actuary must disclose whether additional reserves of the prior opinion date are released as of this opinion date, and the extent of the release;\n d. If the appointed actuary chooses to add a paragraph briefly describing the assumptions that form the basis for the actuarial opinion.\n B. The following paragraphs are to be included in the statement of actuarial opinion in accordance with this section. Language is that which in typical circumstances should be included in a statement of actuarial opinion. The language may be modified as needed to meet the circumstances of a particular case, but the appointed actuary should use language that clearly expresses his professional judgment. However, in any event the opinion shall retain all pertinent aspects of the language provided in this section.\n 1. The opening paragraph should generally indicate the appointed actuary's relationship to the company and his qualifications to sign the opinion. For a company actuary, the opening paragraph of the actuarial opinion should include a statement such as:\n "I, [name], am [title] of [insurance company name] and a member of the American Academy of Actuaries. I was appointed by, or by the authority of, the Board of Directors of said insurer to render this opinion as stated in the letter to the commission dated [insert date]. I meet the Academy qualification standards for rendering the opinion and am familiar with the valuation requirements applicable to life and health insurance companies."\n For a consulting actuary, the opening paragraph should contain a statement such as:\n "I, [name], a member of the American Academy of Actuaries, am associated with the firm of [name of consulting firm]. I have been appointed by, or by the authority of, the Board of Directors of [name of company] to render this opinion as stated in the letter to the commission dated [insert date]. I meet the Academy qualification standards for rendering the opinion and am familiar with the valuation requirements applicable to life and health insurance companies."\n 2. The scope paragraph should include a statement such as:\n "I have examined the actuarial assumptions and actuarial methods used in determining reserves and related actuarial items listed below, as shown in the annual statement of the company, as prepared for filing with state regulatory officials, as of December 31, 20[__]. Tabulated below are those reserves and related actuarial items that have been subjected to asset adequacy analysis.\n                  Asset Adequacy Tested Amounts ((1) and (2)) – Reserves and   Liabilities                   Statement Item             (1)    Formula Reserves             (2)    Additional Actuarial Reserves (a)              Analysis Method (b)              (3)    Other Amount             (4)    Total Amount    (1)+(2)+(3)                   Exhibit 5    A. Life Insurance                                                                                         B. Annuities                                                                                         C. Supplementary Contracts With Life Contingencies                                                                                         D. Accidental Death Benefits                                                                                         E. Disability – Active Lives                                                                                         F. Disability – Disabled Lives                                                                                         G. Miscellaneous Reserves                                                                                         Total (Exh. 5 – Page 3, Item 1)                                                                                         Other actuarial items (Page ...., Line .....)                                                                                         Exhibit 6    A. Active Life Reserve                                                                                         B. Claim Reserve                                                                                         Total (Exh. 6 – Page 3, Item 2)                                                                                         Exhibit 7    Guaranteed Interest Contracts (Column 2, Line 14)                                                                                         Supplemental Contracts and Annuities Certain (Column 3, Line   14)                                                                                         Dividend Accumulations or Refunds (Column 4, Line 14)                                                                                         Deposit-type Contracts (Column 5, Line 14)                                                                                         Other (Column 6, Line 14)                                                                                         Total – Exh. 7 Net Balance (Column 1, Line 14)                                                                                         Exhibit 8 - Part 1    1. Life (Page 3, Item 4.1)                                                                                         2. Health (Page 3, Item 4.2)                                                                                         Total Exhibit 8, Part 1                                                                                         Separate Accounts (Page 3 of the Annual Statement of the Separate   Accounts, Items 1, 2, 3.1, 3.2, 3.3)                                                                                         TOTAL RESERVES                                                                                                                  IMR (General Account, Page ___ Line ___)                                               (Separate Accounts, Page ___ Line ___)                                               AVR (Page ___ Line ___)              (c)                                  Net Deferred and Uncollected Premium                           Notes: (a) The additional actuarial reserves are the reserves established under  14VAC5-310-50  E 2.\n (b) The appointed actuary should indicate the method of analysis, determined in accordance with the standards for asset adequacy analysis referred to in  14VAC5-310-50  D, by means of symbols which should be defined in footnotes to the table.\n (c) Allocated amount of Asset Valuation Reserve (AVR)."\n 3. If the appointed actuary has relied on other experts to develop certain portions of the analysis, the reliance paragraph should include a statement such as:\n "I have relied on [name], [title] for [e.g., "anticipated cash flows from currently owned assets, including variations in cash flows according to economic scenarios" or "certain critical aspects of the analysis performed in conjunction with forming my opinion"], as certified in the attached statement. I have reviewed the information relied upon for reasonableness."\n Such a statement of reliance on other experts should be accompanied by a statement by each of such experts in the form prescribed by subsection E of this section.\n 4. If the appointed actuary has examined the underlying asset and liability records, the reliance paragraph should also include a statement such as:\n "My examination included such review of the actuarial assumptions and actuarial methods and of the underlying basic asset and liability records and such tests of the actuarial calculations as I considered necessary. I also reconciled the underlying basic asset and liability records to [exhibits and schedules listed as applicable] of the company's current annual statement."\n 5. If the appointed actuary has not examined the underlying records, but has relied upon data (e.g., listings and summaries of policies in-force and asset records) prepared by the company or a third party, the reliance paragraph should include a statement such as:\n "In forming my opinion on [specify type of reserves], I have relied upon data prepared by [name and title of company officer certifying in-force records or other data] as certified in the attached statements. I evaluated that data for reasonableness and consistency. I also reconciled that data to [exhibits and schedules to be listed as applicable] of the company's current annual statement. In other respects my examination included review of the actuarial assumptions and actuarial methods and tests of the actuarial calculations I considered necessary."\n This part of the statement shall be accompanied by a statement by each person relied upon in a form substantially similar to that prescribed by subsection E of this section.\n 6. The opinion paragraph should include a statement such as:\n "In my opinion the reserves and related actuarial values concerning the statement items identified above:\n a. Are computed in accordance with presently accepted actuarial standards consistently applied and are fairly stated, in accordance with sound actuarial principles;\n b. Are based on actuarial assumptions that produce reserves at least as great as those called for in any contract provision as to reserve basis and method, and are in accordance with all other contract provisions;\n c. Meet the requirements of Title 38.2 of the Code of Virginia and related rules, regulations and administrative promulgations [OR: the insurance law and regulation of the state of domicile] and are at least as great as the minimum aggregate amounts required by the state in which this statement is filed;\n d. Are computed on the basis of assumptions consistent with those used in computing the corresponding items in the annual statement of the preceding year-end (with any exceptions noted below); and\n e. Include provision for all actuarial reserves and related statement items which ought to be established.\n The reserves and related items, when considered in light of the assets held by the company with respect to such reserves and related actuarial items including, but not limited to, the investment earnings on the assets, and the considerations anticipated to be received and retained under the policies and contracts, make adequate provision, according to presently accepted actuarial standards of practice, for the anticipated cash flows required by the contractual obligations and related expenses of the company.\n The actuarial methods, considerations and analyses used in forming my opinion conform to the appropriate Actuarial Standards of Practice as promulgated by the Actuarial Standards Board, which standards form the basis of this statement of opinion."\n AND ONE OF THE FOLLOWING TWO PARAGRAPHS, WHICHEVER IS APPLICABLE:\n "This opinion is updated annually as required by statute. To the best of my knowledge, there have been no material changes from the applicable date of the annual statement to the date of the rendering of this opinion which should be considered in reviewing this opinion."\n OR:\n "The following material change(s), which occurred between the date of the statement for which this opinion is applicable and the date of this opinion, should be considered in reviewing this opinion:" [Describe the change or changes].\n AND:\n "The impact of unanticipated events subsequent to the date of this opinion is beyond the scope of this opinion. The analysis of asset adequacy portion of this opinion should be viewed recognizing that the company's future experience may not follow all the assumptions used in the analysis.                                                                 Signature of Appointed Actuary                                        Address of Appointed Actuary                                        Telephone Number of Appointed Actuary                                        Date"              C. The adoption for new issues or new claims or other new liabilities of an actuarial assumption that differs from a corresponding assumption used for prior new issues or new claims or other new liabilities is not a change in actuarial assumptions within the meaning of this section.\n D. If the appointed actuary is unable to form an opinion, he shall refuse to issue a statement of actuarial opinion. If the appointed actuary's opinion is adverse or qualified, he shall issue an adverse or qualified actuarial opinion explicitly stating the reason or reasons for the opinion. This statement should follow the scope paragraph and precede the opinion paragraph.\n E. If the appointed actuary relies on the certification of others on matters concerning the accuracy or completeness of any data underlying the actuarial opinion, or the appropriateness of any other information used by the appointed actuary in forming the actuarial opinion, the actuarial opinion should so indicate the persons the actuary is relying upon and a precise identification of the items subject to reliance. In addition, the persons on whom the appointed actuary relies shall provide a certification that precisely identifies the items on which the person is providing information and a statement as to the accuracy, completeness or reasonableness, as applicable, of the items. This certification shall include the signature, title, company, address, and telephone number of the person rendering the certification, as well as the date on which it is signed.   Statutory Authority  §§  12.1-13 ,  38.2-223 , and 38.2-3127.1 of the Code of Virginia.  Historical Notes  Derived from Regulation 45, Case No. INS920377, § 8, eff. December 15, 1992; amended, Virginia Register  Volume 20, Issue 5 , eff. December 31, 2003; Errata, 20:8 VA.R. 850 December 29, 2003.    14VAC5-310-90. Description of actuarial memorandum issued for an asset adequacy analysis and regulatory asset adequacy issues summary.  A. The following general provisions shall apply with respect to the preparation and submission of the asset adequacy memorandum required by §   38.2-1367  of the Code of Virginia.\n 1. In accordance with §   38.2-1367  of the Code of Virginia, the appointed actuary shall prepare a memorandum to the company describing the analysis done in support of his opinion regarding the reserves. The memorandum shall be made available for examination by the commission upon its request but shall be returned to the company after such examination and shall not be considered a record of the Bureau of Insurance or subject to automatic filing with the commission.\n 2. In preparing the memorandum, the appointed actuary may rely on, and include as a part of his memorandum, memoranda prepared and signed by other actuaries who are qualified within the meaning of  14VAC5-310-50  B, with respect to the areas covered in such memoranda, and so state in their memoranda.\n 3. If the commission requests a memorandum and no such memorandum exists or if the commission finds that the analysis described in the memorandum fails to meet the standards of the Actuarial Standards Board or the standards and requirements of this chapter, the commission may designate a qualified actuary to review the opinion and prepare such supporting memorandum as is required for review. The reasonable and necessary expense of the independent review shall be paid by the company but shall be directed and controlled by the commission.\n 4. The reviewing actuary shall have the same status as an examiner for purposes of obtaining data from the company and the work papers and documentation of the reviewing actuary shall be retained by the commission; however, any information provided by the company to the reviewing actuary and included in the work papers shall be considered as material provided by the company to the commission and shall be kept confidential to the same extent as is prescribed by law with respect to other material provided by the company to the commission pursuant to the statute governing this chapter. The reviewing actuary shall not be an employee of a consulting firm involved with the preparation of any prior memorandum or opinion for the insurer pursuant to this chapter for any one of the current year or the preceding three years.\n 5. In accordance with §   38.2-1367  of the Code of Virginia, the appointed actuary shall prepare a regulatory asset adequacy issues summary, the contents of which are specified in subsection C of this section. The regulatory asset adequacy issues summary shall be submitted no later than March 15 of the year following the year for which a statement of actuarial opinion based on asset adequacy is required. The regulatory asset adequacy issues summary is to be kept confidential to the same extent and under the same conditions as the actuarial memorandum.\n B. A section of the memorandum shall document asset adequacy testing by demonstrating that the analysis has been done in accordance with the standards for asset adequacy referred to in  14VAC5-310-50  D and any additional standards under this chapter. It shall specify:\n 1. For reserves:\n a. Product descriptions including market description, underwriting and other aspects of a risk profile, and the specific risks the appointed actuary deems significant;\n b. Source of liability in force;\n c. Reserve method and basis;\n d. Investment reserves;\n e. Reinsurance arrangements;\n f. Identification of any explicit or implied guarantees made by the general account in support of benefits provided through a separate account policy or contract and the methods used by the appointed actuary to provide for the guarantees in the asset adequacy analysis; and\n g. Documentation of assumptions to test reserves for (i) lapse rates, whether base or excess, (ii) interest crediting rate strategy, (iii) mortality, (iv) policyholder dividend strategy, (v) competitor or market interest rate, (vi) annuitization rates, (vii) commission and expenses, and (viii) morbidity.\n The documentation of the assumptions shall be such that an actuary reviewing the actuarial memorandum could form a conclusion as to the reasonableness of the assumption.\n 2. For assets:\n a. Portfolio descriptions, including a risk profile disclosing the quality, distribution and types of assets;\n b. Investment and disinvestment assumptions;\n c. Source of asset data;\n d. Asset valuation bases; and\n e. Documentation of assumptions made for (i) default costs, (ii) bond call function, (iii) mortgage prepayment function, (iv) determining market value for assets sold due to disinvestment strategy, and (v) determining yield on assets acquired through the investment strategy.\n The documentation of the assumptions shall be such that an actuary reviewing the actuarial memorandum could form a conclusion as to the reasonableness of the assumption.\n 3. For the analysis basis:\n a. Methodology;\n b. Rationale for inclusion or exclusion of different blocks of business and how pertinent risks were analyzed;\n c. Rationale for degree of rigor in analyzing different blocks of business, including the rationale for the level of "materiality" that was used in determining how rigorously to analyze different blocks of business;\n d. Criteria for determining asset adequacy, including in the criteria the precise basis for determining if assets are adequate to cover reserves under "moderately adverse conditions" or other conditions as specified in relevant actuarial standards of practice; and\n e. Whether the impact of federal income taxes was considered and the method of treating reinsurance in the asset adequacy analysis.\n 4. Summary of material changes in methods, procedures, or assumptions from prior year's asset adequacy analysis;\n 5. Summary of results; and\n 6. Conclusion.\n C. The regulatory asset adequacy issues summary shall contain the name of the company for which the regulatory asset adequacy issues summary is being supplied and shall be signed and dated by the appointed actuary rendering the actuarial opinion. The regulatory asset adequacy issues summary also shall include each of the following:\n 1. Descriptions of the scenarios tested, including whether those scenarios are stochastic or deterministic, and the sensitivity testing done relative to those scenarios. If negative ending surplus results under certain tests in the aggregate, the actuary should describe those tests and the amount of additional reserve as of the valuation date which, if held, would eliminate the negative aggregate surplus values. Ending surplus values shall be determined by either extending the projection period until the in-force and associated assets and liabilities at the end of the projection period are immaterial or by adjusting the surplus amount at the end of the projection period by an amount that appropriately estimates the value that reasonably can be expected to arise from the assets and liabilities remaining in force;\n 2. The extent to which the appointed actuary uses assumptions in the asset adequacy analysis that are materially different from the assumptions used in the previous asset adequacy analysis;\n 3. The amount of reserves and the identity of the product lines that had been subjected to asset adequacy analysis in the prior opinion but were not subject to analysis for the current opinion;\n 4. Comments on any interim results that may be of significant concern to the appointed actuary. For example, the impact of the insufficiency of assets to support the payment of benefits and expenses and the establishment of statutory reserves during one or more interim periods;\n 5. The methods used by the actuary to recognize the impact of reinsurance on the company's cash flows, including both assets and liabilities, under each of the scenarios tested; and\n 6. Whether the actuary has been satisfied that all options whether explicit or embedded, in any asset or liability, including but not limited to those affecting cash flows embedded in fixed income securities, and equity-like features in any investments have been appropriately considered in the asset adequacy analysis.\n D. The actuarial methods, considerations, and analyses shall conform to appropriate standards of practice and the memorandum shall include the following statement:\n "Actuarial methods, considerations and analyses used in the preparation of this memorandum conform to the appropriate Standards of Practice as promulgated by the Actuarial Standards Board, which standards form the basis for this memorandum."\n E. An appropriate allocation of assets in the amount of Interest Maintenance Reserve (IMR), whether positive or negative, shall be used in any asset adequacy analysis. Analysis of risks regarding asset default shall include an appropriate allocation of assets supporting the Asset Valuation Reserve (AVR); these AVR assets shall not be applied for any other risks with respect to reserve adequacy. Analysis of these and other risks shall include assets supporting other mandatory or voluntary reserves available to the extent not used for risk analysis and reserve support. The amount of the assets used for the AVR shall be disclosed in the Table of Reserves and Liabilities of the opinion and in the memorandum. The method used for selecting particular assets or allocated portions of assets shall be disclosed in the memorandum.   Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Regulation 45, Case No. INS920377, § 9, eff. December 15, 1992; amended, Virginia Register  Volume 20, Issue 5 , eff. December 31, 2003;  Volume 26, Issue 9 , eff. December 31, 2009;  Volume 31, Issue 9 , eff. January 1, 2015.    14VAC5-310-100. Record retention.  The appointed actuary shall retain on file, for at least seven years, sufficient documentation so that it will be possible to determine the procedures followed, the analyses performed, the bases for assumptions and the results obtained.   Statutory Authority  §§  12.1-13 ,  38.2-223 , and 38.2-3127.1 of the Code of Virginia.  Historical Notes  Derived from Regulation 45, Case No. INS920377, § 10, eff. December 15, 1992; amended, Virginia Register  Volume 20, Issue 5 , eff. December 31, 2003.    14VAC5-310-105. Notification of an opinion in error; amended opinion.    A. The insurer required to furnish an actuarial opinion shall require its appointed actuary to notify its Board of Directors or its audit committee, in writing, within five business days after any determination by the appointed actuary that the opinion or other valuation submitted to the domiciliary commissioner was in error as a result of reliance on data or other information, other than assumptions, that, as of the balance sheet date, was factually incorrect.  The opinion shall be considered to be in error if the opinion would not have been issued or would have been materially altered had the correct data or other information been used.  The opinion shall not be considered in error if it would have been materially altered or not issued solely because of data or information concerning events subsequent to the balance sheet date or because actual results differ from those projected.     B. Notification shall be required when a determination prescribed by this section is made between the issuance of the opinion and the balance sheet date for which the next opinion will be issued.  The notification shall include a summary of such findings and an amended opinion.     C. An insurer that is notified pursuant to subsections A or B of this section shall forward a copy of the summary and amended opinion to the domiciliary commissioner within five business days of receipt of such report and shall provide the appointed actuary making the notification with notice of the transmittal and a copy of the summary and amended opinion being furnished to the domiciliary commissioner.  If the appointed actuary fails to receive the notice and prescribed copies within the five-business-day period referred to in the previous sentence, that appointed actuary shall notify the domiciliary commissioner within the next five business days that the submitted opinion should no longer be relied.     D. If the actuary learns that the data or other information relied upon was factually incorrect, but cannot determine what, if any, changes are needed in the statement of opinion, the actuary and the company shall undertake as quickly as is reasonably practicable those procedures necessary for the actuary to make the determination described in subsection A of this section.  If the insurer does not provide the necessary data corrections and other support, including financial support, within 10 business days, the actuary shall proceed to notify the domiciliary commissioner in accordance with provisions in subsection C of this section.     E. No qualified actuary shall be liable in any manner to any person for any statement made pursuant to this section if the statement is made in a good faith effort to comply with this section.   Statutory Authority  §§  12.1-13 ,  38.2-223 , and 38.2-3127.1 of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 20, Issue 5 , eff. December 31, 2003.    14VAC5-310-110. (Repealed.)    Historical Notes     Derived from Regulation 45, Case No. INS920377, § 11, eff. December 15, 1992; repealed, Virginia Register Volume 20, Issue 5, eff. December 31, 2003.     14VAC5-310-120. Severability.    If any provision of this chapter ( 14VAC5-310-10  et seq.), or its application to any person, company or circumstance, is held invalid, such determination shall not affect other provisions or applications of this chapter, which can be given effect without the invalid provision or application, and to that end the provisions of this chapter are severable.   Statutory Authority  §§  12.1-13 ,  38.2-223 , and 38.2-3127.1 of the Code of Virginia.  Historical Notes  Derived from Regulation 45, Case No. INS920377, § 12, eff. December 15, 1992.\n                     Website addresses provided in the Virginia Administrative Code to documents incorporated by reference are for the reader's convenience only, may not necessarily be active or current, and should not be relied upon. To ensure the information incorporated by reference is accurate, the reader is encouraged to use the source document described in the regulation.\n                     As a service to the public, the Virginia Administrative Code is provided online by the Virginia General Assembly. We are unable to answer legal questions or respond to requests for legal advice, including application of law to specific fact. To understand and protect your legal rights, you should consult an attorney.\n\n\t\t\t\t\t\t\t Code of Virginia\n\n\t\t\t\t\t\t\t Administrative Code\n\n\t\t\t\t\t\t\t View by Agency\n\n\t\t\t\t\t\t\t Emergency Regulations\n\n\t\t\t\t\t\t\t VAC# Look Up\n\n\t\t\t\t\t\t\t\t Go\n\n\t\t\t\t\t\t\t Constitution of Virginia\n\n\t\t\t\t\t\t\t Charters\n\n\t\t\t\t\t\t\t Authorities\n\n\t\t\t\t\t\t\t Compacts\n\n\t\t\t\t\t\t\t Uncodified Acts\n\n                             Sign In\n\n                                 Username: \n\n                                 Password: \n\n                                 Cancel\n\n                                  LIS Home\n                                  Lobbyist-in-a-Box\n                                  Privacy Policy\n\n                                © Copyright Commonwealth of Virginia,\n                                 . All rights reserved. Site developed by the  Division of Legislative Automated Systems (DLAS) .\n                                 Sign In","text_length":45159}
{"slug":"va-14vac5-319","jurisdiction":"VA","agency":"SCC-BOI","doc_type":"regulation","citation":"14 VAC 5-319","title":"Chapter 319. Life Insurance Reserves","official_source_url":"https://law.lis.virginia.gov/admincodefull/title14/agency5/chapter319/","access_class":"statutory-public","access_notes":"law.lis.virginia.gov (DLAS self-hosted); gate-zero TOP-20 VA admin code row.","first_seen_at":"2026-07-20T01:49:34.270808+00:00","last_checked_at":"2026-07-20T06:39:10.939479+00:00","versions":[{"fetched_at":"2026-07-20T01:49:34.270808+00:00","version_no":1,"text_length":157627,"effective_date":null,"content_sha256_short":"ebd5146c9c6d"}],"text":"14VAC5-319-80. Severability.\n\n                      Virginia General Assembly  /\n                      LIS Learning Center  /\n                      Privacy Policy  /\n                      LIS home  /\n                      Register Account  /\n                      Login\n\n                     Session Information\n\n                     Bills & Resolutions\n\n                     State Budget\n\n                     Virginia Law\n\n                     Reports to the General Assembly\n\n                          Virginia Law\n\n                                 Select Search Type\n\n                                     All\n                                     Code of Virginia\n                                     Administrative Code\n                                     Constitution\n                                     Charters\n                                     Authorities\n                                     Compacts\n                                     Uncodified Acts\n\n                  Administrative Code\n                   Table of Contents   »  Title 14. Insurance  »  Agency 5. State Corporation Commission, Bureau of Insurance  »  Chapter 319. Life Insurance Reserves\n\n                            Chapter\n\n                          Print\n\n                      Virginia Administrative Code\n\n                      Chapter 319. Life Insurance Reserves  14VAC5-319-10. Definitions.  The following words and terms when used in this regulation shall have the following meanings, unless the context clearly indicates otherwise:\n "1980 CSO valuation tables" means the Commissioners' 1980 Standard Ordinary Mortality Table (1980 CSO Table) without 10-year selection factors, incorporated into the 1980 amendments to the NAIC Standard Valuation Law, and variations of the 1980 CSO Table approved by the NAIC, such as the smoker and nonsmoker versions approved in December 1983.\n "Basic reserves" means reserves calculated in accordance with §   38.2-1372  of the Code of Virginia.\n "Commission" means the State Corporation Commission when acting pursuant to or in accordance with Title 38.2 of the Code of Virginia.\n "Contract segmentation method" means the method of dividing the period from issue to mandatory expiration of a policy into successive segments, with the length of each segment being defined as the period from the end of the prior segment (from policy inception, for the first segment) to the end of the latest policy year as determined below. All calculations are made using the 1980 CSO valuation tables, as defined in this section, (or any other valuation mortality table adopted by the NAIC after January 1, 2000, and promulgated by regulation by the commission for this purpose) and, if elected, the optional minimum mortality standard for deficiency reserves stipulated in  14VAC5-319-40  B.\n The length of a particular contract segment shall be set equal to the minimum of the value t for which G t  is greater than R t  (if G t  never exceeds R t , the segment length is deemed to be the number of years from the beginning of the segment to the mandatory expiration date of the policy), where G t  and R t  are defined as follows:                         G t  =          GP x+k+t                 GP x+k+t-1             where:\n x = original issue age;\n k = the number of years from the date of issue to the beginning of the segment;\n t = 1, 2,...; t is reset to 1 at the beginning of each segment; and\n GP x+k+t-1  = Guaranteed gross premium per $1,000 of face amount for year t of the segment, ignoring policy fees only if level for the premium paying period of the policy.                         R t  =          q x+k+t                 q x+k+t-1             where:\n R t  may be increased or decreased by 1.0% in any policy year, at the company's option, but R t  shall not be less than one; and\n x, k and t are as defined above; and\n q x+k+t-1  = valuation mortality rate for deficiency reserves in policy year k+t but using the mortality of  14VAC5-319-40  B 2 if  14VAC5-319-40  B 3 is elected for deficiency reserves. However, if GP x+k+t  is greater than 0 and GP x+k+t-1  is equal to 0, G t  shall be deemed to be 1,000. If GP x+k+t  and GP x+k+t-1  are both equal to 0, G t  shall be deemed to be 0.\n "Deficiency reserves" means the excess, if greater than 0, of (i) minimum reserves calculated in accordance with §   38.2-1376  of the Code of Virginia over (ii) basic reserves.\n "Guaranteed gross premiums" means the premiums under a policy of life insurance that are guaranteed and determined at issue.\n "Maximum valuation interest rates" means the interest rates defined in §   38.2-1371  of the Code of Virginia that are to be used in determining the minimum standard for the valuation of life insurance policies.\n "NAIC" means the National Association of Insurance Commissioners.\n "Scheduled gross premium" means the smallest illustrated gross premium at issue for other than universal life insurance policies. For universal life insurance policies, scheduled gross premium means the smallest specified premium described in  14VAC5-319-60  A 3 or, if none is so described, the minimum premium described in  14VAC5-319-60  A 4.\n "Segmented reserves" means reserves, calculated using segments produced by the contract segmentation method, equal to the present value of all future guaranteed benefits less the present value of all future net premiums to the mandatory expiration of a policy, where the net premiums within each segment are a uniform percentage of the respective guaranteed gross premiums within the segment. The uniform percentage for each segment is such that, at the beginning of the segment, the present value of the net premiums within the segment equals:\n 1. The present value of the death benefits within the segment, plus\n 2. The present value of any unusual guaranteed cash value (see  14VAC5-319-50  D) occurring at the end of the segment, less\n 3. Any unusual guaranteed cash value occurring at the start of the segment, plus\n 4. For the first segment only, the excess of subdivision 4 a over subdivision 4 b of this definition, as follows:\n a. A net level annual premium equal to the present value, at the date of issue, of the benefits provided for in the first segment after the first policy year, divided by the present value, at the date of issue, of an annuity of one per year payable on the first and each subsequent anniversary within the first segment on which a premium falls due. However, the net level annual premium shall not exceed the net level annual premium on the 19-year premium whole life plan of insurance of the same renewal year equivalent level amount at an age one year higher than the age at issue of the policy.\n b. A net one-year term premium for the benefits provided for in the first policy year.\n The length of each segment is determined by the "contract segmentation method," as defined in this section.\n The interest rates used in the present value calculations for any policy may not exceed the maximum valuation interest rate, determined with a guarantee duration equal to the sum of the lengths of all segments of the policy.\n For both basic reserves and deficiency reserves computed by the segmented method, present values shall include future benefits and net premiums in the current segment and in all subsequent segments.\n "Tabular cost of insurance" means the net single premium at the beginning of a policy year for one-year term insurance in the amount of the guaranteed death benefit in that policy year.\n "Ten-year select mortality factors" means the select factors adopted by the NAIC with the 1980 amendments to the NAIC Standard Valuation Law.\n "This regulation" means Chapter 319 of Title 14 of the Virginia Administrative Code  ( 14VAC5-319 ), which also shall be known as the commission's Rules Establishing Minimum Valuation and Reserve Standards for Life Insurance Policies.\n "Twenty-year select mortality factors" means the select factors adopted by the NAIC as part of the Valuation of Life Insurance Policies Model Regulation and shown in the tables in  14VAC5-319-70 .\n "Unitary reserves" means the present value of all future guaranteed benefits less the present value of all future modified net premiums, where:\n 1. Guaranteed benefits and modified net premiums are considered to the mandatory expiration of the policy; and\n 2. Modified net premiums are a uniform percentage of the respective guaranteed gross premiums, where the uniform percentage is such that, at issue, the present value of the net premiums equals the present value of all death benefits and pure endowments, plus the excess of subdivision 2 a over subdivision 2 b of this definition, as follows:\n a. A net level annual premium equal to the present value, at the date of issue, of the benefits provided for after the first policy year, divided by the present value, at the date of issue, of an annuity of one per year payable on the first and each subsequent anniversary of the policy on which a premium falls due. However, the net level annual premium shall not exceed the net level annual premium on the 19-year premium whole life plan of insurance of the same renewal year equivalent level amount at an age one year higher than the age at issue of the policy.\n b. A net one-year term premium for the benefits provided for in the first policy year.\n The interest rates used in the present value calculations for any policy may not exceed the maximum valuation interest rate, determined with a guarantee duration equal to the length from issue to the mandatory expiration of the policy.\n "Universal life insurance policy" means any individual life insurance policy under the provisions of which separately identified interest credits (other than in connection with dividend accumulations, premium deposit funds or other supplementary accounts) and mortality or expense charges are made to the policy.\n "YRT" means yearly renewable term.   Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 16, Issue 5 , eff. January 1, 2000; amended, Virginia Register  Volume 31, Issue 9 , eff. January 1, 2015.    14VAC5-319-20. Purpose.  A. The purpose of this regulation is to provide:\n 1. Tables of select mortality factors and rules for their use;\n 2. Rules establishing minimum valuation and reserve standards for plans with nonlevel premiums or benefits; and\n 3. Rules establishing minimum valuation and reserve standards for plans with secondary guarantees.\n B. The method for calculating basic reserves defined in this regulation will constitute the Commissioners' Reserve Valuation Method for policies to which this regulation is applicable.   Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 16, Issue 6 , eff. January 1, 2000.    14VAC5-319-30. Applicability.  A. This regulation shall apply to all life insurance policies, with or without nonforfeiture values, issued on or after January 1, 2000, subject to the exceptions and conditions in subsections B and C of this section.\n B. Exceptions to this regulation.\n 1. This regulation shall not apply to any individual life insurance policy issued on or after January 1, 2000, if the policy is issued in accordance with and as a result of the exercise of a reentry provision contained in the original life insurance policy of the same or greater face amount, issued before January 1, 2000, that guarantees the premium rates of the new policy. This regulation also shall not apply to subsequent policies issued as a result of the exercise of such a provision, or a derivation of the provision, in the new policy.\n 2. This regulation shall not apply to any universal life policy that meets all the following requirements:\n a. Secondary guarantee period, if any, is five years or less;\n b. Specified premium for the secondary guarantee period is not less than the net level reserve premium for the secondary guarantee period based on the 1980 CSO valuation tables as defined in  14VAC5-319-10  and the applicable valuation interest rate; and\n c. The initial surrender charge is not less than 100% of the first year annualized specified premium for the secondary guarantee period.\n 3. This regulation shall not apply to any variable life insurance policy that provides for life insurance, the amount or duration of which varies according to the investment experience of any separate account or accounts.\n 4. This regulation shall not apply to any variable universal life insurance policy that provides for life insurance, the amount or duration of which varies according to the investment experience of any separate account or accounts.\n 5. This regulation shall not apply to a group life insurance certificate unless the certificate provides for a stated or implied schedule of maximum gross premiums required in order to continue coverage in force for a period in excess of one year.\n C. Conditions to be met:\n 1. Calculation of the minimum valuation standard for policies with guaranteed nonlevel gross premiums or guaranteed nonlevel benefits (other than universal life policies), or both, shall be in accordance with the provisions of  14VAC5-319-50 .\n 2. Calculation of the minimum valuation standard for flexible premium and fixed premium universal life insurance policies that contain provisions resulting in the ability of a policyholder to keep a policy in force over a secondary guarantee period shall be in accordance with the provisions of  14VAC5-319-60 .   Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 16, Issue 5 , eff. January 1, 2000.    14VAC5-319-40. General calculation requirements for basic reserves and premium deficiency reserves.  A. At the election of the company for any one or more specified plans of life insurance, the minimum mortality standard for basic reserves may be calculated using the 1980 CSO valuation tables with select mortality factors, or any other valuation mortality table adopted by the NAIC on or after January 1, 2000, and promulgated by regulation by the commission for this purpose. If select mortality factors are elected, they may be:\n 1. The 10-year select mortality factors incorporated into the 1980 amendments to the NAIC Standard Valuation Law;\n 2. The 20-year select mortality factors in  14VAC5-319-70 ; or\n 3. Any other table of select mortality factors adopted by the NAIC on or after January 1, 2000, and promulgated by regulation by the commission for the purpose of calculating basic reserves.\n B. Deficiency reserves, if any, are calculated for each policy as the excess, if greater than 0, of the quantity A over the basic reserve. The quantity A is obtained by recalculating the basic reserve for the policy using guaranteed gross premiums instead of net premiums when the guaranteed gross premiums are less than the corresponding net premiums. At the election of the company for any one or more specified plans of insurance, the quantity A and the corresponding net premiums used in the determination of quantity A may be based upon the 1980 CSO valuation tables with select mortality factors, or any other valuation mortality table adopted by the NAIC on or after January 1, 2000, and promulgated by regulation by the commission.\n 1. If select mortality factors are elected, they may be:\n a. The 10-year select mortality factors incorporated into the 1980 amendments to the NAIC Standard Valuation Law;\n b. The 20-year select mortality factors in  14VAC5-319-70 ;\n c. For durations in the first segment, X percent of the 20-year select mortality factors in  14VAC5-319-70 , subject to the conditions set forth in subdivisions B 2 and B 3 of this section; or\n d. Any other table of select mortality factors adopted by the NAIC after January 1, 2000, and promulgated by regulation by the commission for the purpose of calculating deficiency reserves.\n 2. When calculating X as provided by this section, the following shall apply:\n a. X may vary by policy year, policy form, underwriting classification, issue age or any other policy factor expected to affect mortality experience;\n\n  b. X is such that, when using the valuation interest rate used for basic reserves, subdivision (1) is greater than or equal to subdivision (2), as follows:\n (1) The actuarial present value of future death benefits, calculated using the mortality rates resulting from the application of X;\n (2) The actuarial present value of future death benefits calculated using anticipated mortality experience without recognition of mortality improvement beyond the valuation date;\n  c. X is such that the mortality rates resulting from the application of X are at least as great as the anticipated mortality experience, without recognition of mortality improvement beyond the valuation date, in each of the first five years after the valuation date;\n  d. The appointed actuary shall increase X at any valuation date where it is necessary to continue to meet all the requirements of subdivisions B 2 and B 3 of this section;\n  e. The appointed actuary may decrease X at any valuation date as long as X  continues to meet all the requirements of subdivisions B 2 and B 3 of this section; and\n  f. The appointed actuary specifically shall take into account the adverse effect on expected mortality and lapsation of any anticipated or actual increase in gross premiums.\n 3. If X is less than 100% at any duration for any policy, the following requirements shall be met:\n a. The appointed actuary annually shall prepare an actuarial opinion and memorandum for the company in conformance with the requirements of  14VAC5-310-90 ;\n b. The appointed actuary shall disclose, in the regulatory asset adequacy issues summary, the impact of the insufficiency of assets to support the payment of benefits and expenses and the establishment of statutory reserves during one or more interim periods; and\n c. The appointed actuary annually shall opine for all policies subject to this regulation as to whether the mortality rates resulting from the application of X meet the requirements of subdivisions B 2 and B 3 of this section. This opinion shall be supported by an actuarial report, subject to appropriate Actuarial Standards of Practice promulgated by the Actuarial Standards Board of the American Academy of Actuaries. The X factors shall reflect anticipated future mortality, without recognition of mortality improvement beyond the valuation date, taking into account relevant emerging experience.\n C. This subsection applies to both basic reserves and deficiency reserves. Any set of select mortality factors may be used only for the first segment. However, if the first segment is less than 10 years, the appropriate 10-year select mortality factors incorporated into the 1980 amendments to the NAIC Standard Valuation Law may be used thereafter through the tenth policy year from the date of issue.\n D. In determining basic reserves or deficiency reserves, guaranteed gross premiums without policy fees may be used where the calculation involves the guaranteed gross premium if the policy fee is a level dollar amount after the first policy year. In determining deficiency reserves, policy fees may be included in guaranteed gross premiums, even if not included in the actual calculation of basic reserves.\n E. Reserves for policies that have changes to guaranteed gross premiums, guaranteed benefits, guaranteed charges or guaranteed credits that are unilaterally made by the company after issue and that are effective for more than one year after the date of the change shall be the greatest of the following: (i) reserves calculated ignoring the guarantee, (ii) reserves assuming the guarantee was made at issue, and (iii) reserves assuming that the policy was issued on the date of the guarantee.\n F. The commission may require that the company document the extent of the adequacy of reserves for specified blocks, including but not limited to policies issued prior to January 1, 2000. This documentation may include a demonstration of the extent to which aggregation with other nonspecified blocks of business is relied upon in the formation of the appointed actuary opinion pursuant to and consistent with the requirements of  14VAC5-310-90 .\n G. This section is effective for valuations on and after December 31, 2008.  Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 16, Issue 5 , eff. January 1, 2000; amended, Virginia Register  Volume 26, Issue 4 , eff. September 30, 2009.    14VAC5-319-50. Calculation of minimum valuation standard for policies with guaranteed nonlevel gross premiums or guaranteed nonlevel benefits (other than ....  A. Basic reserves shall be calculated as the greater of the segmented reserves and the unitary reserves. Both the segmented reserves and the unitary reserves for any policy shall use the same valuation mortality table and selection factors. At the option of the company, in calculating segmented reserves and net premiums, either of the adjustments described in subdivision 1 or 2 of this subsection may be made:\n 1. Treat the unitary reserve, if greater than 0, applicable at the end of each segment as a pure endowment and subtract the unitary reserve, if greater than 0, applicable at the beginning of each segment from the present value of guaranteed life insurance and endowment benefits for each segment.\n 2. Treat the guaranteed cash surrender value, if greater than 0, applicable at the end of each segment as a pure endowment; and subtract the guaranteed cash surrender value, if greater than 0, applicable at the beginning of each segment from the present value of guaranteed life insurance and endowment benefits for each segment.\n B. Deficiency reserves are subject to the following:\n 1. The deficiency reserve at any duration shall be calculated:\n a. On a unitary basis if the corresponding basic reserve determined by subsection A of this section is unitary;\n b. On a segmented basis if the corresponding basic reserve determined by subsection A of this section is segmented; or\n c. On the segmented basis if the corresponding basic reserve determined by subsection A of this section is equal to both the segmented reserve and the unitary reserve.\n 2. This subsection shall apply to any policy for which the guaranteed gross premium at any duration is less than the corresponding modified net premium calculated by the method used in determining the basic reserves, but using the rate of interest and minimum valuation standards of mortality (specified in  14VAC5-319-40  B).\n 3. Deficiency reserves, if any, shall be calculated for each policy as the excess if greater than 0, for the current and all remaining periods, of the quantity A over the basic reserve, where A is obtained as indicated in  14VAC5-319-40  B.\n 4. For deficiency reserves determined on a segmented basis, the quantity A is determined using segment lengths equal to those determined for segmented basic reserves.\n C. Basic reserves may not be less than the tabular cost of insurance for the balance of the policy year, if mean reserves are used. Basic reserves may not be less than the tabular cost of insurance for the balance of the current modal period or to the paid-to-date, if later, but not beyond the next policy anniversary, if mid-terminal reserves are used. The tabular cost of insurance shall use the same valuation mortality table and interest rates as used for the calculation of the segmented reserves. However, if select mortality factors are used, they shall be the 10-year select factors incorporated into the 1980 amendments of the NAIC Standard Valuation Law. In no case shall total reserves (including basic reserves, deficiency reserves, and any reserves held for supplemental benefits that would expire upon contract termination) be less than the amount that the policyowner would receive (including the cash surrender value of the supplemental benefits, if any, referred to above), exclusive of any deduction for policy loans, upon termination of the policy.\n D. Unusual pattern of guaranteed cash surrender values follow:\n 1. For any policy with an unusual pattern of guaranteed cash surrender values, the reserves actually held prior to the first unusual guaranteed cash surrender value shall not be less than the reserves calculated by treating the first unusual guaranteed cash surrender value as a pure endowment and treating the policy as an n-year policy providing term insurance plus a pure endowment equal to the unusual cash surrender value, where n is the number of years from the date of issue to the date the unusual cash surrender value is scheduled.\n 2. The reserves actually held subsequent to any unusual guaranteed cash surrender value shall not be less than the reserves calculated by treating the policy as an n-year policy providing term insurance plus a pure endowment equal to the next unusual guaranteed cash surrender value, and treating any unusual guaranteed cash surrender value at the end of the prior segment as a net single premium, where\n a. n is the number of years from the date of the last unusual guaranteed cash surrender value prior to the valuation date to the earlier of:\n (1) The date of the next unusual guaranteed cash surrender value, if any, that is scheduled after the valuation date; or\n (2) The mandatory expiration date of the policy;\n b. The net premium for a given year during the n-year period is equal to the product of the net to gross ratio and the respective gross premium; and\n c. The net to gross ratio is equal to subdivision (1) divided by subdivision (2), as follows:\n (1) The present value, at the beginning of the n-year period, of death benefits payable during the n-year period plus the present value, at the beginning of the n-year period, of the next unusual guaranteed cash surrender value, if any, minus the amount of the last unusual guaranteed cash surrender value, if any, scheduled at the beginning of the n-year period.\n (2) The present value, at the beginning of the n-year period, of the scheduled gross premiums payable during the n-year period.\n 3. For purposes of this subsection, a policy is considered to have an unusual pattern of guaranteed cash surrender values if any future guaranteed cash surrender value exceeds the prior year's guaranteed cash surrender value by more than the sum of:\n a. 110% of the scheduled gross premium for that year;\n b. 110% of one year's accrued interest on the sum of the prior year's guaranteed cash surrender value and the scheduled gross premium using the nonforfeiture interest rate used for calculating policy guaranteed cash surrender values; and\n c. 5.0% of the first policy year surrender charge, if any.\n E. There is an optional exemption for yearly renewable term reinsurance. At the option of the company, the following approach for reserves on YRT reinsurance may be used:\n 1. Calculate the valuation net premium for each future policy year as the tabular cost of insurance for that future year.\n 2. Basic reserves shall never be less than the tabular cost of insurance for the appropriate period, as defined in subsection C of this section.\n 3. Deficiency reserves are subject to the following:\n a. For each policy year, calculate the excess, if greater than 0, of the valuation net premium over the respective maximum guaranteed gross premium.\n b. Deficiency reserves shall never be less than the sum of the present values, at the date of valuation, of the excesses determined in accordance with subdivision 3 a of this subsection.\n 4. For purposes of this subsection, the calculations use the maximum valuation interest rate and the 1980 CSO mortality tables with or without 10-year select mortality factors, or any other table adopted on or after January 1, 2000, by the NAIC and promulgated by regulation by the commission for this purpose.\n 5. A reinsurance agreement shall be considered YRT reinsurance for purposes of this subsection if only the mortality risk is reinsured.\n 6. If the assuming company chooses this optional exemption, the ceding company's reinsurance reserve credit shall be limited to the amount of reserve held by the assuming company for the affected policies.\n F. There is an optional exemption for attained-age-based yearly renewable term (YRT) life insurance policies. At the option of the company, the following approach for reserves for attained-age-based YRT life insurance policies may be used:\n 1. Calculate the valuation net premium for each future policy year as the tabular cost of insurance for that future year.\n 2. Basic reserves shall never be less than the tabular cost of insurance for the appropriate period, as defined in subsection C of this section.\n 3. Deficiency reserves.\n a. For each policy year, calculate the excess, if greater than 0, of the valuation net premium over the respective maximum guaranteed gross premium.\n b. Deficiency reserves shall never be less than the sum of the present values, at the date of valuation, of the excesses determined in accordance with subdivision 3 a of this subsection.\n 4. For purposes of this subsection, the calculations use the maximum valuation interest rate and the 1980 CSO valuation tables with or without 10-year select mortality factors, or any other table adopted on or after January 1, 2000, by the NAIC and promulgated by regulation by the commission for this purpose.\n 5. A policy shall be considered an attained-age-based YRT life insurance policy for purposes of this subsection if:\n a. The premium rates (on both the initial current premium scale and the guaranteed maximum premium scale) are based upon the attained age of the insured, such that the rate for any given policy at a given attained age of the insured is independent of the year the policy was issued; and\n b. The premium rates (on both the initial current premium scale and the guaranteed maximum premium scale) are the same as the premium rates for policies covering all insureds of the same sex, risk class, plan of insurance, and attained age.\n 6. For policies that become attained-age-based YRT policies after an initial period of coverage, the approach of this subsection may be used after the initial period if:\n a. The initial period is constant for all insureds of the same sex, risk class, and plan of insurance; or\n b. The initial period runs to a common attained age for all insureds of the same sex, risk class, and plan of insurance; and\n c. After the initial period of coverage, the policy meets the conditions of subdivision F 5 of this section.\n 7. If this election is made, this approach shall be applied in determining reserves for all attained-age-based YRT life insurance policies issued on or after January 1, 2000.\n G. There is an exemption from unitary reserves for certain n-year renewable term life insurance policies. Unitary basic reserves and unitary deficiency reserves need not be calculated for a policy if the following conditions are met:\n 1. The policy consists of a series of n-year periods, including the first period and all renewal periods, where n is the same for each period, except that for the final renewal period, n may be truncated or extended to reach the expiry age, provided that this final renewal period is less than 10 years and less than twice the size of the earlier n-year periods, and for each period, the premium rates on both the initial current premium scale and the guaranteed maximum premium scale are level;\n 2. The guaranteed gross premiums in all n-year periods are not less than the corresponding net premiums based upon the 1980 CSO Table with or without the 10-year select mortality factors; and\n 3. There are no cash surrender values in any policy year.\n H. There is an exemption from unitary reserves for certain juvenile policies. Unitary basic reserves and unitary deficiency reserves need not be calculated for a policy if the following conditions are met, based upon the initial current premium scale at issue:\n 1. At issue, the insured is age 24 or younger;\n 2. Until the insured reaches the end of the juvenile period, which shall occur at or before age 25, the gross premiums and death benefits are level, and there are no cash surrender values; and\n 3. After the end of the juvenile period, gross premiums are level for the remainder of the premium paying period, and death benefits are level for the remainder of the life of the policy.   Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 16, Issue 5 , eff. January 1, 2000.    14VAC5-319-60. Calculation of minimum valuation standard for flexible premium and fixed premium universal life insurance policies that contain provisions ....  A. General provisions are:\n 1. Policies with a secondary guarantee include, but are not limited to, the following:\n a. A policy with a guarantee that the policy will remain in force at the original schedule of benefits, subject only to the payment of specified premiums;\n b. A policy in which the minimum premium at any duration is less than the corresponding one-year valuation premium, calculated using the maximum valuation interest rate and the 1980 CSO valuation tables with or without 10-year select mortality factors, or any other table adopted on or after January 1, 2000, by the NAIC and promulgated by regulation by the commission for this purpose; or\n c. A policy with any combination of subdivisions 1 a and 1 b of this subsection.\n 2. A secondary guarantee period is the period for which the policy is guaranteed to remain in force subject only to a secondary guarantee. When a policy contains more than one secondary guarantee, the minimum reserve shall be the greatest of the respective minimum reserves at that valuation date of each unexpired secondary guarantee, ignoring all other secondary guarantees. Secondary guarantees that are unilaterally changed by the company after issue shall be considered to have been made at issue. Reserves described in subsections B and C of this section shall be recalculated from issue to reflect these changes.\n 3. Specified premiums mean the premiums specified in the policy, the payment of which guarantees that the policy will remain in force at the original schedule of benefits, but which otherwise would be insufficient to keep the policy in force in the absence of the guarantee if maximum mortality and expense charges and minimum interest credits were made and any applicable surrender charges were assessed.\n 4. For purposes of this section, the minimum premium for any policy year is the premium that, when paid into a policy with a 0 account value at the beginning of the policy year, produces a 0 account value at the end of the policy year. The minimum premium calculation shall use the policy cost factors (including mortality charges, loads, and expense charges) and the interest crediting rate, which are all guaranteed at issue.\n 5. The one-year valuation premium means the net one-year premium based upon the original schedule of benefits for a given policy year. The one-year valuation premiums for all policy years are calculated at issue. The select mortality factors defined in  14VAC5-319-40  B 1 b, c, and d may not be used to calculate the one-year valuation premiums.\n 6. The one-year valuation premium should reflect the frequency of fund processing, as well as the distribution of deaths assumption employed in the calculation of the monthly mortality charges to the fund.\n B. Basic reserves for the secondary guarantees shall be the segmented reserves for the secondary guarantee period. In calculating the segments and the segmented reserves, the gross premiums shall be set equal to the specified premiums, if any, or otherwise to the minimum premiums, that keep the policy in force and the segments will be determined according to the contract segmentation method as defined in  14VAC5-319-10 .\n C. Deficiency reserves, if any, for the secondary guarantees shall be calculated for the secondary guarantee period in the same manner as described in  14VAC5-319-50  B with gross premiums set equal to the specified premiums, if any, or otherwise to the minimum premiums that keep the policy in force.\n D. The minimum reserves during the secondary guarantee period are the greater of:\n 1. The basic reserves for the secondary guarantee plus the deficiency reserve, if any, for the secondary guarantees; or\n 2. The minimum reserves required by other rules or regulations governing universal life plans.   Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 16, Issue 5 , eff. January 1, 2000.    14VAC5-319-70. Twenty-year select mortality factors.  The six tables of select mortality factors in this section include: (i) male aggregate, (ii) male nonsmoker, (iii) male smoker, (iv) female aggregate, (v) female nonsmoker, and (vi) female smoker.\n These tables apply to both age last birthday and age nearest birthday mortality tables.\n For sex-blended mortality tables, compute select mortality factors in the same proportion as the underlying mortality. For example, for the 1980 CSO-B Table, the calculated select mortality factors are 80% of the appropriate male table in this list, plus 20% of the appropriate female table in this list.\n TWENTY-YEAR SELECT MORTALITY FACTORS.                 Male, Aggregate                   Issue             Duration                   Age             1             2             3             4             5             6             7             8             9             10             11             12             13             14             15             16             17             18             19             20+                   0-15             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   16             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   17             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   18             96             98             98             99             99             100             100             90             92             92             92             92             93             93             96             97             98             98             99             100                   19             83             84             84             87             87             87             79             79             79             81             81             82             82             82             85             88             91             94             97             100                   20             69             71             71             74             74             69             69             67             69             70             71             71             71             71             74             79             84             90             95             100                   21             66             68             69             71             66             66             67             66             67             70             70             70             70             71             71             77             83             88             94             100                   22             65             66             66             63             63             64             64             64             65             68             68             68             68             69             71             77             83             88             94             100                   23             62             63             59             60             62             62             63             63             64             65             65             67             67             69             70             76             82             88             94             100                   24             60             56             56             59             59             60             61             61             61             64             64             64             66             67             70             76             82             88             94             100                   25             52             53             55             56             58             58             60             60             60             63             62             63             64             67             69             75             81             88             94             100                   26             51             52             55             56             58             58             57             61             61             62             63             64             66             69             66             73             80             86             93             100                   27             51             52             55             57             58             60             61             61             60             63             63             64             67             66             67             74             80             87             93             100                   28             49             51             56             58             60             60             61             62             62             63             64             66             65             66             68             74             81             87             94             100                   29             49             51             56             58             60             61             62             62             62             64             64             62             66             67             70             76             82             88             94             100                   30             49             50             56             58             60             60             62             63             63             64             62             63             67             68             71             77             83             88             94             100                   31             47             50             56             58             60             62             63             64             64             62             63             66             68             70             72             78             83             89             94             100                   32             46             49             56             59             60             62             63             66             62             63             66             67             70             72             73             78             84             89             95             100                   33             43             49             56             59             62             63             64             62             65             66             67             70             72             73             75             80             85             90             95             100                   34             42             47             56             60             62             63             61             63             66             67             70             71             73             75             76             81             86             90             95             100                   35             40             47             56             60             63             61             62             65             67             68             71             73             74             76             76             81             86             90             95             100                   36             38             42             56             60             59             61             63             65             67             68             70             72             74             76             77             82             86             91             95             100                   37             38             45             56             57             61             62             63             65             67             68             70             72             74             76             76             81             86             90             95             100                   38             37             44             53             58             61             62             65             66             67             69             69             73             75             76             77             82             86             91             95             100                   39             37             41             53             58             62             63             65             65             66             68             69             72             74             76             76             81             86             90             95             100                   40             34             40             53             58             62             63             65             65             66             68             68             71             75             76             77             82             86             91             95             100                   41             34             41             53             58             62             63             65             64             64             66             68             70             74             76             77             82             86             91             95             100                   42             34             43             53             58             61             62             63             63             63             64             66             69             72             75             77             82             86             91             95             100                   43             34             43             54             59             60             61             63             62             62             64             66             67             72             74             77             82             86             91             95             100                   44             34             44             54             58             59             60             61             60             61             62             64             67             71             74             77             82             86             91             95             100                   45             34             45             53             58             59             60             60             60             59             60             63             66             71             74             77             82             86             91             95             100                   46             31             43             52             56             57             58             59             59             59             60             63             67             71             74             75             80             85             90             95             100                   47             32             42             50             53             55             56             57             58             59             60             65             68             71             74             75             80             85             90             95             100                   48             32             41             47             52             54             56             57             57             57             61             65             68             72             73             74             79             84             90             95             100                   49             30             40             46             49             52             54             55             56             57             61             66             69             72             73             74             79             84             90             95             100                   50             30             38             44             47             51             53             54             56             57             61             66             71             72             73             75             80             85             90             95             100                   51             28             37             42             46             49             53             54             56             57             61             66             71             72             73             75             80             85             90             95             100                   52             28             35             41             45             49             51             54             56             57             61             66             71             72             74             75             80             85             90             100             100                   53             27             35             39             44             48             51             53             55             57             61             67             71             74             75             76             81             86             100             100             100                   54             27             33             38             44             48             50             53             55             57             61             67             72             74             75             76             81             100             100             100             100                   55             25             32             37             43             47             50             53             55             57             61             68             72             74             75             78             100             100             100             100             100                   56             25             32             37             43             47             49             51             54             56             61             67             70             73             74             100             100             100             100             100             100                   57             24             31             38             43             47             49             51             54             56             59             66             69             72             100             100             100             100             100             100             100                   58             24             31             38             43             48             48             50             53             56             59             64             67             100             100             100             100             100             100             100             100                   59             23             30             39             43             48             48             51             53             55             58             63             100             100             100             100             100             100             100             100             100                   60             23             30             39             43             48             47             50             52             53             57             100             100             100             100             100             100             100             100             100             100                   61             23             30             39             43             49             49             50             52             53             75             100             100             100             100             100             100             100             100             100             100                   62             23             30             39             44             49             49             51             52             75             75             100             100             100             100             100             100             100             100             100             100                   63             22             30             39             45             50             50             52             75             75             75             100             100             100             100             100             100             100             100             100             100                   64             22             30             39             45             50             51             75             75             75             75             100             100             100             100             100             100             100             100             100             100                   65             22             30             39             45             50             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   66             22             30             39             45             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   67             22             30             39             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   68             23             32             55             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   69             23             52             55             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   70             48             52             55             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   71             48             52             55             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   72             48             52             55             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   73             48             52             55             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   74             48             52             55             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   75             48             52             55             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   76             48             52             55             60             60             65             70             70             70             100             100             100             100             100             100             100             100             100             100             100                   77             48             52             55             60             60             65             70             70             100             100             100             100             100             100             100             100             100             100             100             100                   78             48             52             55             60             60             65             70             100             100             100             100             100             100             100             100             100             100             100             100             100                   79             48             52             55             60             60             65             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   80             48             52             55             60             60             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   81             48             52             55             60             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   82             48             52             55             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   83             48             52             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   84             48             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   85+             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                               Male, Nonsmoker                    Issue             Duration                   Age             1             2             3             4             5             6             7             8             9             10             11             12             13             14             15             16             17             18             19             20+                   0-15             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   16             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   17             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   18             93             95             96             98             99             100             100             90             92             92             92             92             95             95             96             97             98             98             99             100                   19             80             81             83             86             87             87             79             79             79             81             81             82             83             83             86             89             92             94             97             100                   20             65             68             69             72             74             69             69             67             69             70             71             71             72             72             75             80             85             90             95             100                   21             63             66             68             71             66             66             67             66             67             70             70             70             71             71             73             78             84             89             95             100                   22             62             65             66             62             63             64             64             64             67             68             68             68             70             70             73             78             84             89             95             100                   23             60             62             58             60             62             62             63             63             64             67             68             68             67             69             71             77             83             88             94             100                   24             59             55             56             58             59             60             61             61             63             65             67             66             66             69             71             77             83             88             94             100                   25             52             53             55             56             58             58             60             60             61             64             64             64             64             67             70             76             82             88             94             100                   26             51             53             55             56             58             60             61             61             61             63             64             64             66             69             67             74             80             87             93             100                   27             51             52             55             58             60             60             61             61             62             63             64             66             67             66             67             74             80             87             93             100                   28             49             52             57             58             60             61             63             62             62             64             66             66             63             66             68             74             81             87             94             100                   29             49             51             57             60             61             61             62             62             63             64             66             63             65             67             68             74             81             87             94             100                   30             49             51             57             60             61             62             63             63             63             64             62             63             66             68             70             76             82             88             94             100                   31             47             50             57             60             60             62             63             64             64             62             63             65             67             70             71             77             83             88             94             100                   32             46             50             57             60             62             63             64             64             62             63             65             66             68             71             72             78             83             89             94             100                   33             45             49             56             60             62             63             64             62             63             65             66             68             71             73             74             79             84             90             95             100                   34             43             48             56             62             63             64             62             62             65             66             67             70             72             74             74             79             84             90             95             100                   35             41             47             56             62             63             61             62             63             66             67             68             70             72             74             75             80             85             90             95             100                   36             40             47             56             62             59             61             62             63             66             67             68             70             72             74             75             80             85             90             95             100                   37             38             45             56             58             59             61             62             63             66             67             67             69             71             73             74             79             84             90             95             100                   38             38             45             53             58             61             62             63             65             65             67             68             70             72             74             73             78             84             89             95             100                   39             37             41             53             58             61             62             63             64             65             67             68             70             71             73             73             78             84             89             95             100                   40             34             41             53             58             61             62             63             64             64             66             67             69             71             73             72             78             83             89             94             100                   41             34             41             53             58             61             61             62             62             63             65             65             67             69             71             71             77             83             88             94             100                   42             34             43             53             58             60             61             62             61             61             63             64             66             67             69             71             77             83             88             94             100                   43             32             43             53             58             60             61             60             60             60             60             62             64             66             68             69             75             81             88             94             100                   44             32             44             52             57             59             60             60             59             59             58             60             62             65             67             69             75             81             88             94             100                   45             32             44             52             57             59             60             59             57             57             57             59             61             63             66             68             74             81             87             94             100                   46             32             42             50             54             56             57             57             56             55             56             59             61             63             65             67             74             80             87             93             100                   47             30             40             48             52             54             55             55             54             54             55             59             61             62             63             66             73             80             86             93             100                   48             30             40             46             49             51             52             53             53             54             55             57             61             62             63             63             70             78             85             93             100                   49             29             39             43             48             50             51             50             51             53             54             57             61             61             62             62             70             77             85             92             100                   50             29             37             42             45             47             48             49             50             51             54             57             61             61             61             61             69             77             84             92             100                   51             27             35             40             43             45             47             48             50             51             53             57             60             61             61             62             70             77             85             92             100                   52             27             34             39             42             44             45             48             49             50             53             56             60             60             62             62             70             77             85             100             100                   53             25             31             37             41             44             45             47             49             50             51             56             59             61             61             62             70             77             100             100             100                   54             25             30             36             39             43             44             47             48             49             51             55             59             59             61             62             70             100             100             100             100                   55             24             29             35             38             42             43             45             48             49             50             56             58             59             61             62             100             100             100             100             100                   56             23             29             35             38             42             42             44             47             48             50             55             57             58             59             100             100             100             100             100             100                   57             23             28             35             38             42             42             43             45             47             49             53             55             56             100             100             100             100             100             100             100                   58             22             28             33             37             41             41             43             45             45             47             51             53             100             100             100             100             100             100             100             100                   59             22             26             33             37             41             41             42             44             44             46             50             100             100             100             100             100             100             100             100             100                   60             20             26             33             37             41             40             41             42             42             45             100             100             100             100             100             100             100             100             100             100                   61             20             26             33             37             41             40             41             42             42             75             100             100             100             100             100             100             100             100             100             100                   62             19             25             32             38             40             40             41             42             75             75             100             100             100             100             100             100             100             100             100             100                   63             19             25             33             36             40             40             41             75             75             75             100             100             100             100             100             100             100             100             100             100                   64             18             24             32             36             39             40             75             75             75             75             100             100             100             100             100             100             100             100             100             100                   65             18             24             32             36             39             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   66             18             24             32             36             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   67             18             24             32             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   68             18             24             55             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   69             18             52             55             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   70             48             52             55             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   71             48             52             55             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   72             48             52             55             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   73             48             52             55             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   74             48             52             55             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   75             48             52             55             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   76             48             52             55             60             60             65             70             70             70             100             100             100             100             100             100             100             100             100             100             100                   77             48             52             55             60             60             65             70             70             100             100             100             100             100             100             100             100             100             100             100             100                   78             48             52             55             60             60             65             70             100             100             100             100             100             100             100             100             100             100             100             100             100                   79             48             52             55             60             60             65             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   80             48             52             55             60             60             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   81             48             52             55             60             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   82             48             52             55             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   83             48             52             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   84             48             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   85+             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                              Male, Smoker                   Issue             Duration                   Age             1             2             3             4             5             6             7             8             9             10             11             12             13             14             15             16             17             18             19             20+                   0-15             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   16             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   17             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   18             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   19             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   20             98             100             100             100             100             100             100             99             99             99             100             99             99             99             100             100             100             100             100             100                   21             95             98             99             100             95             96             96             95             96             97             97             96             96             96             96             97             98             98             99             100                   22             92             95             96             90             90             93             93             92             93             95             95             93             93             92             93             94             96             97             99             100                   23             90             92             85             88             88             89             89             89             90             90             90             90             89             90             92             94             95             97             98             100                   24             87             81             82             85             84             86             88             86             86             88             88             86             86             88             89             91             93             96             98             100                   25             77             78             79             82             81             83             83             82             83             85             84             84             84             85             86             89             92             94             97             100                   26             75             77             79             82             82             83             83             82             83             84             84             84             84             85             81             85             89             92             96             100                   27             73             75             78             82             82             83             83             82             82             82             82             84             84             80             81             85             89             92             96             100                   28             71             73             79             82             81             82             83             81             81             82             82             82             80             80             81             85             89             92             96             100                   29             69             72             78             81             81             82             82             81             81             81             81             77             80             80             81             85             89             92             96             100                   30             68             71             78             81             81             81             82             81             81             81             76             77             80             80             81             85             89             92             96             100                   31             65             70             77             81             79             81             82             81             81             76             77             79             81             81             83             86             90             93             97             100                   32             63             67             77             78             79             81             81             81             76             77             77             80             83             83             85             88             91             94             97             100                   33             60             65             74             78             79             79             81             76             77             77             79             80             83             85             85             88             91             94             97             100                   34             57             62             74             77             79             79             75             76             77             79             79             81             83             85             87             90             92             95             97             100                   35             53             60             73             77             79             75             75             76             77             79             80             82             84             86             88             90             93             95             98             100                   36             52             59             71             75             74             75             75             76             77             79             79             81             83             85             87             90             92             95             97             100                   37             49             58             70             71             74             74             75             76             77             78             79             81             84             86             86             89             92             94             97             100                   38             48             55             66             70             72             74             74             75             76             78             79             81             83             85             87             90             92             95             97             100                   39             45             50             65             70             72             72             74             74             75             77             79             81             84             86             86             89             92             94             97             100                   40             41             49             63             68             71             72             73             74             74             76             78             80             83             85             86             89             92             94             97             100                   41             40             49             63             68             71             72             72             72             73             75             76             78             81             84             85             88             91             94             97             100                   42             40             49             62             68             70             71             71             71             71             73             75             76             81             83             85             88             91             94             97             100                   43             39             50             62             67             69             69             70             70             70             71             73             76             79             83             85             88             91             94             97             100                   44             39             50             60             66             68             69             68             69             69             69             71             74             79             81             85             88             91             94             97             100                   45             37             50             60             66             68             68             68             67             67             67             69             73             78             81             85             88             91             94             97             100                   46             37             48             58             63             65             67             66             66             66             67             71             74             78             81             84             87             90             94             97             100                   47             36             47             55             61             63             64             64             64             65             67             71             75             79             81             84             87             90             94             97             100                   48             35             46             53             58             60             62             63             63             65             67             72             75             79             81             83             86             90             93             97             100                   49             34             45             51             56             58             59             61             62             63             67             72             77             80             81             83             86             90             93             97             100                   50             34             43             49             53             55             57             60             61             63             67             73             78             80             81             81             85             89             92             96             100                   51             32             42             47             52             55             57             60             61             63             67             73             78             80             83             84             87             90             94             97             100                   52             32             40             46             50             54             56             60             61             63             67             73             78             81             84             85             88             91             94             100             100                   53             30             37             44             49             54             56             59             61             65             67             74             79             83             85             87             90             92             100             100             100                   54             30             36             43             48             53             55             59             61             65             67             74             80             84             85             89             91             100             100             100             100                   55             29             35             42             47             53             55             59             61             65             67             75             80             84             86             90             100             100             100             100             100                   56             28             35             42             47             53             55             57             60             63             68             74             79             83             85             100             100             100             100             100             100                   57             28             35             42             47             53             54             57             60             64             67             74             78             81             100             100             100             100             100             100             100                   58             26             33             43             48             54             54             56             59             63             67             73             78             100             100             100             100             100             100             100             100                   59             26             33             43             48             54             53             57             59             63             66             73             100             100             100             100             100             100             100             100             100                   60             25             33             43             48             54             53             56             58             62             66             100             100             100             100             100             100             100             100             100             100                   61             25             33             43             49             55             55             57             59             63             75             100             100             100             100             100             100             100             100             100             100                   62             25             33             43             50             56             56             58             61             75             75             100             100             100             100             100             100             100             100             100             100                   63             24             33             45             51             56             56             59             75             75             75             100             100             100             100             100             100             100             100             100             100                   64             24             34             45             51             57             57             75             75             75             75             100             100             100             100             100             100             100             100             100             100                   65             24             34             45             52             57             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   66             24             35             45             53             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   67             25             35             45             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   68             25             36             55             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   69             27             52             55             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   70             48             52             55             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   71             48             52             55             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   72             48             52             55             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   73             48             52             55             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   74             48             52             55             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   75             48             52             55             60             60             65             70             70             70             70             100             100             100             100             100             100             100             100             100             100                   76             48             52             55             60             60             65             70             70             70             100             100             100             100             100             100             100             100             100             100             100                   77             48             52             55             60             60             65             70             70             100             100             100             100             100             100             100             100             100             100             100             100                   78             48             52             55             60             60             65             70             100             100             100             100             100             100             100             100             100             100             100             100             100                   79             48             52             55             60             60             65             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   80             48             52             55             60             60             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   81             48             52             55             60             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   82             48             52             55             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   83             48             52             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   84             48             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   85+             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                                            Female, Aggregate                   Issue             Duration                   Age             1             2             3             4             5             6             7             8             9             10             11             12             13             14             15             16             17             18             19             20+                   0-15             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   16             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   17             99             100             100             100             100             100             100             100             93             95             96             97             97             100             100             100             100             100             100             100                   18             83             83             84             84             84             84             86             78             78             79             82             84             85             88             88             90             93             95             98             100                   19             65             66             68             68             68             68             63             63             64             66             69             71             72             74             75             80             85             90             95             100                   20             48             50             51             51             51             47             48             48             49             51             56             57             58             61             63             70             78             85             93             100                   21             47             48             50             51             47             47             48             49             51             53             57             60             61             64             64             71             78             86             93             100                   22             44             47             48             45             47             47             48             49             53             54             60             61             63             64             66             73             80             86             93             100                   23             42             45             44             45             47             47             49             51             53             54             61             64             64             67             69             75             81             88             94             100                   24             39             40             42             44             47             47             50             51             54             56             64             64             66             69             70             76             82             88             94             100                   25             34             38             41             44             47             47             50             53             56             57             64             67             69             71             73             78             84             89             95             100                   26             34             38             41             45             49             49             51             56             58             59             66             69             70             73             70             76             82             88             94             100                   27             34             38             41             47             50             51             54             57             59             60             69             70             73             70             71             77             83             88             94             100                   28             34             37             43             47             53             53             56             59             62             63             70             73             70             72             74             79             84             90             95             100                   29             34             38             43             49             54             56             58             60             63             64             73             70             72             74             75             80             85             90             95             100                   30             35             38             43             50             56             56             59             63             66             67             70             71             74             75             76             81             86             90             95             100                   31             35             38             43             51             56             58             60             64             67             65             71             72             74             75             76             81             86             90             95             100                   32             35             39             45             51             56             59             63             66             65             66             72             72             75             76             76             81             86             90             95             100                   33             36             39             44             52             58             62             64             65             66             67             72             74             75             76             76             81             86             90             95             100                   34             36             40             45             52             58             63             63             66             67             68             74             74             76             76             76             81             86             90             95             100                   35             36             40             45             53             59             61             65             67             68             70             75             74             75             76             75             80             85             90             95             100                   36             36             40             45             53             55             62             65             67             68             70             74             74             74             75             75             80             85             90             95             100                   37             36             41             47             52             57             62             65             67             68             69             72             72             73             75             74             79             84             90             95             100                   38             34             41             44             52             57             63             66             68             69             70             72             71             72             74             75             80             85             90             95             100                   39             34             40             45             53             58             63             66             68             69             69             70             70             70             73             74             79             84             90             95             100                   40             32             40             45             53             58             65             65             67             68             69             70             69             70             73             73             78             84             89             95             100                   41             32             40             45             53             57             63             64             67             68             68             69             69             69             73             74             79             84             90             95             100                   42             32             40             45             52             56             61             63             65             66             68             69             68             70             74             75             80             85             90             95             100                   43             31             39             45             51             55             59             61             65             65             66             68             69             69             74             77             82             86             91             95             100                   44             31             39             45             50             54             58             61             63             64             66             67             68             71             75             78             82             87             91             96             100                   45             31             38             44             49             53             56             59             62             63             65             67             68             71             77             79             83             87             92             96             100                   46             29             37             43             48             51             54             59             62             63             65             67             69             71             77             78             82             87             91             96             100                   47             28             35             41             46             49             54             57             61             62             66             68             69             71             77             77             82             86             91             95             100                   48             28             35             41             44             49             52             57             61             63             66             68             71             72             75             77             82             86             91             95             100                   49             26             34             39             43             47             52             55             61             63             67             69             71             72             75             75             80             85             90             95             100                   50             25             32             38             41             46             50             55             61             63             67             69             72             72             75             74             79             84             90             95             100                   51             25             32             38             41             45             50             55             61             63             66             68             69             71             74             74             79             84             90             95             100                   52             23             30             36             41             45             51             56             61             62             65             66             68             68             73             73             78             84             89             100             100                   53             23             30             36             41             47             51             56             61             62             63             65             66             68             72             72             78             83             100             100             100                   54             22             29             35             41             47             53             57             61             61             62             62             66             66             69             70             76             100             100             100             100                   55             22             29             35             41             47             53             57             61             61             61             62             63             64             68             69             100             100             100             100             100                   56             22             29             35             41             45             51             56             59             60             61             62             63             64             67             100             100             100             100             100             100                   57             22             29             35             41             45             50             54             56             58             59             61             62             63             100             100             100             100             100             100             100                   58             22             30             36             41             44             49             53             56             57             57             61             62             100             100             100             100             100             100             100             100                   59             22             30             36             41             44             48             51             53             55             56             59             100             100             100             100             100             100             100             100             100                   60             22             30             36             41             43             47             50             51             53             55             100             100             100             100             100             100             100             100             100             100                   61             22             29             35             39             42             46             49             50             52             80             100             100             100             100             100             100             100             100             100             100                   62             20             28             33             39             41             45             47             49             80             80             100             100             100             100             100             100             100             100             100             100                   63             20             28             33             38             41             44             46             80             80             80             100             100             100             100             100             100             100             100             100             100                   64             19             27             32             36             40             42             80             80             80             80             100             100             100             100             100             100             100             100             100             100                   65             19             25             30             35             39             72             75             75             80             80             100             100             100             100             100             100             100             100             100             100                   66             19             25             30             35             72             72             75             75             80             80             100             100             100             100             100             100             100             100             100             100                   67             19             25             30             72             72             72             75             75             80             80             100             100             100             100             100             100             100             100             100             100                   68             19             25             68             72             72             72             75             75             80             80             100             100             100             100             100             100             100             100             100             100                   69             19             64             68             72             72             72             75             75             80             80             100             100             100             100             100             100             100             100             100             100                   70             60             60             64             68             68             72             75             75             80             80             100             100             100             100             100             100             100             100             100             100                   71             60             60             64             68             68             72             75             75             80             80             100             100             100             100             100             100             100             100             100             100                   72             60             60             64             68             68             72             75             75             80             80             100             100             100             100             100             100             100             100             100             100                   73             60             60             64             68             68             72             75             75             80             80             100             100             100             100             100             100             100             100             100             100                   74             60             60             64             68             68             72             75             75             80             80             100             100             100             100             100             100             100             100             100             100                   75             60             60             64             68             68             72             75             75             80             80             100             100             100             100             100             100             100             100             100             100                   76             60             60             64             68             68             72             75             75             80             100             100             100             100             100             100             100             100             100             100             100                   77             60             60             64             68             68             72             75             75             100             100             100             100             100             100             100             100             100             100             100             100                   78             60             60             64             68             68             72             75             100             100             100             100             100             100             100             100             100             100             100             100             100                   79             60             60             64             68             68             72             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   80             60             60             64             68             68             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   81             60             60             64             68             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   82             60             60             64             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   83             60             60             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   84             60             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   85+             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                              Female, Nonsmoker                   Issue             Duration                   Age             1             2             3             4             5             6             7             8             9             10             11             12             13             14             15             16             17             18             19             20+                   0-15             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   16             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100             100                   17             96             98             98             98             98             99             99             99             92             92             93             95             95             97             99             99             99             100             100             100                   18             78             80             80             80             80             81             81             74             75             75             78             79             82             83             85             88             91             94             97             100                   19             60             62             63             63             63             65             59             59             60             60             64             67             67             70             72             78             83             89             94             100                   20             42             44             45             45             45             42             42             42             45             45             50             51             53             56             58             66             75             83             92             100                   21             41             42             44             45             41             42             42             44             47             47             51             53             54             57             59             67             75             84             92             100                   22             39             41             44             41             41             42             44             45             49             49             54             56             57             58             60             68             76             84             92             100                   23             38             41             38             40             41             42             44             46             49             50             56             57             58             60             62             70             77             85             92             100                   24             36             36             38             40             41             42             46             47             50             51             58             59             60             62             63             70             78             85             93             100                   25             32             34             37             40             41             43             46             49             51             53             59             60             62             63             64             71             78             86             93             100                   26             32             34             37             41             43             45             47             50             53             53             60             62             63             64             62             70             77             85             92             100                   27             32             34             38             43             46             47             49             51             53             55             62             63             64             62             62             70             77             85             92             100                   28             30             34             39             43             47             49             51             53             56             58             63             63             61             62             63             70             78             85             93             100                   29             30             35             40             45             50             51             52             55             58             59             64             61             62             63             63             70             78             85             93             100                   30             31             35             40             46             51             52             53             56             59             60             62             62             63             65             65             72             79             86             93             100                   31             31             35             40             46             51             53             55             58             60             58             62             62             63             65             65             72             79             86             93             100                   32             32             35             40             45             51             53             56             59             57             58             62             63             63             65             64             71             78             86             93             100                   33             32             36             41             47             52             55             58             55             58             59             63             63             65             65             65             72             79             86             93             100                   34             33             36             41             47             52             55             55             57             58             59             63             65             64             65             64             71             78             86             93             100                   35             33             36             41             47             52             53             57             58             59             61             63             64             64             64             64             71             78             86             93             100                   36             33             36             41             47             49             53             57             58             59             61             63             64             63              64             63             70             78             85             93             100                   37             32             36             41             44             49             53             57             58             59             60             62             62             61             62             63             70             78             85             93             100                   38             32             37             39             45             50             54             57             58             60             60             61             61             61             62             61             69             77             84             92             100                   39             30             35             39             45             50             54             57             58             60             59             60             60             59             60             61             69             77             84             92             100                   40             28             35             39             45             50             54             56             57             59             59             60             59             59             59             60             68             76             84             92             100                   41             28             35             39             45             49             52             55             55             58             57             58             59             58             59             60             68             76             84             92             100                   42             27             35             39             44             49             52             54             55             56             57             57             57             58             60             61             69             77             84             92             100                   43             27             34             39             44             47             50             53             53             55             55             56             57             56             60             61             69             77             84             92             100                   44             26             34             38             42             47             50             52             53             54             55             55             55             56             61             62             70             77             85             92             100                   45             26             33             38             42             45             48             51             51             52             53             54             55             56             61             62             70             77             85             92             100              46     24   32   37   40   43   47   49   51   52   53   54   55   56   60   61   69   77   84   92  100\n  47     24   30   35   39   42   45   47   49   51   53   54   55   56   59   60   68   76   84   92  100\n  48     23   30   35   37   40   44   47   49   50   53   54   55   55   59   57   66   74   83   91  100\n  49     23   29   33   35   39   42   45   48   50   53   54   55   55   57   56   65   74   82   91  100\n  50     21   27   32   34   37   41   44   48   50   53   54   55   55   56   55   64   73   82   91  100\n  51     21   26   30   34   37   41   44   48   49   51   53   53   54   55   55   64   73   82   91  100\n  52     20   25   30   33   37   41   44   47   48   50   50   51   51   55   53   62   72   81  100  100\n  53     19   24   29   32   37   41   43   47   48   48   49   49   51   52   52   62   71  100  100  100\n  54     18   24   29   32   37   41   43   45   47   47   47   49   49   51   51   61  100  100  100  100\n  55     18   23   28   32   37   41   43   45   45   45   46   46   47   50   50  100  100  100  100  100\n  56     18   23   28   32   36   39   42   44   44   45   46   46   46   49  100  100  100  100  100  100\n  57     18   23   28   31   35   38   41   42   44   44   45   45   46  100  100  100  100  100  100  100\n  58     17   23   26   31   35   36   38   41   41   42   45   45  100  100  100  100  100  100  100  100\n  59     17   23   26   30   33   35   38   39   40   41   44  100  100  100  100  100  100  100  100  100\n  60     17   23   26   30   32   34   36   38   39   40  100  100  100  100  100  100  100  100  100  100\n  61     17   22   25   29   32   33   35   36   38   80  100  100  100  100  100  100  100  100  100  100\n  62     16   22   25   28   30   32   34   35   80   80  100  100  100  100  100  100  100  100  100  100\n  63     16   20   24   28   30   32   34   80   80   80  100  100  100  100  100  100  100  100  100  100\n  64     14   21   24   27   29   30   80   80   80   80  100  100  100  100  100  100  100  100  100  100\n  65     15   19   23   25   28   72   75   75   80   80  100  100  100  100  100  100  100  100  100  100\n  66     15   19   23   25   72   72   75   75   80   80  100  100  100  100  100  100  100  100  100  100\n  67     15   19   22   72   72   72   75   75   80   80  100  100  100  100  100  100  100  100  100  100\n  68     13   18   68   72   72   72   75   75   80   80  100  100  100  100  100  100  100  100  100  100\n  69     13   64   68   72   72   72   75   75   80   80  100  100  100  100  100  100  100  100  100  100\n  70     60   60   64   68   68   72   75   75   80   80  100  100  100  100  100  100  100  100  100  100\n  71     60   60   64   68   68   72   75   75   80   80  100  100  100  100  100  100  100  100  100  100\n  72     60   60   64   68   68   72   75   75   80   80  100  100  100  100  100  100  100  100  100  100\n  73     60   60   64   68   68   72   75   75   80   80  100  100  100  100  100  100  100  100  100  100\n  74     60   60   64   68   68   72   75   75   80   80  100  100  100  100  100  100  100  100  100  100\n  75     60   60   64   68   68   72   75   75   80   80  100  100  100  100  100  100  100  100  100  100\n  76     60   60   64   68   68   72   75   75   80  100  100  100  100  100  100  100  100  100  100  100\n  77     60   60   64   68   68   72   75   75  100  100  100  100  100  100  100  100  100  100  100  100\n  78     60   60   64   68   68   72   75  100  100  100  100  100  100  100  100  100  100  100  100  100\n  79     60   60   64   68   68   72  100  100  100  100  100  100  100  100  100  100  100  100  100  100\n  80     60   60   64   68   68  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100\n  81     60   60   64   68  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100\n  82     60   60   64  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100\n  83     60   60  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100\n  84     60  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100\n  85+   100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100\n ---------------------------------------------------------------------------------------------------------\n Female, Smoker\n ---------------------------------------------------------------------------------------------------------\n Issue                                                Duration\n  Age    1    2    3    4    5    6    7    8    9    10   11   12   13   14   15   16   17   18   19  20+\n ---------------------------------------------------------------------------------------------------------\n 0-15   100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100\n  16    100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100\n  17    100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100\n  18     99  100  100  100  100  100  100   95   96   97  100  100  100  100  100  100  100  100  100  100\n  19     87   89   92   92   92   92   84   84   86   86   92   93   95   96   99   99   99  100  100  100\n  20     74   77   80   80   80   73   73   73   75   77   83   83   86   88   90   92   94   96   98  100\n  21     71   74   78   78   71   71   73   74   77   79   85   86   88   89   90   92   94   96   98  100\n  22     68   71   75   70   71   71   73   74   78   79   88   90   89   89   92   94   95   97   98  100\n  23     65   69   67   70   70   70   73   77   79   81   89   90   90   92   92   94   95   97   98  100\n  24     62   60   64   69   70   70   74   77   79   81   92   90   92   93   93   94   96   97   99  100\n  25     53   58   63   67   69   70   74   78   81   82   92   93   93   95   95   96   97   98   99  100\n  26     53   58   63   69   71   72   75   79   82   82   93   93   95   96   90   92   94   96   98  100\n  27     52   56   63   70   74   74   78   81   82   84   93   95   95   90   90   92   94   96   98  100\n  28     52   56   64   71   75   77   79   82   85   86   95   95   90   92   92   94   95   97   98  100\n  29     51   56   64   71   78   78   81   84   86   88   95   90   90   92   92   94   95   97   98  100\n  30     51   56   64   72   79   79   82   85   88   89   90   90   92   93   93   94   96   97   99  100\n  31     51   56   64   72   78   81   84   84   88   84   90   90   92   93   93   94   96   97   99  100\n  32     51   56   64   71   78   81   85   86   84   85   90   90   92   94   93   94   96   97   99  100\n  33     51   57   62   71   78   82   85   83   84   85   90   92   93   93   93   94   96   97   99  100\n  34     51   56   62   71   78   82   81   83   85   86   90   92   92   94   93   94   96   97   99  100\n  35     51   56   62   71   78   79   83   84   85   86   90   91   91   93   93   94   96   97   99  100\n  36     49   56   62   71   74   79   83   84   85   86   90   90   91   93   92   94   95   97   98  100\n  37     48   55   62   67   74   79   83   84   85   86   89   90   89   92   91   93   95   96   98  100\n  38     47   55   57   66   72   77   81   84   86   86   87   88   88   90   91   93   95   96   98  100\n  39     45   50   57   66   72   77   81   83   85   86   86   87   86   89   90   92   94   96   98  100\n  40     41   50   57   66   72   77   81   83   84   85   86   86   86   89   89   91   93   96   98  100\n  41     40   50   57   65   71   76   79   81   83   84   85   86   85   89   90   92   94   96   98  100\n  42     40   49   57   65   69   74   77   80   82   83   84   85   86   90   92   94   95   97   98  100\n  43     39   49   55   63   69   73   76   78   80   82   83   84   85   92   93   94   96   97   99  100\n  44     39   48   55   62   67   71   75   78   80   80   82   84   86   93   96   97   98   98   99  100\n  45     37   47   55   61   65   70   73   76   78   80   81   84   86   94   97   98   98   99   99  100\n  46     36   46   53   59   63   68   71   75   77   79   83   85   86   93   96   97   98   98   99  100\n  47     34   44   51   57   62   66   70   75   77   80   83   85   86   93   94   95   96   98   99  100\n  48     34   44   50   54   60   64   69   74   77   80   84   86   87   92   92   94   95   97   98  100\n  49     33   42   48   53   58   63   68   74   77   81   84   86   87   92   91   93   95   96   98  100\n  50     31   41   46   51   57   61   67   74   77   81   85   87   87   91   90   92   94   96   98  100\n  51     30   39   45   51   56   61   67   74   75   80   83   85   85   90   90   92   94   96   98  100\n  52     29   38   45   50   56   62   68   74   75   79   81   83   84   90   90   92   94   96  100  100\n  53     28   37   43   49   57   62   68   73   74   77   79   81   83   89   89   91   93  100  100  100\n  54     28   36   43   49   57   63   69   73   74   75   78   80   81   87   89   91  100  100  100  100\n  55     26   35   42   49   57   63   69   73   73   74   76   78   79   86   87  100  100  100  100  100\n  56     26   35   42   49   56   62   67   71   72   74   76   78   79   85  100  100  100  100  100  100\n  57     26   35   42   49   55   61   66   69   72   73   76   78   79  100  100  100  100  100  100  100\n  58     28   36   43   49   55   59   63   68   69   72   76   78  100  100  100  100  100  100  100  100\n  59     28   36   43   49   54   57   63   67   68   70   76  100  100  100  100  100  100  100  100  100\n  60     28   36   43   49   53   57   61   64   67   69  100  100  100  100  100  100  100  100  100  100\n  61     26   35   42   48   52   56   59   63   66   80  100  100  100  100  100  100  100  100  100  100\n  62     26   33   41   47   51   55   58   62   80   80  100  100  100  100  100  100  100  100  100  100\n  63     25   33   41   46   51   55   57   80   80   80  100  100  100  100  100  100  100  100  100  100\n  64     25   33   40   45   50   53   80   80   80   80  100  100  100  100  100  100  100  100  100  100\n  65     24   32   39   44   49   72   75   75   80   80  100  100  100  100  100  100  100  100  100  100\n  66     24   32   39   44   72   72   75   75   80   80  100  100  100  100  100  100  100  100  100  100\n  67     24   32   39   72   72   72   75   75   80   80  100  100  100  100  100  100  100  100  100  100\n  68     24   32   68   72   72   72   75   75   80   80  100  100  100  100  100  100  100  100  100  100\n  69     24   64   68   72   72   72   75   75   80   80  100  100  100  100  100  100  100  100  100  100\n  70     60   60   64   68   68   72   75   75   80   80  100  100  100  100  100  100  100  100  100  100\n  71     60   60   64   68   68   72   75   75   80   80  100  100  100  100  100  100  100  100  100  100\n  72     60   60   64   68   68   72   75   75   80   80  100  100  100  100  100  100  100  100  100  100\n  73     60   60   64   68   68   72   75   75   80   80  100  100  100  100  100  100  100  100  100  100\n  74     60   60   64   68   68   72   75   75   80   80  100  100  100  100  100  100  100  100  100  100\n  75     60   60   64   68   68   72   75   75   80   80  100  100  100  100  100  100  100  100  100  100\n  76     60   60   64   68   68   72   75   75   80  100  100  100  100  100  100  100  100  100  100  100\n  77     60   60   64   68   68   72   75   75  100  100  100  100  100  100  100  100  100  100  100  100\n  78     60   60   64   68   68   72   75  100  100  100  100  100  100  100  100  100  100  100  100  100\n  79     60   60   64   68   68   72  100  100  100  100  100  100  100  100  100  100  100  100  100  100\n  80     60   60   64   68   68  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100\n  81     60   60   64   68  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100\n  82     60   60   64  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100\n  83     60   60  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100\n  84     60  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100\n  85+   100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100  100\n ---------------------------------------------------------------------------------------------------------  Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 16, Issue 5 , eff. January 1, 2000.    14VAC5-319-80. Severability.    If any provisions of this regulation or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the rules comprising this regulation and the application of such provision to other persons or circumstances shall not be affected thereby.   Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 16, Issue 5 , eff. January 1, 2000.\n                     Website addresses provided in the Virginia Administrative Code to documents incorporated by reference are for the reader's convenience only, may not necessarily be active or current, and should not be relied upon. To ensure the information incorporated by reference is accurate, the reader is encouraged to use the source document described in the regulation.\n                     As a service to the public, the Virginia Administrative Code is provided online by the Virginia General Assembly. We are unable to answer legal questions or respond to requests for legal advice, including application of law to specific fact. To understand and protect your legal rights, you should consult an attorney.\n\n\t\t\t\t\t\t\t Code of Virginia\n\n\t\t\t\t\t\t\t Administrative Code\n\n\t\t\t\t\t\t\t View by Agency\n\n\t\t\t\t\t\t\t Emergency Regulations\n\n\t\t\t\t\t\t\t VAC# Look Up\n\n\t\t\t\t\t\t\t\t Go\n\n\t\t\t\t\t\t\t Constitution of Virginia\n\n\t\t\t\t\t\t\t Charters\n\n\t\t\t\t\t\t\t Authorities\n\n\t\t\t\t\t\t\t Compacts\n\n\t\t\t\t\t\t\t Uncodified Acts\n\n                             Sign In\n\n                                 Username: \n\n                                 Password: \n\n                                 Cancel\n\n                                  LIS Home\n                                  Lobbyist-in-a-Box\n                                  Privacy Policy\n\n                                © Copyright Commonwealth of Virginia,\n                                 . All rights reserved. Site developed by the  Division of Legislative Automated Systems (DLAS) .\n                                 Sign In","text_length":157627}
{"slug":"va-14vac5-320","jurisdiction":"VA","agency":"SCC-BOI","doc_type":"regulation","citation":"14 VAC 5-320","title":"Chapter 320. Rules Establishing Minimum Reserve Standards for Individual and Group Accident and Sickness Insurance Contracts","official_source_url":"https://law.lis.virginia.gov/admincodefull/title14/agency5/chapter320/","access_class":"statutory-public","access_notes":"law.lis.virginia.gov (DLAS self-hosted); gate-zero TOP-20 VA admin code row.","first_seen_at":"2026-07-20T01:49:34.270808+00:00","last_checked_at":"2026-07-20T06:39:10.939479+00:00","versions":[{"fetched_at":"2026-07-20T01:49:34.270808+00:00","version_no":1,"text_length":37091,"effective_date":null,"content_sha256_short":"98085e591e35"}],"text":"14VAC5-320-70:3. APPENDIX C. RESERVES FOR WAIVER OF PREMIUM.\n\n                      Virginia General Assembly  /\n                      LIS Learning Center  /\n                      Privacy Policy  /\n                      LIS home  /\n                      Register Account  /\n                      Login\n\n                     Session Information\n\n                     Bills & Resolutions\n\n                     State Budget\n\n                     Virginia Law\n\n                     Reports to the General Assembly\n\n                          Virginia Law\n\n                                 Select Search Type\n\n                                     All\n                                     Code of Virginia\n                                     Administrative Code\n                                     Constitution\n                                     Charters\n                                     Authorities\n                                     Compacts\n                                     Uncodified Acts\n\n                  Administrative Code\n                   Table of Contents   »  Title 14. Insurance  »  Agency 5. State Corporation Commission, Bureau of Insurance  »  Chapter 320. Rules Establishing Minimum Reserve Standards for Individual and Group Accident and Sickness Insurance Contracts\n\n                            Chapter\n\n                          Print\n\n                      Virginia Administrative Code\n\n                      Chapter 320. Rules Establishing Minimum Reserve Standards for Individual and Group Accident and Sickness Insurance Contracts  14VAC5-320-10. Purpose.    The purpose of this chapter ( 14VAC5-320-10  et seq.), is to set forth rules governing reserve standards for accident and sickness insurance policies which the Commission deems necessary to carry out the provisions of §§  38.2-1311  and  38.2-1314  of the Code of Virginia.   Statutory Authority  §§  12.1-13 ,  38.2-223 ,  38.2-1311  and  38.2-1314  of the Code of Virginia.  Historical Notes  Derived from Regulation 15, Case No. INS930382, § 1, eff. January 1, 1994.    14VAC5-320-20. General.  A. Scope.\n 1. These standards apply to all individual and group accident and sickness insurance coverages, except credit accident and sickness insurance coverages, provided by policies or contracts delivered or issued for delivery by any domestic, foreign or alien company licensed to transact the business of insurance in this Commonwealth.\n 2. When a company determines that adequacy of its accident and sickness insurance reserves requires reserves in excess of the minimum standards specified herein, such increased reserves shall be held and shall be considered the minimum reserves for that company.\n 3. With respect to any block of contracts, or with respect to a company's accident and sickness business as a whole, a prospective gross premium valuation is the ultimate test of reserve adequacy as of a given valuation date. Such a gross premium valuation will take into account for contracts in force, in a claims status, or in a continuation of benefits status on the valuation date, the present value as of the valuation date of: all expected benefits unpaid, all expected expenses unpaid, and all unearned or expected premiums, adjusted for future premium increases reasonably expected to be put into effect.\n Such a gross premium valuation is to be performed whenever a significant doubt exists as to reserve adequacy with respect to any major block of contracts, or with respect to the company's accident and sickness business as a whole. In the event inadequacy is found to exist, immediate loss recognition shall be made and the reserves restored to adequacy. Adequate reserves (inclusive of claim, premium and contract reserves, if any) shall be held with respect to all contracts, regardless of whether contract reserves are required for such contracts under these standards. Whenever minimum reserves, as defined in these standards, exceed reserve requirements as determined by a prospective gross premium valuation, such minimum reserves remain the minimum requirement under these standards.\n B. Categories of reserves. The following sections of this chapter ( 14VAC5-320-10  et seq.) set forth minimum standards for three categories of accident and sickness insurance reserves:\n 14VAC5-320-30. Claim Reserves\n 14VAC5-320-40. Premium Reserves\n 14VAC5-320-50. Contract Reserves\n Adequacy of a company's accident and sickness insurance reserves is to be determined on the basis of all three categories combined. However, these standards emphasize the importance of determining appropriate reserves for each of the three categories separately.\n C. Appendices. These standards contain two appendices which are in integral part of the standards, and one additional "supplementary" appendix which is not part of the standards as such, but is included for explanatory and illustrative purposes only.\n Appendix A. Specific minimum standards with respect to morbidity, mortality and interest, which apply to claim reserves according to year of incurral and to contract reserves according to year of issue.\n Appendix B. Glossary of Technical Terms used.\n Appendix C. (Supplementary) Waiver of Premium Reserves.   Statutory Authority  §§  12.1-13 ,  38.2-223 ,  38.2-1311  and  38.2-1314  of the Code of Virginia.  Historical Notes  Derived from Regulation 15, Case No. INS930382, § 3, eff. January 1, 1994.    14VAC5-320-30. Claim reserves.  A. General.\n 1. Claim reserves are required for all incurred but unpaid claims on all accident and sickness insurance policies.\n 2. Appropriate claim expense reserves are required with respect to the estimated expense of settlement of all incurred but unpaid claims.\n 3. All such reserves for prior valuation years are to be tested for adequacy and reasonableness along the lines of claim runoff schedules in accordance with the statutory financial statement including consideration of any residual unpaid liability.\n B. Minimum standards for claim reserves.\n 1. Disability income.\n a. Interest. The maximum interest rate for claim reserves is specified in Appendix A.\n b. Morbidity. Minimum standards with respect to morbidity are those specified in Appendix A except that, at the option of the company:\n (1) For claims with a duration from date of disablement of less than two years, reserves may be based on the company's experience, if such experience is considered credible, or upon other assumptions designed to place a sound value on the liabilities.\n (2) For group disability income claims with a duration from date of disablement of more than two years but less than five years, reserves may, with the approval of the Commission, be based on the company's experience for which the company maintains underwriting and claim administration control. The request for such approval of a plan of modification to the reserve basis must include:\n -An analysis of the credibility of the experience;\n -A description of how all of the company's experience is proposed to be used in setting reserves;\n -A description and quantification of the margins to be included;\n -A summary of the financial impact that the proposed plan of modification would have had on the company's last filed annual statement;\n -A copy of the approval of the proposed plan of modification by the Commission or the chief insurance regulatory official of the company's state of domicile; and\n -Any other information deemed necessary by the Commission.\n c. Duration of disablement. For contracts with an elimination period, the duration of disablement should be measured as dating from the time that benefits would have begun to accrue had there been no elimination period.\n 2. All other benefits.\n a. Interest. The maximum interest rate for claim reserves is specified in Appendix A.\n b. Morbidity or other contingency. The reserve should be based on the company's experience, if such experience is considered credible, or upon other assumptions designed to place a sound value on the liabilities.\n C. Claim reserve methods generally. Any generally accepted or reasonable actuarial method or combination of methods may be used to estimate all claim liabilities. The methods used for estimating liabilities generally may be aggregate methods, or various reserve items may be separately valued. Approximations based on groupings and averages may also be employed. Adequacy of the claim reserves, however, shall be determined in the aggregate.   Statutory Authority  §§  12.1-13 ,  38.2-223 ,  38.2-1311  and  38.2-1314  of the Code of Virginia.  Historical Notes  Derived from Regulation 15, Case No. INS930382, § 4, eff. January 1, 1994.    14VAC5-320-40. Premium reserves.  A. General.\n 1. Unearned premium reserves are required for all contracts with respect to the period of coverage for which premiums, other than premiums paid in advance, have been paid beyond the date of valuation.\n 2. If premiums due and unpaid are carried as an asset, such premiums must be treated as premiums in force, subject to unearned premium reserve determination. The value of unpaid commissions, premium taxes, and the cost of collection associated with due and unpaid premiums must be carried as an offsetting liability.\n 3. The gross premiums paid in advance for a period of coverage commencing after the next premium due date which follows the date of valuation may be appropriately discounted to the valuation date and shall be held either as a separate liability or, unless questioned by the Commission, as an addition to the unearned premium reserve which would otherwise be required as a minimum.\n B. Minimum standards for unearned premium reserves.\n 1. The minimum unearned premium reserve with respect to any contract is the pro-rata unearned modal premium that applies to the premium period beyond the valuation date, with such premium determined on the basis of:\n a. The valuation net modal premium on the contract reserve basis applying to the contract; or\n b. The gross modal premium for the contract if no contract reserve applies.\n 2. However, in no event may the sum of the unearned premium and contract reserves for all contracts of the company subject to contract reserve requirements be less than the gross modal unearned premium reserve on all such contracts, as of the date of valuation. Such reserve shall never be less than the expected claims for the period beyond the valuation date represented by such unearned premium reserve, to the extent not provided for elsewhere.\n C. Premium reserve methods generally. When computing premium reserves, the company may employ suitable approximations and estimates including, but not limited to, groupings, averages and aggregate estimation. Such approximations or estimates should be tested periodically to determine their continuing adequacy and reliability.   Statutory Authority  §§  12.1-13 ,  38.2-223 ,  38.2-1311  and  38.2-1314  of the Code of Virginia.  Historical Notes  Derived from Regulation 15, Case No. INS930382, § 5, eff. January 1, 1994.    14VAC5-320-50. Contract reserves.  A. General.\n 1. Contract reserves are required, unless otherwise specified in subdivision 2, for:\n a. All individual and group contracts with which level premiums are used; or\n b. All individual and group contracts with respect to which, due to the gross premium pricing structure at issue, the value of the future benefits at any time exceeds the value of any appropriate future valuation net premiums at that time. The values specified in this subdivision shall be determined on the basis specified in subsection B of this section.\n 2. Contracts not requiring a contract reserve are:\n a. Contracts which cannot be continued after one year from issue; or\n b. Contracts already in force before the effective date of these standards for which no contract reserve was required under the immediately preceding standards.\n 3. The contract reserve is in addition to claim reserves and premium reserves.\n 4. The methods and procedures for contract reserves should be consistent with those claim reserves for any contract, or else appropriate adjustment must be made when necessary to assure provision for the aggregate liability. The definition of the date of incurral must be the same in both determinations.\n B. Minimum standards for contract reserves; basis.\n 1. Morbidity or other contingency. Minimum standards with respect to morbidity are those set forth in Appendix A. Valuation net premiums used under each contract must have a structure consistent with the gross premium structure at issue of the contract as this relates to advancing age of the insured, contract duration and period for which gross premiums have been calculated.\n Contracts for which tabular morbidity standards are not specified in Appendix A shall be valued using tables established for reserve purposes by a qualified actuary and acceptable to the Commission.\n 2. Interest. The maximum interest rate is specified in Appendix A.\n 3. Termination rates. Termination rates used in the computation of reserves shall be on the basis of a mortality table as specified in Appendix A except as noted in the following paragraph.\n Under contracts for which premium rates are not guaranteed, and where the effects of company underwriting are specifically used by policy duration in the valuation morbidity standard or for return of premium or other deferred cash benefits, total termination rates may be used at ages and durations where these exceed specified mortality table rates, but not in excess of the lesser of:\n a. Eighty percent of the total termination rate used in the calculation of the gross premiums, or\n b. Eight percent. Where a morbidity standard specified in Appendix A is on an aggregate basis, such morbidity standard may be adjusted to reflect the effect of company underwriting by policy duration. The adjustments must be appropriate to the underwriting and be acceptable to the Commission.\n 4. Reserve method.\n a. For insurance except long-term care and return of premium or other deferred cash benefits, the minimum reserve is the reserve calculated on the two-year full preliminary term method; that is under which the terminal reserve is zero at the first and also the second contract anniversary.\n b. For long-term care insurance, the minimum reserve is the reserve calculated on the one-year full preliminary term method.\n c. For return of premium or other deferred cash benefits, the minimum reserve is the reserve calculated as follows:\n -On the one year preliminary term method if such benefits are provided at any time before the twentieth anniversary;\n -On the two year preliminary term method if such benefits are only provided on or after the twentieth anniversary.\n The preliminary term method may be applied only in relation to the date of issue of a contract. Reserve adjustments introduced later, as a result of rate increases, revisions in assumptions (e.g., projected inflation rates) or for other reasons, are to be applied immediately as of the effective date of adoption of the adjusted basis.\n 5. Negative reserves. Negative reserves on any benefit may be offset against positive reserves for other benefits in the same contract, but the total contract reserve with respect to all benefits combined may not be less than zero.\n C. Alternative methods and assumptions generally. Provided the contract reserve on all contracts to which an alternative method or basis is applied is not less in the aggregate than the amount determined according to the applicable standards specified above, a company may use any reasonable assumptions as to interest rates, termination and/or mortality rates, and rates of morbidity or other contingency. Also, subject to the preceding condition, the company may employ methods other than the methods stated above in determining a sound value of its liabilities under such contracts, including, but not limited to the following: the net level premium method; the one-year full preliminary term method; prospective valuation on the basis of actual gross premiums with reasonable allowance for future expenses; the use of approximations such as those involving age groupings, groupings of several years of issue, average amounts of indemnity, grouping of similar contract forms; the computation of the reserve for one contract benefit as a percentage of, or by other relation to, the aggregate contract reserves exclusive of the benefit or benefits so valued; and the use of a composite annual claim cost for all or any combination of the benefits included in the contracts valued.\n D. Tests for adequacy and reasonableness of contract reserves. Annually, an appropriate review shall be made of the company's prospective contract liabilities on contracts valued by tabular reserves, to determine the continuing adequacy and reasonableness of the tabular reserves giving consideration to future gross premiums. The company shall make appropriate increments to such tabular reserves if such tests indicate that the basis of such reserves is no longer adequate; subject, however, to the minimum standards of subsection B of this section.\n In the event a company has a contract or a group of related similar contracts, for which future gross premiums will be restricted by contract, Commission regulation, or for other reasons, such that the future gross premiums reduced by expenses for administration, commissions, and taxes will be insufficient to cover future claims, the company shall establish contract reserves for such shortfall in the aggregate.   Statutory Authority  §§  12.1-13 ,  38.2-223 ,  38.2-1311  and  38.2-1314  of the Code of Virginia.  Historical Notes  Derived from Regulation 15, Case No. INS930382, § 6, eff. January 1, 1994.    14VAC5-320-60. Reinsurance.    Increases to, or credits against reserves carried, arising because of reinsurance assumed or reinsurance ceded, must be determined in a manner consistent with these minimum reserve standards and with all applicable provisions of the reinsurance contracts which affect the company's liabilities.   Statutory Authority  §§  12.1-13 ,  38.2-223 ,  38.2-1311  and  38.2-1314  of the Code of Virginia.  Historical Notes  Derived from Regulation 15, Case No. INS930382, § 7, eff. January 1, 1994.    14VAC5-320-70. Severability.    If any provision in this chapter ( 14VAC5-320-10  et seq.) or the application thereof to any person or circumstance is held for any reason to be invalid, the remainder of the provisions in this chapter shall not be affected thereby.   Statutory Authority  §§  12.1-13 ,  38.2-223 ,  38.2-1311  and  38.2-1314  of the Code of Virginia.  Historical Notes  Derived from Regulation 15, Case No. INS930382, § 8, eff. January 1, 1994.    14VAC5-320-70:1. APPENDIX A. SPECIFIC STANDARDS FOR MORBIDITY, INTEREST AND MORTALITY.  APPENDIX A. SPECIFIC STANDARDS FOR MORBIDITY, INTEREST AND MORTALITY.\n I. MORBIDITY\n A. Minimum morbidity standards for valuation of specified individual contract accident and sickness insurance benefits are as follows:\n 1. Disability Income Benefits Due to Accident or Sickness.\n a. Contract Reserves:\n Contracts issued on or after January 1, 1965 and prior to January 1, 1986:\n The 1964 Commissioners Disability Table (64 CDT).\n Contracts issued on or after January 1, 1994:\n The 1985 Commissioners Individual Disability Tables A (85CIDA):\n Or\n The 1985 Commissioners Individual Disability Tables B (85CIDB).\n Contracts issued during 1986 through 1993:\n Optional use of either the 64CDT or the appropriate 1985 tables (85CIDA and/or 85CIDB).\n Each company shall elect, with respect to all individual contracts issued in any one statement year, whether it will use Tables A or Tables B as the minimum standard. The company may, however, elect to use the other tables with respect to any subsequent statement year.\n b. Claim Reserves:\n The minimum morbidity standard in effect for contract reserves on currently issued contracts, as of the date the claim is incurred.\n 2. Hospital Benefits, Surgical Benefits and Maternity Benefits (Scheduled benefits or fixed time period benefits only).\n a. Contract Reserves:\n Contracts issued on or after January 1, 1955, and before January 1, 1982:\n The 1956 Intercompany Hospital-Surgical Tables.\n Contracts issued on or after January 1, 1982:\n The 1974 Medical Expense Tables, Table A, Transactions of the Society of Actuaries, Volume XXX, pg. 63. Refer to the paper (in the same volume, pg. 9) to which this table is appended, including its discussions, for methods of adjustment for benefits not directly valued in Table A: "Development of the 1974 Medical Expense Benefits," Houghton and Wolf.\n b. Claim Reserves:\n No specific standard. See 5, below.\n 3. Cancer Expense Benefits (Scheduled benefits or fixed time period benefits only).\n a. Contract Reserves:\n Contracts issued prior to January 1, 1986:\n Any tables established for reserve purposes by a qualified actuary and acceptable to the Commission provided, however that the 1974 Cancer Tables as published by Nelson & Warren, Inc. (74N&W Tables) shall not be used unless:\n (1) A qualified actuary renders an opinion annually in writing indicating that the use of such tables is appropriate and produces reserves which are based on credible experience or other assumptions designed to place a sound value on the insurer's liabilities; or\n (2) An additional reserve is held in addition to the reserve calculated pursuant to the 74N&W Tables, which additional reserve shall be based on the difference between the company's calculated reserve and the reservation which would be produced by use of the 1985 NAIC Cancer Claim Cost Tables (NAIC Tables) in an amount not less than the following:\n (a) As of 12/31/94: the additional reserve divided by three; and\n (b) As of 12/31/95: two times the additional reserve divided by three; and\n (c) As of 1/1/96 and all years thereafter: the full amount of reserve as required and calculated in accordance with the NAIC Tables.\n Contracts issued on or after January 1, 1986:\n The NAIC Tables\n b. Claim Reserves:\n No Specific standard. See 5, below.\n 4. Accidental Death Benefits.\n a. Contract Reserves; Contracts issued on or after January 1, 1965:\n The 1959 Accidental Death Benefits Table.\n b. Claim Reserves:\n Actual amount incurred.\n 5. Other Individual Contract Benefits.\n a. Contract Reserves:\n For all other individual contract benefits, morbidity assumptions are to be determined as provided in the reserve standards.\n b. Claim Reserves:\n For all benefits other than disability, claim reserves are to be determined as provided in the standards.\n B. Minimum morbidity standards for valuation of specified group contract accident and sickness insurance benefits are as follows:\n 1. Disability Income Benefits Due to Accident or Sickness.\n a. Contract Reserves:\n Contracts issued prior to January 1, 1994:\n The same basis, if any, as that employed by the company as of December 31, 1993;\n Contracts issued on or after January 1, 1994;\n The 1987 Commissioners Group Disability Income Table (87CGDT).\n b. Claim Reserves:\n For claims incurred on or after January 1, 1994;\n The 1987 Commissioners Group Disability Income Table (87CGDT);\n For claims incurred prior to January 1, 1994:\n Use of the 87CGDT is optional.\n 2. Other Group Contract Benefits.\n a. Contract Reserves:\n For all other group contract benefits, morbidity assumptions are to be determined as provided in the reserve standards.\n b. Claim Reserves:\n For all benefits other than disability, claim reserves are to be determined as provided in the standards.\n II. INTEREST\n A. For contract reserves the maximum interest rate is the maximum rate permitted by law in the valuation of whole life insurance issued on the same date as the accident and sickness insurance contract.\n B. For claim reserves on policies that require contract reserves, the maximum interest rate is the maximum rate permitted by law in the valuation of whole life insurance issued on the same date as the claim incurral date.\n C. For claim reserves on policies not requiring contract reserves, the maximum interest rate is the maximum rate permitted by law in the valuation of single premium immediate annuities issued on the same date as the claim incurral date, reduced by 100 basis points.\n III. MORTALITY\n A. Except as provided in subsection B, the mortality basis used shall be according to a table (but without use of selection factors) permitted by law for the valuation of whole life insurance issued on the same date as the accident and sickness insurance contract.\n B. Other mortality tables adopted by the NAIC and promulgated by the Commission may be used in the calculation of the minimum reserve if appropriate for the type of benefits and if approved by the Commission. The request for such approval must include the proposed mortality table and the reason that the standard specified in subsection A is inappropriate.     14VAC5-320-70:2. APPENDIX B. GLOSSARY OF TECHNICAL TERMS USED.  APPENDIX B. GLOSSARY OF TECHNICAL TERMS USED.\n As used in this valuation standard, the following terms have the following meaning:\n ANNUAL-CLAIM COST. The net annual cost per unit of benefit before the addition of expenses, including claim settlement expenses, and a margin for profit or contingencies. For example, the annual claim cost for a $100 monthly disability benefit, for a maximum disability benefit period of one year, with an elimination period of one week, with respect to a male at age 35, in a certain occupation might be $12, while the gross premium for this benefit might be $18. The additional $6 would cover expenses and profit or contingencies.\n CLAIMS ACCRUED. That portion of claims incurred on or prior to the valuation date which result in liability of the company for the payment of benefits for medical services which have been rendered on or prior to the valuation date, and for the payment of benefits for days of hospitalization and days of disability which have occurred on or prior to the valuation date, which the company has not paid as of the valuation date, but for which it is liable, and will have to pay after the valuation date. This liability is sometimes referred to as a liability for "accrued" benefits. A claim reserve, which represents an estimate of this accrued claim liability, must be established.\n CLAIMS REPORTED. When a company has been informed that a claim has been incurred, if the date reported is on or prior to the valuation date, the claim is considered as a reported claim for annual statement purposes.\n CLAIMS UNACCRUED. That portion of claims incurred on or prior to the valuation date which result in liability of the company for the payment of benefits for medical services expected to be rendered after the valuation date, and for benefits expected to be payable for days of hospitalization and days of disability occurring after the valuation date. This liability is sometimes referred to as a liability for unaccrued benefits. A claim reserve, which represents an estimate of the unaccrued claim payments expected to be made (which may or may not be discounted with interest), must be established.\n CLAIMS UNREPORTED. When a company has not been informed, on or before the valuation date, concerning a claim that has been incurred on or prior to the valuation date, the claim is considered as an unreported claim for annual statement purposes.\n DATE OF DISABLEMENT. The earliest date the insured is considered as being disabled under the definition of disability in the contract, based on a doctor's evaluation or other evidence. Normally this date will coincide with the start of any elimination period.\n ELIMINATION PERIOD. A specified number of days, weeks, or months starting at the beginning of each period of loss, during which no benefits are payable.\n GROSS PREMIUM. The amount of premium charged by the company. It includes the net premium (based on claim-cost) for the risk, together with any loading for expenses, profit or contingencies.\n GROUP INSURANCE. The term group insurance includes blanket insurance and franchise insurance and any other forms of group insurance.\n LEVEL PREMIUM. A premium calculated to remain unchanged throughout either the lifetime of the policy, or for some shorter projected period of years. The premium need not be guaranteed; in which case, although it is calculated to remain level, it may be changed if any of the assumptions on which it was based are revised at a later time.\n Generally, the annual claim costs are expected to increase each year and the company, instead of charging premiums that correspondingly increase each year, charges a premium calculated to remain level for a period of years or for the lifetime of the contract. In this case the benefit portion of the premium is more than needed to provide for the cost of benefits during the earlier years of the policy and less than the actual cost in the later years. The building of a prospective contract reserve is a natural result of level premiums.\n LONG-TERM CARE INSURANCE. Any insurance policy or rider advertised, marketed, offered or designed to provide coverage for not less than 12 consecutive months for each covered person on an expense incurred, indemnity, prepaid or other basis; for one or more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance or personal care, mental health or substance abuse services provided in a setting other than an acute care unit of a hospital. Such term also includes a policy or rider which provides for payment of benefits based upon cognitive impairment or the loss of functional capacity. Long-term care insurance may be issued by insurers; fraternal benefit societies; health services plans; health maintenance organizations; cooperative non-profit life benefit companies or mutual assessment life, accident and sickness insurers or any similar organization to the extent it is otherwise authorized to issue life or accident and sickness insurance. Long-term care insurance shall not include any insurance policy which is offered primarily to provide basic Medicare supplemental coverage, basic hospital expense coverage, basic medical-surgical expense coverage, hospital confinement indemnity coverage, major medical expense coverage, disability income or related asset-protection coverage, accident only coverage, specified disease or specified accident coverage, or limited benefit health coverage.\n MODAL PREMIUM. This refers to the premium paid on a contract based on a premium term which could be annual, semi-annual, quarterly, monthly, or weekly. Thus if the annual premium is $100 and if, instead, monthly premiums of $9 are paid then the modal premium is $9.\n NEGATIVE RESERVE. Normally the terminal reserve is a positive value. However, if the values of the benefits are decreasing with advancing age or duration it could be a negative value, called a negative reserve.\n PRELIMINARY TERM RESERVE METHOD. Under this method of valuation the valuation net premium for each year falling within the preliminary term period is exactly sufficient to cover the expected incurred claims of that year, so that the terminal reserves will be zero at the end of the year. As of the end of the preliminary term period, a new constant valuation net premium or stream of changing valuation premiums) becomes applicable such that the present value of all such premiums is equal to the present value of all claims expected to be incurred following the end of the preliminary term period.\n PRESENT VALUE OF AMOUNTS NOT YET DUE ON CLAIMS. The reserve for "claims unaccrued" (see definition), which may be discounted at interest.\n RESERVE. The term "reserve" is used to include all items of benefit liability, whether in the nature of incurred claim liability or in the nature of contract liability relating to future periods of coverage, and whether the liability is accrued or unaccrued. A company under its contracts promises benefits which result in:\n 1. Claims which have been incurred, that is, for which the company has become obligated to make payment, on or prior to the valuation date. On these claims, payments expected to be made after the valuation date for accrued and unaccrued benefits are liabilities of the company which should be provided for by establishing claim reserves; or\n 2. Claims which are expected to be incurred after the valuation date. Any present liability of the company for these future claims should be provided for by the establishment of contract reserves and unearned premium reserves.\n TERMINAL RESERVE. This is the reserve at the end of a contract year, and is defined as the present value of benefits expected to be incurred after that contract year minus the present value of future valuation net premiums.\n UNEARNED PREMIUM RESERVE. This reserve values that portion of the premium paid or due to the insurer which is applicable to the period of coverage extending beyond the valuation date. Thus if an annual premium of $120 was paid on November 1, $20 would be earned as of December 31 and the remaining $100 would be unearned. The unearned premium reserve could be on a gross basis as in this example, or on a valuation net premium basis.\n VALUATION NET MODAL PREMIUM. This is the modal fraction of the valuation net annual premium that corresponds to the gross modal premium in effect on any contract to which contract reserves apply. Thus if the mode of payment in effect is quarterly, the valuation net modal premium is the quarterly equivalent of the valuation net annual premium.     14VAC5-320-70:3. APPENDIX C. RESERVES FOR WAIVER OF PREMIUM.  APPENDIX C. RESERVES FOR WAIVER OF PREMIUM.\n (Supplementary Explanatory Material)\n Waiver of premium reserves involve several special considerations. First, the disability valuation tables promulgated by the NAIC are based on exposures that include contracts on premium waiver as in-force contracts. Hence, contract reserves based on these tables are NOT reserves on "active lives" but rather reserves on contracts "in force." This is true for the 1964 CDT and for both the 1985 CIDA and CIDB tables.\n Accordingly, tabular reserves using any of these tables should value reserves on the following basis:\n Claim reserves should include reserves for premiums expected to be waived, valuing as a minimum the valuation net premium being waived.\n Premium reserves should include contracts on premium waiver as in-force contracts, valuing as a minimum the unearned modal valuation net premium being waived.\n Contract reserves should include recognition of the waiver of premium benefit in addition to other contract benefits provided for, valuing as a minimum the valuation net premium to be waived.\n If a company is, instead, valuing reserves on what is truly an active life table, or if a specific valuation table is not being used but the company's gross premiums are calculated on a basis that includes in the projected exposure only those contracts for which premiums are being paid, then it may not be necessary to provide specifically for waiver of premium reserves. Any company using such a true "active life" basis should carefully consider, however, whether or not additional liability should be recognized on account of premiums waived during periods of disability or during claim continuation.\n                     Website addresses provided in the Virginia Administrative Code to documents incorporated by reference are for the reader's convenience only, may not necessarily be active or current, and should not be relied upon. To ensure the information incorporated by reference is accurate, the reader is encouraged to use the source document described in the regulation.\n                     As a service to the public, the Virginia Administrative Code is provided online by the Virginia General Assembly. We are unable to answer legal questions or respond to requests for legal advice, including application of law to specific fact. To understand and protect your legal rights, you should consult an attorney.\n\n\t\t\t\t\t\t\t Code of Virginia\n\n\t\t\t\t\t\t\t Administrative Code\n\n\t\t\t\t\t\t\t View by Agency\n\n\t\t\t\t\t\t\t Emergency Regulations\n\n\t\t\t\t\t\t\t VAC# Look Up\n\n\t\t\t\t\t\t\t\t Go\n\n\t\t\t\t\t\t\t Constitution of Virginia\n\n\t\t\t\t\t\t\t Charters\n\n\t\t\t\t\t\t\t Authorities\n\n\t\t\t\t\t\t\t Compacts\n\n\t\t\t\t\t\t\t Uncodified Acts\n\n                             Sign In\n\n                                 Username: \n\n                                 Password: \n\n                                 Cancel\n\n                                  LIS Home\n                                  Lobbyist-in-a-Box\n                                  Privacy Policy\n\n                                © Copyright Commonwealth of Virginia,\n                                 . All rights reserved. Site developed by the  Division of Legislative Automated Systems (DLAS) .\n                                 Sign In","text_length":37091}
{"slug":"va-14vac5-323","jurisdiction":"VA","agency":"SCC-BOI","doc_type":"regulation","citation":"14 VAC 5-323","title":"Chapter 323. Rules Governing Preneed Life Insurance Minimum Standards for Determining Reserve Liabilities and Nonforfeiture Values","official_source_url":"https://law.lis.virginia.gov/admincodefull/title14/agency5/chapter323/","access_class":"statutory-public","access_notes":"law.lis.virginia.gov (DLAS self-hosted); gate-zero TOP-20 VA admin code row.","first_seen_at":"2026-07-20T01:49:34.270808+00:00","last_checked_at":"2026-07-20T06:39:10.939479+00:00","versions":[{"fetched_at":"2026-07-20T01:49:34.270808+00:00","version_no":1,"text_length":10754,"effective_date":null,"content_sha256_short":"d9cec3da519f"}],"text":"Documents Incorporated by Reference (14VAC5-323)\n\n                      Virginia General Assembly  /\n                      LIS Learning Center  /\n                      Privacy Policy  /\n                      LIS home  /\n                      Register Account  /\n                      Login\n\n                     Session Information\n\n                     Bills & Resolutions\n\n                     State Budget\n\n                     Virginia Law\n\n                     Reports to the General Assembly\n\n                          Virginia Law\n\n                                 Select Search Type\n\n                                     All\n                                     Code of Virginia\n                                     Administrative Code\n                                     Constitution\n                                     Charters\n                                     Authorities\n                                     Compacts\n                                     Uncodified Acts\n\n                  Administrative Code\n                   Table of Contents   »  Title 14. Insurance  »  Agency 5. State Corporation Commission, Bureau of Insurance  »  Chapter 323. Rules Governing Preneed Life Insurance Minimum Standards for Determining Reserve Liabilities and Nonforfeiture Values\n\n                            Chapter\n\n                          Print\n\n                      Virginia Administrative Code\n\n                      Chapter 323. Rules Governing Preneed Life Insurance Minimum Standards for Determining Reserve Liabilities and Nonforfeiture Values  14VAC5-323-10. Authority.  This chapter is promulgated by the commission, pursuant to §  38.2-223  of the Code of Virginia and in accordance with §§   38.2-1369 ,  38.2-3206  through  38.2-3209 , and  38.2-4120  of the Code of Virginia and  14VAC5-319-40 , to approve, recognize, permit, and prescribe the use of the 1980 Commissioners Standard Ordinary (CSO) Life Valuation Mortality Table for use in determining the minimum standard of valuation of reserves and the minimum standard nonforfeiture values for insurers offering preneed insurance in this Commonwealth.  Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 25, Issue 8 , eff. January 1, 2009; amended, Virginia Register  Volume 31, Issue 9 , eff. January 1, 2015.    14VAC5-323-20. Definitions.  The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:\n "2001 CSO Mortality Table" means that mortality table, which is included in the Proceedings of the NAIC (2nd Quarter 2002), consisting of separate rates of mortality for male and female lives, developed by the American Academy of Actuaries CSO Task Force from the Valuation Basic Mortality Table developed by the Society of Actuaries Individual Life Insurance Valuation Mortality Task Force, and adopted by the NAIC in December 2002. Unless the context indicates otherwise, the "2001 CSO Mortality Table" includes both the ultimate form of that table and the select and ultimate form of that table and includes both the smoker and nonsmoker mortality tables and the composite mortality tables. It also includes both the age-nearest-birthday and age-last-birthday bases of the mortality tables.\n "Commission" means the State Corporation Commission.\n "NAIC" means the National Association of Insurance Commissioners.\n "Preneed insurance," "preneed insurance contract," or "preneed insurance policy" means a life insurance policy, or other life insurance contract which at issue, whether by assignment or otherwise, has for a purpose, the funding of a preneed funeral contract as defined in §  54.1-2800  of the Code of Virginia.\n "Ultimate 1980 CSO" means the Commissioners 1980 Standard Ordinary Life Valuation Mortality Table without any selection factors, incorporated into the 1980 NAIC amendments to the Standard Valuation Law and Standard Nonforfeiture Law for Life Insurance models, and adopted by the NAIC in December 1983. It is a mortality table consisting of separate rates of mortality for male and female lives, developed by the Society of Actuaries Committee to recommend new mortality tables for valuation of standard individual ordinary life insurance, as set forth in Transactions, Society of Actuaries, Vol. XXXIII (1981), pp. 673 and 674.  Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 25, Issue 8 , eff. January 1, 2009.    14VAC5-323-30. Minimum valuation mortality standards.  For preneed insurance contracts, and similar policies and contracts, the minimum mortality standard for determining reserve liabilities and nonforfeiture values for both male and female insureds shall be the Ultimate 1980 CSO.  Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 25, Issue 8 , eff. January 1, 2009.    14VAC5-323-40. Minimum valuation interest rate standards.  A. The interest rates used in determining the minimum standard for valuation of preneed insurance shall be the calendar year statutory valuation interest rates as defined in  §  38.2-1371  of the Code of Virginia.\n B. The interest rates used in determining the minimum standard for nonforfeiture values for preneed insurance shall be the calendar year statutory nonforfeiture interest rates as defined in §  38.2-3209  of the Code of Virginia.  Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 25, Issue 8 , eff. January 1, 2009; amended, Virginia Register  Volume 31, Issue 9 , eff. January 1, 2015.    14VAC5-323-50. Minimum valuation method standards.  A. The method used in determining the standard for the minimum valuation of reserves of preneed insurance shall be the method defined in §§   38.2-1368  and   38.2-1369  of the Code of Virginia.\n B. The method used in determining the standard for the minimum nonforfeiture values for preneed insurance shall be the method defined in §  38.2-3209  of the Code of Virginia.  Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 25, Issue 8 , eff. January 1, 2009; amended, Virginia Register  Volume 31, Issue 9 , eff. January 1, 2015.    14VAC5-323-60. Transition provisions.  A. For preneed insurance policies issued on or after January 1, 2009, and before January 1, 2012, the 2001 CSO Mortality Table may be used as the minimum standard for reserves and minimum standard for nonforfeiture benefits for both male and female insureds pursuant to the requirements of the rules entitled "Use of the 2001 CSO Mortality Table in Determining Minimum Reserve Liabilities and Nonforfeiture Benefits ( 14VAC5-321 )."\n B. If an insurer elects to use the 2001 CSO Mortality Table as a minimum standard for any preneed insurance policy issued on or after January 1, 2009, and before January 1, 2012, the insurer shall provide, as a part of the actuarial opinion memorandum submitted in support of the company's asset adequacy testing, an annual written notification to the domiciliary commissioner. The notification shall include:\n 1. A complete list of all preneed insurance policy forms that use the 2001 CSO as a minimum standard;\n 2. A certification signed by the appointed actuary stating that the reserve methodology employed by the company in determining reserves for the preneed insurance policies issued after January 1, 2009, and using the 2001 CSO as a minimum standard, develops adequate reserves (for the purposes of this certification, the preneed insurance policies using the 2001 CSO as a minimum standard cannot be aggregated with any other insurance policies.); and\n 3. Supporting information regarding the adequacy of reserves for preneed insurance policies issued after January 1, 2009, and using the 2001 CSO as a minimum standard for reserves.\n C. Preneed insurance policies issued on or after January 1, 2012, shall use the Ultimate 1980 CSO in the calculation of minimum nonforfeiture values and minimum reserves.  Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 25, Issue 8 , eff. January 1, 2009.    14VAC5-323-70. Severability.  If any provision of this chapter or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the chapter and the application of the provision to other persons or circumstances shall not be affected thereby.  Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 25, Issue 8 , eff. January 1, 2009.    Documents Incorporated by Reference (14VAC5-323)   Transactions, Society of Actuaries, Vol. XXXIII, 1981, pp. 673 and 674\n                     Website addresses provided in the Virginia Administrative Code to documents incorporated by reference are for the reader's convenience only, may not necessarily be active or current, and should not be relied upon. To ensure the information incorporated by reference is accurate, the reader is encouraged to use the source document described in the regulation.\n                     As a service to the public, the Virginia Administrative Code is provided online by the Virginia General Assembly. We are unable to answer legal questions or respond to requests for legal advice, including application of law to specific fact. To understand and protect your legal rights, you should consult an attorney.\n\n\t\t\t\t\t\t\t Code of Virginia\n\n\t\t\t\t\t\t\t Administrative Code\n\n\t\t\t\t\t\t\t View by Agency\n\n\t\t\t\t\t\t\t Emergency Regulations\n\n\t\t\t\t\t\t\t VAC# Look Up\n\n\t\t\t\t\t\t\t\t Go\n\n\t\t\t\t\t\t\t Constitution of Virginia\n\n\t\t\t\t\t\t\t Charters\n\n\t\t\t\t\t\t\t Authorities\n\n\t\t\t\t\t\t\t Compacts\n\n\t\t\t\t\t\t\t Uncodified Acts\n\n                             Sign In\n\n                                 Username: \n\n                                 Password: \n\n                                 Cancel\n\n                                  LIS Home\n                                  Lobbyist-in-a-Box\n                                  Privacy Policy\n\n                                © Copyright Commonwealth of Virginia,\n                                 . All rights reserved. Site developed by the  Division of Legislative Automated Systems (DLAS) .\n                                 Sign In","text_length":10754}
{"slug":"va-14vac5-341","jurisdiction":"VA","agency":"SCC-BOI","doc_type":"regulation","citation":"14 VAC 5-341","title":"Chapter 341. Rules Governing Standards for the Content of Dwelling Property Insurance Policies","official_source_url":"https://law.lis.virginia.gov/admincodefull/title14/agency5/chapter341/","access_class":"statutory-public","access_notes":"law.lis.virginia.gov (DLAS self-hosted); gate-zero TOP-20 VA admin code row.","first_seen_at":"2026-07-20T01:49:34.270808+00:00","last_checked_at":"2026-07-20T06:39:10.939479+00:00","versions":[{"fetched_at":"2026-07-20T01:49:34.270808+00:00","version_no":1,"text_length":45465,"effective_date":null,"content_sha256_short":"6709b32ff02c"}],"text":"14VAC5-341-90. Policy conditions.\n\n                      Virginia General Assembly  /\n                      LIS Learning Center  /\n                      Privacy Policy  /\n                      LIS home  /\n                      Register Account  /\n                      Login\n\n                     Session Information\n\n                     Bills & Resolutions\n\n                     State Budget\n\n                     Virginia Law\n\n                     Reports to the General Assembly\n\n                          Virginia Law\n\n                                 Select Search Type\n\n                                     All\n                                     Code of Virginia\n                                     Administrative Code\n                                     Constitution\n                                     Charters\n                                     Authorities\n                                     Compacts\n                                     Uncodified Acts\n\n                  Administrative Code\n                   Table of Contents   »  Title 14. Insurance  »  Agency 5. State Corporation Commission, Bureau of Insurance  »  Chapter 341. Rules Governing Standards for the Content of Dwelling Property Insurance Policies\n\n                            Chapter\n\n                          Print\n\n                      Virginia Administrative Code\n\n                      Chapter 341. Rules Governing Standards for the Content of Dwelling Property Insurance Policies  14VAC5-341-10. Scope and applicability.  A. This chapter sets forth the standards of content for policies of dwelling property insurance covering solely owner-occupied dwellings, including condominium units. This chapter applies to insurers licensed to do business in Virginia and issuing policies of dwelling property insurance pursuant to the provisions of Chapter 21 (§  38.2-2100  et seq.) of Title 38.2 of the Code of Virginia.\n B. Compliance with this chapter is required for policies delivered or issued for delivery in Virginia with effective dates on and after December 31, 2023. Insurers and rate service organizations shall submit filings for compliance with this chapter no later than May 1, 2023.\n C. No insurer shall represent to a prospective purchaser or a policyholder that a dwelling property policy subject to the provisions of this chapter is a homeowners policy as defined in §  38.2-130  of the Code of Virginia.\n D. This chapter does not apply to policies that:\n 1. Are lender-placed;\n 2. Insure owner-occupied farms;\n 3. Insure manufactured homes as defined in §  46.2-100  of the Code of Virginia, except for policies insuring manufactured homes as defined in §  46.2-653.1  of the Code of Virginia;\n 4. Are issued pursuant to Chapter 27 (§  38.2-2700  et seq.) of Title 38.2 of the Code of Virginia;\n 5. Are issued pursuant to Chapter 48 (§  38.2-4800  et seq.) of Title 38.2 of the Code of Virginia; or\n 6. Primarily insure the personal property of renters.\n E. Insurers shall file with the commission all policies or endorsements for approval before use.\n F. Policies and endorsements shall not be less favorable than the provisions set forth in this chapter. Insurers may provide broader and more favorable coverages, terms, and conditions than those set forth in this chapter. Insurers may use any policy language that is not less favorable to the insured and complies with provisions of this chapter.  Statutory Authority  §§  12.1-13  and  38.2-223  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 38, Issue 11 , eff. January 1, 2022; amended, Virginia Register  Volume 39, Issue 10 , eff. December 31, 2022.    14VAC5-341-20. Severability.  If a provision of this chapter or its application to a person or circumstance is for any reason held to be invalid by a court, the remainder of this chapter and the application of the provisions to other persons or circumstances shall not be affected.\n   Statutory Authority  §§  12.1-13 ,  38.2-223 , and  38.2-2108  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 38, Issue 11 , eff. January 1, 2022.    14VAC5-341-30. Definitions.  The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:\n \"Actual cash value\" means the amount equal to the replacement cost minus depreciation of damaged or stolen property at the time of the loss.\n \"Aircraft\" means a machine or device capable of atmospheric flight, including hobby or model aircraft, drones, self-propelled missiles, and spacecraft.\n \"Business\" means a trade, profession, or occupation whether full-time, part-time, or occasional activity, including (i) farming, (ii) the rental of the whole or a part of the residence premises by an insured, (iii) the business use of part of the residence premises, or (iv) home-sharing.\n \"Business\" shall not include:\n 1. The occasional rental of the whole or a part of the residence premises for dwelling purposes;\n 2. The rental or holding for rental of a part of the residence premises for no more than two roomers or boarders for use as a primary residence;\n 3. The rental of a part of the residence premises as a private garage;\n 4. The rental of a part of the residence premises as an office, school, or studio; or\n 5. The insured's use of the residence premises for remote work under an agreement with the insured's employer.\n \"Commission\" means the State Corporation Commission.\n \"Condominium unit\" means a dwelling as defined in §  55.1-1900  of the Code of Virginia.\n \"Dwelling\" means any residential structure specifically named in the policy.\n \"Farms\" or \"farming\" means the use of land and buildings primarily for agricultural purposes with the objective of raising animals to produce food for sale or distribution to the public and growing crops for sale or distribution to the public.\n \"Fixtures\" means permanently installed components of the dwelling or other structures including wells; plumbing systems; pumps; air conditioning equipment, systems, and parts; heating equipment, systems, and parts; hot water heaters; lighting systems; or built-in appliances and other components where removal would deface or damage the dwelling.\n \"Functional replacement cost\" means the cost to repair or replace the damaged dwelling or other structures with less costly common construction materials and methods that are functionally equivalent to materials and methods used in the original construction.\n \"Home-sharing\" means rental of the whole or a part of the residence premises for lodging purposes through an online-enabled application, website, or digital network during the policy term (i) for more than seven consecutive or random days or (ii) that generates revenue of more than $2,500. An individual occupying the residence premises through home-sharing is not a roomer, boarder, tenant, or guest.\n \"Hovercraft\" means a self-propelled air cushioned vehicle that can travel over land and water.\n \"Insured\" means (i) any person named as an insured in the policy, (ii) if residents of the named insured's household, the named insured's spouse if not a named insured, and relatives of either, and (iii) other persons younger than 21 years of age in the care of an insured.\n \"Motor vehicle\" means a vehicle that is self-propelled or designed for self-propulsion and is designed or licensed for use on public roads.\n \"Occasional rental\" means rental of the whole or a part of the residence premises for lodging purposes during a policy term (i) for seven or fewer consecutive or random days or (ii) that generates revenue of up to $2,500 . Occasional rental does not include home-sharing as defined in this section.\n \"Pollutant\" means solid, liquid, gaseous, thermal, or radioactive irritants or contaminants, including acids, alkalis, chemicals, fumes, vapors, and waste.\n \"Recreational motor vehicle\" means a motor vehicle designed for recreational use off public roads and not subject to motor vehicle registration.\n \"Replacement cost\" means the cost to repair or replace the damaged or stolen property with material of like kind and quality without deduction for depreciation.\n \"Residence employee\" means an employee of an insured who provides maintenance or domestic services for the residence premises.\n \"Residence premises\" means the dwelling, other structures, and grounds at the location named in the policy.\n \"Theft\" means an act of stealing or attempt to steal, including loss of property from a known place under circumstances when a probability of theft exists.\n \"Vacant\" means a dwelling (i) that has not been occupied as a residence for more than 30 consecutive days immediately before a loss and (ii) where most of the named insured's personal property has been removed such that the dwelling is not functional as a customary place of residence. A dwelling is not occupied if the dwelling is being used without the permission of an insured. A dwelling under construction or being remodeled, repaired, or renovated is not vacant.\n \"Vandalism\" or \"malicious mischief\" means the willful and malicious damage to or destruction of the property excluding loss by pilferage, theft, burglary, or larceny.  Statutory Authority  §§  12.1-13 ,  38.2-223 , and  38.2-2108  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 38, Issue 11 , eff. January 1, 2022.    14VAC5-341-40. Mandatory property coverages.  A. Insurers shall provide coverage for the dwelling on the residence premises, including fixtures.\n 1. Insurers shall also provide coverage for materials and supplies while located on the residence premises and intended for use in construction, alteration, or repair of the dwelling or other structures.\n 2. For a dwelling that is a condominium unit, insurers shall provide a limit of liability of at least $5,000 for the dwelling and fixtures that are the responsibility of the condominium unit owner.\n B. Insurers shall provide coverage for other structures and the fixtures of other structures on the residence premises.\n 1. Insurers shall provide a limit of liability of at least 10% of the dwelling limit of liability. Upon request of the named insured, an insurer may provide any other limit of liability for other structures coverage that is not less than 5.0% of the dwelling limit of liability.\n 2. Insurers may exclude coverage for other structures that are used for business or rented or held for rental, unless the structure is (i) rented to roomers, boarders, or tenants of the dwelling or (ii) rented for use solely as a private garage.\n 3. For condominium units, insurers shall provide coverage for other structures and fixtures of other structures that are the responsibility of the condominium unit owner.\n C. Insurers shall provide coverage for (i) breakage of glass or safety glazing material that is part of a dwelling or other structure and (ii) damage to covered property by glass that is part of a dwelling or other structure. This coverage does not increase the limit of liability that applies to the damaged covered property. Insurers may exclude loss if the dwelling was vacant.\n D. Insurers shall provide coverage for the expenses incurred for the removal of debris of covered property damaged by a covered cause of loss and the expense for the removal of fallen trees that damage covered property. Expenses for debris removal are included within the limit of liability applicable to the damaged property.\n E. Insurers shall provide coverage for contractual fire department service charges and volunteer fire department service charges as follows:\n 1. Contractual fire department   service charges where the fire department is called to save or protect insured property from a covered cause of loss. Insurers may limit this coverage to a residence premises not located within the limits of a city, municipality, or fire protection district furnishing fire department services.\n 2. Fire department service charges made by volunteer fire departments pursuant to §  38.2-2130  of the Code of Virginia.\n 3. Insurers shall provide at least $250 of coverage for each type of fire department service charges.\n 4. Insurers may not apply a deductible to the coverages in subdivisions 1 and 2 of this subsection.\n F. Insurers shall offer ordinance or law coverage, subject to the exclusions or limitations within this chapter, pursuant to §  38.2-2124  of the Code of Virginia at the dwelling limit of liability within the policy or as an endorsement. This limit of liability is in addition to the limit of liability applicable to the dwelling. Insurers may make other limits of liability available for insureds to purchase. When ordinance or law coverage is provided within the policy or as an endorsement,  14VAC5-341-70  A 3 does not apply.\n G. Insurers shall provide coverage of at least 10% of the dwelling limit of liability for the increase in necessary living expenses when the dwelling is uninhabitable due to a covered cause of loss. Insurers shall provide coverage of at least 20% of the household and personal property limit of liability for condominium units.\n 1. Insurers shall provide this coverage for the time reasonably required to return the dwelling to a habitable condition or for the insured's household to become settled in any permanent quarters.\n 2. Insurers shall provide additional living expense coverage for at least two weeks while a civil authority limits access to the residence premises as a result of damage to neighboring premises by a covered cause of loss.\n 3. Insurers may exclude living expenses that do not continue.\n 4. This coverage is not limited by the expiration date of the policy.\n 5. Insurers may not apply a deductible to this coverage.\n H. Insurers shall provide coverage of at least 10% of the dwelling limit of liability for the fair rental value of any part of the dwelling or other structure. Insurers shall provide coverage of at least 20% of the household and personal property limit of liability for condominium units.\n 1. Insurers shall provide this coverage for the time reasonably required to restore the dwelling or other structures to a tenantable condition following damage caused by a covered cause of loss.\n 2. Insurers shall provide fair rental value coverage for at least two weeks while a civil authority limits access to the residence premises as a result of damage to neighboring premises by a covered cause of loss.\n 3. Insurers may exclude expenses that do not continue.\n 4. Insurers may exclude coverage for loss or expense due to cancellation of a lease or agreement.\n 5. This coverage is not limited by the expiration date of the policy.\n 6. Insurers may not apply a deductible to this coverage.\n I. Insurers shall provide coverage for damage to trees, shrubs, plants, or lawns caused by fire, lightning, explosion, riot, civil commotion, aircraft, or vehicles not owned or operated by a resident of the residence premises. When expanded or open causes of loss are provided by the policy, insurers shall also include coverage for damage to trees, shrubs, plants, or lawns caused by vandalism and malicious mischief, and actual or attempted burglary.\n 1. Insurers shall provide a limit of liability for this coverage of at least 5.0% of the dwelling limit of liability.\n 2. Insurers may limit the amount of coverage to no more than $250 for each tree, shrub, or plant on the residence premises. The limit of coverage includes debris removal coverage when the tree, plant, or shrub does not cause damage to covered property.\n J. Insurers shall provide coverage for loss or damage to property while removed or being removed from the residence premises because the property is endangered by a covered cause of loss.\n 1. Coverage is provided for damage from any cause subject to the exclusions and limitations permitted in this chapter.\n 2. Insurers shall provide this coverage for at least 30 days for each removal.\n 3. This coverage is not limited by the expiration date of the policy.\n 4. This coverage does not increase the limit of liability that applies to the damaged covered property.\n K. Insurers shall provide coverage for the cost of making reasonable repairs to protect covered property from further damage when the repairs are directly attributable to damage caused by a covered cause of loss. The repairs are included as part of the amount of the loss.\n L. If expanded or open causes of loss are provided by the policy, insurers shall pay the cost incurred to tear out and replace the part of the dwelling or other structure necessary to gain access to the system or appliance from which the water or steam escaped if a loss to the dwelling or other structures is caused by water or steam escaping from a system or appliance. Insurers may exclude loss to the system or appliance from which the water or steam escapes.\n M. Insurers shall provide coverage for direct physical loss to the dwelling, other structures, and household and personal property involving collapse of a dwelling or other structure or any part of a dwelling or other structure:\n 1.   Caused by one or more of the following:\n a. The causes of loss in  14VAC5-341-60  C;\n b. Hidden decay;\n c. Hidden insect or vermin damage;\n d. Weight of contents, equipment, animals, or people;\n e. Weight of rain that collects on a roof; or\n f. Use of defective materials or methods in construction, remodeling, or renovation if the collapse occurs during the construction, remodeling, or renovation.\n 2. Loss to an awning, fence, patio, pavement, swimming pool, underground pipe, flue, drain, cesspool, septic tank, foundation, retaining wall, bulkhead, pier, wharf, or dock is not included under subdivisions 1 b through 1 f of this subsection unless the loss is a direct result of the collapse of a building.\n 3. Collapse does not include settling, cracking, shrinking, bulging, or expansion. A building that is in danger of falling down or caving in is not in a state of collapse.\n 4. This coverage does not increase the limit of liability applicable to the damaged covered property.\n 5. Insurers may exclude collapse when providing only basic causes of loss set forth in  14VAC5-341-60  B.  Statutory Authority  §§  12.1-13 ,  38.2-223 , and  38.2-2108  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 38, Issue 11 , eff. January 1, 2022; amended, Virginia Register  Volume 42, Issue 7 , eff. December 1, 2025.    14VAC5-341-50. Optional coverage for household and personal property.  A. Insurers may offer coverage for household and personal property. If offered:\n 1. Insurers shall provide coverage for household and personal property on the residence premises that is owned or used by an insured.\n 2. At the request of the named insured at the time of loss, insurers shall provide coverage for household and personal property owned by a:\n a. Guest while the property is on the residence premises or\n b. Residence employee while the property is on the residence premises.\n B. Insurers shall provide coverage for the insured's property (i) on the residence premises during an occasional rental or (ii) on the part of the residence premises occupied by roomers, boarders, or tenants.\n C. Insurers shall provide coverage for household and personal property while it is being moved to the insured's new principal residence within the United States. Insurers shall provide coverage for property while it is being moved for 30 days from the date that moving the   property begins. The household and personal property limit of liability applies to property being moved to another location. If the move began during the policy term, coverage may not be limited by the expiration of the policy.\n D. Insurers shall provide coverage for the following types of household and personal property at limits of at least the following:\n 1. $500 total per loss on cemetery property on or off the residence premises including monuments, headstones, grave markers, and urns.\n 2. $100 total per loss on coin collections, medals, gold, platinum, and silver, except goldware and gold-plated ware shall not be deemed to be gold and silverware and silver-plated ware shall not be deemed to be silver.\n 3. $500 total per loss on passports, tickets, or stamp collections.\n 4. $1,000 total per loss on watercraft, trailers used with watercraft, and watercraft furnishings, equipment, and outboard motors. This limit does not apply to rowboats or canoes.\n 5. $500 on trailers, semi-trailers, and campers not otherwise covered in this chapter.  Statutory Authority  §§  12.1-13 ,  38.2-223 , and  38.2-2108  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 38, Issue 11 , eff. January 1, 2022.    14VAC5-341-60. Causes of loss.  A. Insurers shall provide, at a minimum, the basic causes of loss in subsection B of this section. If an insurer provides expanded causes of loss, the causes of loss may be no less favorable than the causes of loss in subsections B and C of this section. If an insurer provides open causes of loss, the causes of loss may be no less favorable than the causes of loss in subsection D of this section. The same causes of loss shall apply to the dwelling and other structures. Insurers may offer basic, expanded, or open causes of loss for household and personal property.\n B. When providing basic causes of loss, insurers shall provide coverage for direct loss caused by the following:\n 1. Fire or lightning.\n 2. Windstorm or hail. Insurers may exclude loss to:\n a. The interior of the dwelling or other structure or the household and personal property within caused by rain, snow, sand, or dust unless the rain, snow, sand, or dust enters through an opening caused by the force of wind or hail;\n b. Windmills, wind pumps, or towers; crop silos or contents; or metal smokestacks;\n c. Grain, hay, straw, or other crops, when outside;\n d. Overhead structures, including supports and screening, constructed principally of cloth, metal, fiberglass, or plastic erected to provide protection from the elements;\n e. Signs;\n f. Satellite dishes; radio or television antennas, including lead-in wiring, masts, or towers;\n g. Fences; seawalls or property line and other free-standing walls;\n h. Greenhouses, hothouses, slathouses, trellises, pergolas, cabanas, or outdoor equipment pertaining to the service of the residence premises;\n i. Wharves, docks, piers, boathouses, bulkheads, or other structures located over or partially over water and the household and personal property on or within;\n j. Property damaged by water from sprinklered equipment or from other piping, unless the equipment or piping was damaged as a direct result of wind or hail; or\n k. Watercraft while not inside a fully enclosed building. This provision does not apply to rowboats or canoes.\n 3. Explosion.\n 4. Riot or civil commotion.\n 5. Aircraft.\n 6. Vehicles.\n 7. Sudden or accidental damage from smoke or soot, other than smoke from agricultural smudging or industrial operations.\n C. Insurers may offer the following expanded causes of loss. If provided, coverage shall be for direct loss to the covered property from the causes of loss listed in subsection B of this section and the following causes of loss:\n 1. Vandalism, malicious mischief, and burglary. Insurers may exclude loss if the dwelling was vacant. If a covered cause of loss ensues, insurers shall provide coverage for the ensuing loss.\n 2. Falling objects. Insurers may exclude loss to:\n a. Property within the dwelling or other structure that is caused by a falling object unless the falling object first damages the exterior of the roof or walls of the dwelling or other structure; or\n b. The falling object itself.\n 3. Weight of ice, snow, or sleet that damages the (i) dwelling, (ii) other structure, or (iii) household and personal property contained in a dwelling or other structure if the weight of ice, snow, or sleet first damages the dwelling or other structure. Insurers may exclude loss to:\n a. Awnings and their supports; or\n b. Fences, pavements, patios, swimming pools, foundations, retaining walls, bulkheads, piers, wharves, or docks.\n 4. Sudden and accidental tearing apart, cracking, burning, or bulging of a steam or hot water heating system, or of an appliance for heating water, but excluding loss caused by or resulting from freezing.\n 5. Freezing of plumbing, heating, or air conditioning systems, and domestic appliances. Insurers may exclude loss caused by or resulting from freezing while a dwelling is under construction, vacant, or unoccupied for a period in excess of four consecutive days unless the insured has (i) exercised due diligence in maintaining heat in the dwelling or other structure or (ii) drained the systems and appliances and shut off the water supply.\n 6. Accidental discharge, leakage, or overflow of water or steam from within a plumbing, heating, or air conditioning system, or domestic appliance. This does not include loss caused by or resulting from freezing.\n 7. Sudden and accidental injury from electrical currents artificially generated to electrical appliances, devices, fixtures, and wiring.\n D. Insurers may offer open causes of loss. If provided, insurers shall provide coverage for direct loss to the dwelling and other structures and may exclude direct loss caused by any of the following:\n 1. Wear and tear; marring or scratching; deterioration; inherent vice; latent defect; mechanical breakdown; rust, mold, or wet or dry rot; pollutants, smog, smoke from agricultural smudging or industrial operations; settling, cracking, shrinkage, bulging, or expansion of pavements, patios, foundations, walls, floors, roofs, or ceilings; or birds, vermin, rodents, insects, or animals owned or kept by an insured. If a covered cause of loss ensues, insurers shall provide coverage for the ensuing loss.\n 2. Vandalism and malicious mischief, burglary, or glass breakage if the dwelling was vacant. If a covered cause of loss ensues, insurers shall provide coverage for the ensuing loss.\n 3. Continuous or repeated seepage or leakage of water or steam from within a plumbing, heating, or air conditioning system or domestic appliance over a period of weeks, months, or years. This exclusion does not apply to household and personal property.\n 4. Windstorm, hail, ice, snow, or sleet to any of the following property:\n a. Overhead structures, including supports and screening, constructed principally of cloth, metal, fiberglass, or plastic, erected to provide protection from the elements;\n b. Outdoor radio or television antennas including the lead-in wiring, masts, or towers;\n c. Fences;\n d. Seawalls or property line and other free-standing walls;\n e. Greenhouses, hothouses, slathouses, trellises, pergolas, or cabanas;\n f. Outdoor equipment pertaining to the service of the residence premises; or\n g. Wharves, docks, piers, boathouses, bulkheads, or other structures located over or partially over water and the household and personal property on or within.\n 5. Theft of property that is not an integral part of the dwelling or other structure at the time of loss or from a dwelling or other structure that is under construction.\n 6. Collapse, except as required by subsection M of  14VAC5-341-40 .  Statutory Authority  §§  12.1-13 ,  38.2-223 , and  38.2-2108  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 38, Issue 11 , eff. January 1, 2022.    14VAC5-341-70. Permitted exclusions.  A. For all causes of loss, regardless of any other cause of loss or event contributing concurrently or in any sequence to the loss, insurers may exclude loss caused directly or indirectly by any of the following:\n 1. Water, as follows:\n a. Flood, ground surface water, waves, seiche, tidal water or tidal waves, overflow of a body of water, or spray from any of these, whether natural or manmade;\n b. Water that backs up through sewers or drains;\n c. Water that overflows or is discharged from a sump pump or other type of system designed to remove subsurface water that is drained from the foundation area;\n d. Water below the surface of the ground including water that exerts pressure on or flows, seeps, or leaks through (i) sidewalks; (ii) driveways; (iii) foundations; (iv) swimming pools; (v) walls; (vi) basements or floors; or (vii) doors, windows, or other openings; or\n e. Material carried or moved by water referred to in subdivisions 1 a, 1 b, and 1 c of this subsection.\n The exclusions for water loss in subdivisions 1 a through 1 e of this subsection do not apply to an ensuing loss caused by fire or explosion.\n 2. Earth movement, natural or man-made, including earthquake, volcanic eruption, landslide, mudflow, or other earth movement caused by sinking, rising, shifting, or expansion. Insurers shall provide coverage for an ensuing loss caused by fire, explosion, or breakage of glass that is a part of the dwelling or other structure.\n 3. Enforcement of ordinances or laws regulating the construction, repair, or demolition of dwellings or other structures. Insurers shall provide coverage when an ordinance or law requires the use of safety glass in replacement of damaged glass that is a part of the dwelling or other structure.\n 4. Interruption of power or other utility service furnished to the residence premises if the interruption takes place away from the residence premises. Insurers shall provide coverage for the ensuing loss if a covered cause of loss ensues on the residence premises because of the power interruption.\n 5. Enemy attack by armed forces including action taken by military, naval, or air forces in resisting an actual or immediately impending enemy attack, including invasion, insurrection, rebellion, revolution, civil war, usurped power, or action taken by governmental authority in hindering, combating, or defending against the event; order of civil authority except acts of destruction at the time of and for preventing the spread of fire, provided that the fire did not originate from an excluded cause of loss.\n 6. Nuclear reaction, nuclear radiation, or radioactive contamination as set forth in §  38.2-2102  of the Code of Virginia.\n 7. Freezing, thawing, or by the pressure of ice, snow, or water to fences, pavements, patios, swimming pools, foundations, retaining walls, bulkheads, piers, wharves, or docks.\n 8. The exclusions in subdivisions 1 through 7 of this subsection apply even if one or more of the following concurrently contribute to the loss:\n a. Weather conditions;\n b. Acts or decisions including the failure to act or decide of a person, group, organization, or governmental body;\n c. Faulty, inadequate, or defective:\n (1) Planning, zoning, development, surveying, or siting;\n (2) Design, specifications, workmanship, repair, construction, renovation, remodeling, grading, or compaction;\n (3) Materials used in repair, construction, renovation, or remodeling; or\n (4) Maintenance.\n B. Insurers may exclude direct loss caused by:\n 1. An intentional act by a person insured under the policy that was directed or committed by that person, but only with respect to that person.\n 2. Neglect of the insured to use all reasonable means to protect the property during and after a loss.\n C. Insurers may exclude coverage for the following types of property:\n 1. Accounts, bills, currency including virtual or digital, deeds, evidences of debt, money, scrip, stored value cards, smart cards, securities, bullion, manuscripts , letters of credit, bank notes, or notes other than bank notes;\n 2. Aircraft and parts except insurers shall provide coverage for (i) drones without cameras and drones that are not capable of carrying people or cargo; or (ii) hobby aircraft or model aircraft that is not capable of carrying people or cargo;\n 3. Animals, birds, or fish;\n 4. Business property, except household and personal property is not business property unless the property is in that part of the residence premises rented and occupied for home-sharing;\n 5. Electronic equipment that is permanently installed in a motor vehicle;\n 6. Tapes, wires, records, discs, or other media used with electronic equipment in a motor vehicle while the property is in or on a motor vehicle;\n 7. Motor vehicles, motorized bicycles, and hovercraft except (i) vehicles used to service the residence premises, (ii) utility trailers that are not licensed for road use, and (iii) electric mobility devices designed to assist an individual that has a disability;\n 8. Property of (i) tenants , (ii) roomers and boarders not related to the insured, and (iii) home-share occupants during the period of their home-sharing rental;\n 9. Property rented to others, except as provided in subsection B of  14VAC5-341-50 ;\n 10. Property that is unlawful to own or possess under state or federal law; or\n 11. Property that is separately described and specifically insured by this insurance or other insurance.  Statutory Authority  §§  12.1-13 ,  38.2-223 , and  38.2-2108  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 38, Issue 11 , eff. January 1, 2022.    14VAC5-341-80. Loss settlement provisions.  A. Insurers shall include loss settlement provisions in accordance with this section.\n B. When providing only basic causes of loss for the dwelling and other structures, insurers may provide loss settlement on an actual cash value basis. When providing actual cash value loss settlement, insurers shall apply actual cash value loss settlement as follows:\n 1. Subject to the limit of liability, insurers may pay the smaller of the following amounts:\n a. Cost to repair or replace with like kind and quality; or\n b. Actual cash value of the damaged property.\n 2. Insurers may apply actual cash value loss settlement to:\n a. Household and personal property;\n b. Outdoor radio and television antennas; satellite dishes;\n c. Awnings; or\n d. Property described under subsections A and B of  14VAC5-341-40 , and permanently installed flooring (including wall-to-wall carpeting) when providing only basic causes of loss set forth in subsection B of  14VAC5-341-60 .\n C. If the loss settlement provision in subsection B of this section does not apply, insurers shall apply replacement cost less settlement as follows:\n 1. Insurers shall apply replacement cost loss settlement to the dwelling and other structures, including permanently installed flooring. Wall-to-wall carpeting is permanently installed flooring.\n 2. Insurers may limit replacement cost settlement to the following:\n a. The limit of liability applicable to the dwelling or other structures;\n b. The replacement cost of the dwelling or other structures or a part of the dwelling or other structure on the residence premises and intended for the same occupancy and use; or\n c. The amount spent in repairing or replacing the dwelling or other structures or a part of the dwelling or other structure and intended for the same occupancy and use.\n 3. The insured may assert a claim for the actual cash value of the dwelling or other structures without prejudicing the insured's right to make further claim for the difference between the actual cash value and the replacement cost in accordance with §  38.2-2119  B of the Code of Virginia. The claim for the difference must be made within six months of (i) the last date on which the insured received a payment for actual cash value or (ii) date of entry of a final order of a court of competent jurisdiction declaratory of the right of the insured to full replacement cost, whichever shall last occur.\n 4. When the repair or replacement cost is $2,500 or less, insurers shall be liable for the full cost of repair or replacement before the repair or replacement has been completed.\n 5. Insurers may apply an insurance-to-value ratio for replacement cost loss settlement as follows:\n a. Insurers may require an insurance-to-value ratio of no more than 80% before full replacement cost loss settlement applies.\n b. If the insurance-to-value ratio is less than 80% for the damaged dwelling or other structure, an insurer may limit its liability for loss to the larger of the following:\n (1) The actual cash value of that part of the dwelling or other structure; or\n (2) That proportion of the full cost of repair or replacement without deduction for depreciation of that part of the dwelling or other structure damaged or destroyed that the whole amount of insurance applicable to the dwelling or other structure for the cause of loss bears to 80% of the full replacement cost of the dwelling or other structure.\n c. In calculating the 80% insurance-to-value ratio, insurers shall disregard the cost of (i) excavations; (ii) underground flues and pipes; (iii) underground wiring and drains; and (iv) brick, stone, and concrete foundations, piers, and other supports that are below the under surface of the lowest basement floor, or where there is no basement, that are below the surface of the ground inside the foundation walls.\n 6. Insurers may provide replacement cost loss settlement on household and personal property as authorized by §  38.2-2119  B of the Code of Virginia.\n D. Insurers may offer functional replacement cost loss settlement for the property described in subsections A and B of  14VAC5-341-40 , under the conditions outlined in this subsection.\n 1. Functional replacement cost is only permitted at the option of the insured.\n 2. Insurers may not apply functional replacement cost loss settlement to property that qualifies for an amount of insurance equal to 80% or more of the full replacement cost of the dwelling or other structure.\n 3. Insurers shall provide the notice required by §  38.2-2119  C of the Code of Virginia.\n 4. Insurers may limit functional replacement cost loss settlement to the following:\n a. The limit of liability applicable to the dwelling or other structures;\n b. The amount necessary to repair or replace the damaged property with functionally equivalent property at a lower cost than would be required to replace the damaged property with material of like kind and quality; or\n c. The amount spent in repairing or replacing the dwelling or other structure or part of the dwelling or other structure intended for the same occupancy and use.\n E. Insurers shall determine loss to property that is part of a pair or set in a reasonable and fair proportion of the total value of the pair or set.\n F. Insurers shall adjust losses with the named insured and shall pay the named insured unless another payee is specifically named.\n G. Insurers shall restore the limits of liability after a loss .\n H. Insurers may apply a property deductible unless prohibited or otherwise limited in this chapter. Insurers may apply a special property deductible for the following causes of loss (i) wind, (ii) hail, or (iii) theft. No more than one deductible may be applied to a loss. The amount of any property deductible may not exceed 10% of the dwelling limit of coverage.\n I. Insurers may (i) take all or part of the damaged property at the agreed or appraised value or (ii) repair, rebuild, or replace the damaged property with other of like kind and quality within a reasonable time. Within 30 days after receiving the insured's proof of loss, the insurer shall provide notice to the insured of the insurer's decision to (i) take the property at the agreed or appraised value or (ii) repair, rebuild, or replace the damaged property.  Statutory Authority  §§  12.1-13 ,  38.2-223 , and  38.2-2108  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 38, Issue 11 , eff. January 1, 2022.    14VAC5-341-90. Policy conditions.  A. Insurers shall include the following statutory conditions:\n 1. The nuclear clause set forth in §  38.2-2102  of the Code of Virginia;\n 2. The conditions set forth §  38.2-2104  of the Code of Virginia:\n a. Assignment of the policy.\n b. The time that coverage begins and ends.\n 3. The conditions set forth in §  38.2-2105  of the Code of Virginia:\n a. Abandonment.\n b. Appraisal.\n c. Mortgagee interests and obligations.\n d. Pro rata liability.\n e. Requirements in case loss occurs.\n f. Suit.\n g. When loss payable.\n B. Insurers shall include the following conditions:\n 1. If an insurer adopts revisions of the forms or endorsements that would broaden coverage currently provided without additional premium charge, the insurer shall automatically apply the broadened coverage from the effective date of the revisions.\n 2. If a named insured dies, insurers shall modify the definition of insured as follows:\n a. The named insured includes:\n (1) The spouse, if not already a named insured and if a resident of the household at the time of the death; and\n (2) The legal representative with respect to the residence premises and property of the deceased insured at the time of the death.\n b. Insured also includes:\n (1) Members of the deceased's household who were insured at the time of the named insured's death, but only while residents of the residence premises; and\n (2) Persons having proper temporary custody of the insured property until the appointment and qualification of the legal representative.\n 3. Insurers may not invalidate the policy if the insured waives, in writing, before a loss any right of recovery against a party for loss occurring on the residence premises. If not waived, the insurer may require from the insured an assignment of all right of recovery against a party for loss to the extent that the insurer made payment.\n 4. Terms or conditions in the policy that are less favorable than those provided for in this chapter or the applicable statutes are construed to conform to this chapter and those statutes.\n 5. Insurers shall include the relevant termination provisions in §§  38.2-2113  and  38.2-2114  of the Code of Virginia in the policy. In addition, the following apply:\n a. Return premium calculations resulting from an insurer-initiated termination shall be pro rata.\n b. Terminations for non-payment of premium shall be calculated pro rata.\n c. Return premium calculations resulting from an insured-initiated termination may be short rate except the penalty may not be more than 10% of the pro rata premium for the expired time.\n d. Insurers may not refuse to renew the policy except in accordance with the provisions of §§  38.2-2113  and  38.2-2114  of the Code of Virginia.\n C. Insurers may include any of the following conditions. Insurers may:\n 1. Restrict the application of the policy to loss during the policy term.\n 2. Void the entire policy (i) if, whether before or after the loss, an insured has willfully concealed or misrepresented any material fact or circumstance concerning the insurance or the interest of the insured in the insurance or (ii) in the case of fraud or false swearing by the insured relating to the insurance.\n 3. Require the insured to notify the police if loss is by theft.\n 4. Require that coverage under the policy is excess over a service agreement, home warranty, or similar service warranty.\n 5. Require that a bailee for hire may not benefit under the policy.\n 6. Elect to waive a policy provision. Any waiver of a policy provision by the insurer must be in writing.\n 7. Exclude coverage, refuse to pay claims, or refuse to provide benefits under a policy if those actions would expose the insurer to a violation of applicable trade or economic sanctions, laws, or regulations, including those administered and enforced by the U.S. Treasury Department's Office of Foreign Assets Control.  Statutory Authority  §§  12.1-13 ,  38.2-223 , and  38.2-2108  of the Code of Virginia.  Historical Notes  Derived from Virginia Register  Volume 38, Issue 11 , eff. January 1, 2022.\n                     Website addresses provided in the Virginia Administrative Code to documents incorporated by reference are for the reader's convenience only, may not necessarily be active or current, and should not be relied upon. To ensure the information incorporated by reference is accurate, the reader is encouraged to use the source document described in the regulation.\n                     As a service to the public, the Virginia Administrative Code is provided online by the Virginia General Assembly. We are unable to answer legal questions or respond to requests for legal advice, including application of law to specific fact. To understand and protect your legal rights, you should consult an attorney.\n\n\t\t\t\t\t\t\t Code of Virginia\n\n\t\t\t\t\t\t\t Administrative Code\n\n\t\t\t\t\t\t\t View by Agency\n\n\t\t\t\t\t\t\t Emergency Regulations\n\n\t\t\t\t\t\t\t VAC# Look Up\n\n\t\t\t\t\t\t\t\t Go\n\n\t\t\t\t\t\t\t Constitution of Virginia\n\n\t\t\t\t\t\t\t Charters\n\n\t\t\t\t\t\t\t Authorities\n\n\t\t\t\t\t\t\t Compacts\n\n\t\t\t\t\t\t\t Uncodified Acts\n\n                             Sign In\n\n                                 Username: \n\n                                 Password: \n\n                                 Cancel\n\n                                  LIS Home\n                                  Lobbyist-in-a-Box\n                                  Privacy Policy\n\n                                © Copyright Commonwealth of Virginia,\n                                 . All rights reserved. Site developed by the  Division of Legislative Automated Systems (DLAS) .\n                                 Sign In","text_length":45465}
{"slug":"wa-taa-eo-25-01","jurisdiction":"WA","agency":"OIC","doc_type":"bulletin","citation":"WA OIC Emergency Order 25-01","title":"Emergency Order No: 25-01 Providing relief to Washington consumers from December 2025 atmospheric river and winter weather event","official_source_url":"https://www.insurance.wa.gov/sites/default/files/2025-12/WSR%2026-01-162-emergency-order-25-01.pdf","access_class":"statutory-public","access_notes":"insurance.wa.gov; gate-zero TOP-20 WA bulletins row (no restriction located).","first_seen_at":"2026-07-20T01:47:18.601887+00:00","last_checked_at":"2026-07-20T06:36:55.915092+00:00","versions":[{"fetched_at":"2026-07-20T01:47:18.601887+00:00","version_no":1,"text_length":8014,"effective_date":null,"content_sha256_short":"c4cc6ee62104"}],"text":"PATTY KUDERER                                   STATE OF WASHINGTON                                Phone: 360-725-7000\nSTATE INSURANCE COMMISSIONER                                                                           www.insurance.wa.gov\n\n                                                             OFFICE OF\n                                              INSURANCE COMMISSIONER\n\n                                                      EMERGENCY ORDER NO. 25-01\n\n                TO:                ALL INSURERS AUTHORIZED OR ADMITTED TO TRANSACT\n                                  PROPERTY AND AUTOMOBILE INSURANCE BUSINESS IN\n                                  WASHINGTON STATE AND ALL ENTITIES REGULATED BY THE\n                                  INSURANCE COMMISSIONER\n\n                FROM:             PATTY KUDERER, INSURANCE COMMISSIONER\n\n                RE:               PROVIDING RELIEF TO WASHINGTON CONSUMERS FROM 2025\n                                  ATMOSPHERIC RIVER AND WINTER WEATHER EVENT BY\n                                  ADDRESSING GRACE PERIODS FOR NONPAYMENT OF PREMIUM\n                                  AND TEMPORARILY PROHIBITING CANCELLATION AND\n                                  NONRENEWAL OF PROPERTY & CASUALTY INSURANCE\n                                  POLICIES\n\n                PURSUANT TO RCW 48.02.060(4), the Insurance Commissioner of the state of Washington\n                (“Insurance Commissioner”) orders all insurers, insurance producers, surplus line brokers, and other\n                entities regulated by the Insurance Commissioner (hereafter “Regulated Entities”), as follows:\n\n                      A. Between December 15, 2025, and February 12, 2026, all Regulated Entities transacting any\n                         property and automobile insurance business shall provide grace periods of no less than\n                         forty-five (45) days for nonpayment of premium and shall waive otherwise applicable\n                         charges and fees associated with nonpayment of premium, such as late fees and\n                         reinstatement fees.\n                      B. Between December 15, 2025, and February 12, 2026, no property and automobile insurer\n                         shall cancel a policy issued for nonpayment of premium, unless specifically directed to do\n                         so by the insured.\n                      C. Between December 15, 2025, and February 12, 2026, the 45-day notice period for\n                         nonrenewal notices in RCW 48.18.2901(1)(a)(i) is suspended during the state of\n                         emergency. No property and automobile insurer shall issue a notice of nonrenewal less\n                         than 120 days before the expiration date of the policy.\n\n                                         Mailing Address: PO Box 40255 Olympia, WA 98504-0255\n                                          Street Address: 5000 Capitol Blvd Tumwater, WA 98501\nOFFICE OF THE INSURANCE COMMISSIONER\n\nEmergency Order No. 25-01\nRe: Providing Relief to Washington Consumers from December 2025 Atmospheric River and\nWinter Weather Event\nPage 2\n\n       BASIS\n\n            1. On December 10, 2025, the Governor issued Proclamation 25-07 declaring an emergency\n               related to the December Atmospheric River and Winter Weather Event. The proclamation\n               provides in pertinent part as follows (emphasis added):\n\n                I, Bob Ferguson, Governor of the state of Washington, as a result of the above-noted\n                situation and under Chapters 38.52 and 43.06 RCW, do hereby proclaim that a State of\n                Emergency exists throughout the entire state of Washington, and direct that the plans and\n                procedures in the Washington State Comprehensive Emergency Management Plan be\n                implemented. State agencies and departments are directed to utilize state resources in\n                accordance with the Washington State Comprehensive Emergency Management Plan and\n                to do everything reasonably possible to assist affected political subdivisions in an effort to\n                respond to and recover from this extreme weather event.\n            2. The geographical extent of this emergency order is all areas of the state affected by\n               flooding, landslides, mudslides, bank erosion, or wind damage as a result of the\n               Atmospheric River and Winter Weather Event of December 2025 including, but not\n               limited to, Whatcom County, Skagit County, Snohomish County, King County, and\n               Lewis County.\n            3. The December 2025 Atmospheric River and Winter Weather Event has harmed or\n               threatened to harm the property, safety and welfare of Washington citizens who have lost\n               homes and other property or whose lives or employment have been otherwise disrupted\n               by the December 2025 Atmospheric River and Winter Weather Event in the state of\n               Washington.\n            4. RCW 48.02.060(4)(b) & (c) provides in pertinent part that, when the Governor proclaims a\n               state of emergency under RCW 43.06.010(12), the Insurance Commissioner may issue an\n               order that addresses any or all of the following matters related to insurance policies issued\n               in this state: (b) grace periods for payment of insurance premiums and performance of other\n               duties by insureds; and (c) temporary postponement of cancellations or nonrenewals.\n            5. RCW 48.02.060(5) provides that an order by the Insurance Commissioner under subsection\n               (4) of this section may remain effective for not more than sixty (60) days unless the\n               Insurance Commissioner extends the termination date for the order for an additional period\n               of not more than thirty (30) days. The Insurance Commissioner may extend the order if, in\n               the Insurance Commissioner’s judgment, the circumstances warrant an extension. An order\n               of the Insurance Commissioner under subsection (4) of this section is not effective after the\n               related state of emergency is terminated by proclamation of the Governor under RCW\n               43.06.210. The order must specify, by line of insurance: (a) the geographic areas in which\n               the order applies, which must be within but may be less extensive than the geographic area\n               specified in the Governor’s proclamation of a state of emergency and must be specific\n               according to an appropriate means of delineation, such as the United States postal service\n               zip codes or other appropriate means; and\n               (b) the date on which the order becomes effective and the date on which the order terminates.\n            6. Emergency action by the Insurance Commissioner is necessary to protect the property,\n               safety, and welfare of Washington citizens affected by the December 2025 Atmospheric\n               River and Winter Weather Event in the state of Washington.\nOFFICE OF THE INSURANCE COMMISSIONER\n\nEmergency Order No. 25-01\nRe: Providing Relief to Washington Consumers from December 2025 Atmospheric River and\nWinter Weather Event\nPage 3\n\n       ORDER\n\n                NOW, THEREFORE, the Insurance Commissioner hereby activates the provisions of\n       RCW 48.02.060(4)(b) & (c) in order to protect the property, safety and welfare of Washington\n       citizens affected by the December 2025 Atmospheric River and Winter Weather Event in the state\n       of Washington, as set forth above.\n\n               This Order shall remain in effect until February 12, 2026, subject to the further order of the\n       Insurance Commissioner extending its effect.\n\n       THIS ORDER IS EFFECTIVE IMMEDIATELY AND IS ENTERED at Olympia, Washington,\n       this 15th day of December, 2025.\n\n       PATTY KUDERER\n       Insurance Commissioner","text_length":8014}
{"slug":"wa-taa-2025-01","jurisdiction":"WA","agency":"OIC","doc_type":"bulletin","citation":"WA OIC TAA 2025-01","title":"2025-01: Implementation of Chapter 389, Laws of 2025","official_source_url":"https://www.insurance.wa.gov/sites/default/files/2025-08/technical-assistance-advisory-2025-01_0.pdf","access_class":"statutory-public","access_notes":"insurance.wa.gov; gate-zero TOP-20 WA bulletins row (no restriction located).","first_seen_at":"2026-07-20T01:47:18.601887+00:00","last_checked_at":"2026-07-20T06:36:55.915092+00:00","versions":[{"fetched_at":"2026-07-20T01:47:18.601887+00:00","version_no":1,"text_length":11779,"effective_date":null,"content_sha256_short":"38af79056b3b"}],"text":"PATTY KUDERER                                 STATE OF WASHINGTON                                  Phone: 360-725-7000\nSTATE INSURANCE COMMISSIONER                                                                           www.insurance.wa.gov\n\n                                                           OFFICE OF\n                                             INSURANCE COMMISSIONER\n\n                                            Technical Assistance Advisory 2025-011\n\n          TO:                  All health carriers operating in the State of Washington\n\n          FROM:                Insurance Commissioner Patty Kuderer\n\n          DATE:                August 8, 2025\n\n          SUBJECT:             Implementation of Chapter 389, Laws of 2025\n\n          The purpose of this Technical Assistance Advisory (“TAA”) is to provide guidance related to the\n          implementation of SSB 5579 (Chapter 389, Laws of 2025), an act relating to prohibiting health\n          carriers, facilities, and providers from making any public statements of any potential or planned\n          contract termination until 45 days before the termination date, unless disclosure satisfies a legal\n          obligation. Several key provisions of the law take effect as of July 27, 2025, while others become\n          effective at later dates.\n\n          Background\n\n          To offer health plans in Washington State, health carriers must meet network access standards\n          established by the Office of the Insurance Commissioner (OIC).2 Health carriers establish their\n          provider networks by entering into contracts with a broad range of health care providers and facilities.\n          Washington state law establishes standards for health carrier/provider contracting, including: terms\n          and conditions of payment; standards for parties to a contract to notify the other party of contract\n          termination without cause; requirements for carriers to notify OIC when they receive a notice of a\n          potential contract termination from a provider or facility, and standards for carriers to provide health\n          plan enrollees advance notice of a potential contract termination.3\n\n          Health carrier contracts with hospitals, health systems, and other health care providers are often multi-\n          year contracts. Over the past two years, OIC has observed an increasing trend of mid-term contract\n          termination notices, with 48 notices issued between July 2023 and July 2025. Notice of contract\n          termination initiates negotiations between the parties to the contract. During this period, it is not\n          unusual for parties to the contract to communicate publicly, whether through op-eds in local\n\n          1\n            This advisory is an interpretive policy statement released to advise the public of the OIC’s current opinions,\n            approaches, and likely courses of action. It is advisory only. RCW 34.05.230(1).\n          2\n            Chap. 284-170 WAC, Subchapter B.\n          3\n            WAC 284-170-401; WAC 284-170-421.\n                                           Mailing Address: PO Box 40255 Olympia, WA 98504-0255\n                                            Street Address: 5000 Capitol Blvd Tumwater WA 98501\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2025-01\nImplementation of Chapter 389, Laws of 2025\nAugust 7, 2025\nPage 2\n\nnewspapers, press releases, websites, communication with legislators, or communication with\nenrollees or patients.4\n\nThe Legislature enacted SSB 5579 (Chapter 389, Laws of 2025), finding that public communications\nand notices to health plan members by carriers, health care providers, or health care facilities during\ncontract negotiations have raised concerns for enrollees, patients, and affected communities.5 The\nLegislature’s stated intent for enacting the new law is to provide consistent policies for\ncommunication with enrollees and affected communities regarding potential contract terminations.6\nThe law applies to fully-insured health plans regulated by OIC, as well as health plans offered to state\nand public school employees and retirees through the Public Employee Benefits Board (PEBB) and\nSchool Employees Benefits Board (SEBB) programs under Chapter 41.05 RCW.7\n\nRecently, carriers and providers have contacted the OIC to inquire about when the provisions of the\nbill take effect.\n\nAuthority\n\nSubsections 2(1) through (3) of Chapter 389, Laws of 2025, provide as follows:\n\n                (1) In the case of a provider contract that is expiring by its own terms or for which one\n        party has given notice to the other party of an intended termination without cause in\n        accordance with the terms of the provider contract, neither the health care provider, the health\n        care facility, any health care provider employed by, contracted with, or otherwise affiliated\n        with the facility, nor the carrier may make or cause to be made public statements, including\n        by directly communicating with impacted health plan enrollees and patients, regarding such\n        expiration or termination until 45 days prior to the termination date, unless: (a) The disclosure\n        is required to satisfy a specific legal obligation; or (b) the expiration or termination has already\n        been disclosed publicly because of a legal obligation. Communications exclusively with the\n        governor, legislators, or state agency staff regarding a potential or intended contract\n        termination do not constitute a public statement.\n\n                (2) Nothing in this section requires a carrier, health care facility, or health care provider\n        to provide notice of a potential termination to enrollees, unless required to do so as a regulatory\n        or legal requirement.\n\n4\n  See, e.g. “Information about Providence’s negotiation with Regence and Asuris in Washington State”,\nMarch 31, 2025; “Samaritan Healthcare ends contract with Premera amidst ongoing rate dispute”, Sept. 8,\n2023.\n5\n  Sec. 1 of Chap. 389, Laws of 2025.\n6\n  Id.\n7\n  This law does not apply to a provider contract that is expiring or being terminated by an independent\nindividual provider or single-specialty or multispecialty group practice of five or fewer providers. Sec. 2(8)\nof Chap. 389, Laws of 2025.\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2025-01\nImplementation of Chapter 389, Laws of 2025\nAugust 7, 2025\nPage 3\n\n                 (3) Public statements or communication with health plan enrollees or patients by a\n        carrier, health care facility, or health care provider may not occur prior to the date the carrier,\n        health care facility, or health care provider has given written notice of the termination to the\n        other party, unless agreed upon by both parties.\n\nSubsection 2(4) directs the Commissioner, in consultation with health carriers, health care providers,\nhealth care facilities, and consumers, to develop standard template language for notices sent to health\nplan enrollees and patients by health carriers, health care facilities, or health care providers by\nDecember 1, 2025. The minimum required elements of the notice template are clearly stated in statute.\nSubsection 2(5) directs OIC to ensure carriers include the requirements in Section 2 of the Act in all\nprovider contracts by January 1, 2027. Subsection 2(6) authorizes the Commissioner to enforce the\nprovisions of the Act related to carriers beginning January 1, 2026. It also gives the Commissioner\nauthority to submit information regarding potential violations of Section 2 to the Department of\nHealth or the applicable health profession disciplinary authority.\n\nAnalysis\n\nThere are various dates that impact compliance with this statute. Statutes that do not include a specific\neffective date are effective 90 days after the Legislature adjourns. The Legislature did not impose a\nspecific effective date for any provision of SSB 5579. Therefore, the substantive provisions of SSB\n5579, including Section 2, went into effect on July 27, 2025, and are in effect now. This includes Sec.\n2(1) of the law, which prohibits a health care provider, health care facility, or carrier from making or\ncausing to be made public statements, including by directly communicating with impacted health plan\nenrollees and patients, regarding such expiration or termination until 45 days before the contract\ntermination date when one party has given notice to the other of an intended contract termination\nwithout cause. It also includes Sec. 2(3) that prohibits public statements or communication with health\nplan enrollees or patients by a carrier, health care facility, or health care provider before the date the\ncarrier, health care facility, or health care provider has given written notice of the termination to the\nother party, unless agreed upon by both parties.\n\nAs directed by the Legislature in Section 2(4) of the law, the OIC is developing standard template\nlanguage for consumer notices regarding potential contract termination or expiration that carriers and\nproviders can use without needing to obtain the OIC’s prior approval. Section 2(4)(b) establishes the\nminimum information that must be included in any notice developed pursuant to Section 2(4). OIC\nwill be distributing drafts of the template language for public comment and review and will finalize\nthe template language on or before December 1, 2025, as required by statute. Notices developed\npursuant to Sec. 2(4) of the law must include, at a minimum:\n\n               (i) A reference to the specific facility or facilities by name that would be affected by\n        the potential contract termination or expiration, and an indication of whether the potential\n        termination or expiration would apply to hospital-based providers;\n\n                (ii) Direction to enrollees related to appointments that are scheduled past the date of\n        the potential contract termination or expiration date; and\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2025-01\nImplementation of Chapter 389, Laws of 2025\nAugust 7, 2025\nPage 4\n\n                (iii) Information concerning the enrollee's continuity of care rights pursuant to the\n        federal no surprises act, 42 U.S.C. Sec. 300gg-111.\n\nAs directed by Section 2(6), the Commissioner will forebear initiating any enforcement action against\na carrier until January 1, 2026. Similarly, the OIC will not provide any formal referrals to health care\nproviders’ licensing authorities until January 1, 2026. The Commissioner will provide informational\nnotices to carriers and providers if the Commissioner discovers violations of the provisions in Sec. 2\nthat occur or occurred between July 27, 2025, and January 1, 2026. Any informational notices issued\nby the OIC will be public records and may be subject to disclosure.\n\nConclusion:\n\nBecause there is no other effective date clause in SSB 5579, the substantive provisions of the Act,\nincluding Section 2, went into effect on July 27, 2025. Although the Commissioner will forebear\ninitiating any enforcement action against a carrier, or any formal referral to a health care provider’s\nlicensing authority until January 1, 2026, she will provide informational notices to carriers and\nproviders if she discovers violations of the provisions in Sec. 2 that occur between now and January\n1, 2026. The Commissioner will distribute drafts of the enrollee/patient notice template language for\npublic comment and review, and will finalize the template language on or before December 1, 2025.\n\nPlease direct any questions about this advisory to Jennifer Kreitler, who may be contacted at\nJennifer.Kreitler@oic.wa.gov or by phone at 360-725-7127.","text_length":11779}
{"slug":"wa-taa-2025-02","jurisdiction":"WA","agency":"OIC","doc_type":"bulletin","citation":"WA OIC TAA 2025-02","title":"2025-02: OIC’s Interpretation of Chapter 48.200 RCW – Health care benefit managers","official_source_url":"https://www.insurance.wa.gov/sites/default/files/2025-09/technical-assistance-advisory-2025-02.pdf","access_class":"statutory-public","access_notes":"insurance.wa.gov; gate-zero TOP-20 WA bulletins row (no restriction located).","first_seen_at":"2026-07-20T01:47:18.601887+00:00","last_checked_at":"2026-07-20T06:36:55.915092+00:00","versions":[{"fetched_at":"2026-07-20T01:47:18.601887+00:00","version_no":1,"text_length":14416,"effective_date":null,"content_sha256_short":"5e7551ebec79"}],"text":"PATTY KUDERER                                 STATE OF WASHINGTON                                  Phone: 360-725-7000\nSTATE INSURANCE COMMISSIONER                                                                           www.insurance.wa.gov\n\n                                                           OFFICE OF\n                                            INSURANCE COMMISSIONER\n\n                                           Technical Assistance Advisory 2025-021\n\n          TO:                  All health care benefit managers and health carriers operating in the State of\n                               Washington\n\n          FROM:                Insurance Commissioner Patty Kuderer\n\n          DATE:                September 15, 2025\n\n          SUBJECT:             OIC’s Interpretation of Chapter 48.200 RCW – Health care benefit managers\n\n          The purpose of this Technical Assistance Advisory (“TAA”) is to provide guidance related to the\n          application of Chapter 48.200 RCW to health care benefit managers, including pharmacy benefit\n          managers, and provide guidance related to provisions enacted by Engrossed Second Substitute Senate\n          Bill 5213 (E2SSB 5213, Chapter 242, Laws of 2024). The Washington State Office of the Insurance\n          Commissioner (“OIC”) released a preproposal statement of inquiry (CR-101) on July 22, 2025,\n          pertaining to E2SSB 5213 and health care benefit managers (R 2025-11, WSR 25-15-143).\n\n          Background\n\n          The Legislature enacted Chapter 48.200 RCW in 2020, with the express intent to protect and promote\n          the health, safety, and welfare of Washington residents by establishing standards for regulatory\n          oversight of health care benefit managers.2\n\n          Health Care Benefit Managers\n\n          To conduct business in Washington state, health care benefit managers (“HCBMs”) are required to\n          register with the Insurance Commissioner and annually renew their registration.3 “Health care benefit\n          manager” is defined as follows:\n\n          1\n            This advisory is an interpretive policy statement released to advise the public of the OIC’s current opinions,\n            approaches, and likely courses of action. It is advisory only. RCW 34.05.230(1).\n          2\n            RCW 48.200.010.\n          3\n            RCW 48.200.030.\n                                           Mailing Address: PO Box 40255 Olympia, WA 98504-0255\n                                            Street Address: 5000 Capitol Blvd Tumwater WA 98501\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2025-02\nOIC’s Interpretation of Chapter 48.200 RCW – Health care benefit managers\nSeptember 15, 2025\nPage 2\n\n    A person or entity providing services to, or acting on behalf of, a health carrier or employee\n    benefits programs, that directly or indirectly impacts the determination or utilization of benefits\n    for, or patient access to, health care services, drugs, and supplies including, but not limited to:\n\n    •   Prior authorization or preauthorization of benefits or care;\n    •   Certification of benefits or care;\n    •   Medical necessity determinations;\n    •   Utilization review;\n    •   Benefit determinations;\n    •   Claims processing and repricing for services and procedures;\n    •   Outcome management;\n    •   Payment or authorization of payment to providers and facilities for services or procedures;\n    •   Dispute resolution, grievances, or appeals relating to determinations or utilization of benefits;\n    •   Provider network management; or\n    •   Disease management.4\n\nThere are several sub-types of HCBMs, such as laboratory benefit manager, mental health benefit\nmanager, and pharmacy benefit manager.5 Chapter 48.200 RCW applies to health care benefit\nmanagers, as defined in RCW 48.200.020, who provide any of the services listed above to, or act on\nbehalf of health carriers as defined in RCW 48.200.020 or employee benefits programs6 as defined in\nRCW 48.200.020. Health care benefit managers do not include the following:\n\n    •   Health care service contractors as defined in RCW 48.44.010;\n    •   Health maintenance organizations as defined in RCW 48.46.020;\n    •   Issuers as defined in RCW 48.01.053;\n    •   The public employees' benefits board established in RCW 41.05.055;\n    •   The school employees' benefits board established in RCW 41.05.740;\n    •   Discount plans as defined in RCW 48.155.010;\n    •   Direct patient-provider primary care practices as defined in RCW 48.150.010;\n    •   An employer administering its employee benefit plan or the employee benefit plan of an\n        affiliated employer under common management and control;\n    •   A union, either on its own or jointly with an employer, administering a benefit plan on behalf\n        of its members;\n    •   An insurance producer selling insurance or engaged in related activities within the scope of\n        the producer's license;\n\n4\n  RCW 48.200.020(5)(a).\n5\n  See definitions of laboratory benefit manager, mental health benefit manager, and pharmacy benefit\nmanager under RCW 48.200.020.\n6\n  \"Employee benefits programs\" means programs under both the public employees' benefits board established\nin RCW 41.05.055 and the school employees' benefits board established in RCW 41.05.740. Id.\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2025-02\nOIC’s Interpretation of Chapter 48.200 RCW – Health care benefit managers\nSeptember 15, 2025\nPage 3\n\n    •   A creditor acting on behalf of its debtors with respect to insurance, covering a debt between\n        the creditor and its debtors;\n    •   A behavioral health administrative services organization or other county-managed entity that\n        has been approved by the state health care authority to perform delegated functions on behalf\n        of a carrier;\n    •   A hospital licensed under chapter 70.41 RCW or ambulatory surgical facility licensed under\n        chapter 70.230 RCW, to the extent that it performs provider credentialing or recredentialing,\n        but no other functions of a health care benefit manager as described in subsection (4)(a) of\n        this section;\n    •   The Robert Bree collaborative under chapter 70.250 RCW;\n    •   The health technology clinical committee established under RCW 70.14.090;\n    •   The prescription drug purchasing consortium established under RCW 70.14.060; or\n    •   Any other entity that performs provider credentialing or recredentialing, but no other functions\n        of a health care benefit manager as described in RCW 48.200.020(4)(a).\n\nHealth care benefit managers are required to comply with the requirements set forth in RCW\n48.200.030 through RCW 48.200.050. Included in these requirements is the obligation for HCBMs\nto register with OIC and annually renew their registration. HCBMs also must file with OIC all benefit\nmanagement contracts and contract amendments between the health care benefit manager and a health\ncarrier, provider, pharmacy, pharmacy services administration organization, or other health care\nbenefit manager, entered into directly or indirectly in support of a contract with a carrier or employee\nbenefits programs. These contracts are required to be filed within 30 days following the effective date\nof the contract or contract amendment. Contracts and contract amendments between health care\nbenefit managers and health carriers that were executed prior to July 23, 2023, and are currently in\nforce, must be filed with OIC no later than 60 days following July 23, 2023.7\n\nPharmacy Benefit Managers\n\nTo conduct business in Washington state, pharmacy benefit managers (“PBMs”), a sub-type of\nHCBMs, also are required to register with the OIC and annually renew their registration.8 “Pharmacy\nbenefit manager” is defined as follows:\n\n    A person that contracts with pharmacies on behalf of a health carrier, employee benefits program,\n    or medicaid managed care program to:\n\n        •   Process claims for prescription drugs or medical supplies or provide retail network\n            management for pharmacies or pharmacists;\n        •   Pay pharmacies or pharmacists for prescription drugs or medical supplies;\n\n7\n  See OIC Technical Assistance Advisory 2024-01 for more information about OIC’s Interpretation of\nChapter 48.200 RCW & RCW 48.43.731 (Carrier Filing Requirements related to HCBM contracts).\n8\n  RCW 48.200.030.\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2025-02\nOIC’s Interpretation of Chapter 48.200 RCW – Health care benefit managers\nSeptember 15, 2025\nPage 4\n\n          •   Negotiate rebates, discounts, or other price concessions with manufacturers for drugs paid\n              for or procured as described in this subsection;\n          •   Establish or manage pharmacy networks; or\n          •   Make credentialing determinations.9\n\nChapter 48.200 RCW applies to pharmacy benefit managers as defined in RCW 48.200.020, that\ncontract with pharmacies to conduct any of the services listed above on behalf of health carriers\ndefined in RCW 48.200.020, employee benefits programs defined in RCW 48.200.020, or medicaid\nmanaged care programs.\n\nPharmacy benefit managers are required to comply with the requirements set forth in RCW\n48.200.030 through RCW 48.200.050 (applying generally to health care benefit managers), and RCW\n48.200.220 through RCW 48.200.320 (applying specifically to pharmacy benefit managers).\n\nSpecific Plans Chapter 48.200 RCW Does Not Apply To\n\nChapter 48.200 RCW does not apply to health care benefit managers as defined in RCW\n48.200.020, who provide the services listed above exclusively to, or act exclusively on behalf of:\n\n      •   Medicare supplement plans;\n      •   Medicare Advantage plans (Part C of Medicare);\n      •   Medicaid, except that pharmacy benefit managers that contract with pharmacies on behalf of\n          Medicaid managed care plans are subject to Chap. 48.200 RCW;\n      •   Children’s Health Insurance Program plans;\n      •   Discount Plans;\n      •   Union Plans;\n      •   Self-insured health plans (unless the plan is an employee benefits program defined under\n          RCW 48.200.020); or\n      •   Plans that provide monetary payment, such as income replacement disability plans or life\n          insurance accelerate benefits, unless these plans provide coverage for health care services,\n          drugs and supplies.\n\nExample #1: A health care benefit manager provides health care benefit management services for\nMedicare supplement plans and fully-insured health plans. The health care benefit manager must\nregister with OIC because it provides health care benefit manager services to fully-insured health\nplans.\n\nExample #2: A health care benefit manager provides health care benefit management services\nexclusively for self-funded employer group health plans other than employee benefit programs as\n\n9\n    RCW 48.200.020(14)(a).\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2025-02\nOIC’s Interpretation of Chapter 48.200 RCW – Health care benefit managers\nSeptember 15, 2025\nPage 5\n\ndefined in RCW 48.200.020(4) (PEBB/SEBB Uniform Medical Plan). The health care benefit\nmanager is not required to register with OIC.\n\nAs discussed further below in the Section, “Application of E2SSB 5213 to Self-funded Group Health\nPlans that Opt-In,” E2SSB 5213 applies RCW 48.200.280, 48.200.310, and 48.200.320 to self-\nfunded group health plans governed by the provisions of the federal employee retirement income\nsecurity act of 1974 (29 U.S.C. Sec. 1001 et seq.) only if the self-funded group health plan elects to\nparticipate in RCW 48.200.280, 48.200.310, and 48.200.320.\n\nApplication of E2SSB 5213 to Self-Funded Private Group Health Plans that Opt-In (Effective\nJanuary 1, 2026)\n\nRCW 48.200.330(1) provides that Chapter 48.200 RCW is inapplicable to persons or entities\nproviding services to, or acting on behalf of, a union or employer administering a self-funded group\nhealth plan governed by the provisions of the federal employee retirement income security act of 1974\n(29 U.S.C. Sec. 1001 et seq.), unless a self-funded private group health plan chooses to participate in\nRCW 48.200.280, 48.200.310, and 48.200.320 governing certain pharmacy benefit management\nbusiness practices. This “opt-in” process is established in RCW 48.200.330(2) and (3).\n\nAs a result of these legislative changes, pharmacy benefit managers acting on behalf of self-funded\nprivate group health plans that have opted to participate in RCW 48.200.280, 48.200.310,\nand 48.200.320 as provided in RCW 48.200.330 will be required to comply with\nRCW 48.200.280, 48.200.310, and 48.200.320 in administering that self-funded private group health\nplan’s pharmacy benefits. In this circumstance, pharmacy benefit managers are not subject to any\nother provisions in Chapter 48.200 RCW. Furthermore, the Legislature has expressly stated in RCW\n48.200.330(3) that the OIC does not have enforcement authority related to a pharmacy benefit\nmanager's conduct pursuant to a contract with a self-funded group health plan governed by the federal\nemployee retirement income security act of 1974, 29 U.S.C. Sec. 1001 et seq., that elects to participate\nin RCW 48.200.280, 48.200.310, and 48.200.320.\n\nOIC will implement the self-funded private group health plan opt-in process during Fall 2025, and as\npart of that process, make a list of the health plans that have opted in under RCW 48.200.330 available\non its website on or before December 1, 2025.\n\nRulemaking\n\nOn December 18, 2024, the OIC adopted rules relating to health care benefit managers (R 2024-02).\nOn July 22, 2025, the OIC filed a preproposal statement of inquiry (CR-101, WSR 25-15-143)\nregarding additional rulemaking to ensure the OIC can continue to effectively oversee health care\nbenefit managers, including pharmacy benefit managers. In this rulemaking, the OIC may amend\nChapter 284-180 Washington Administrative Code (WAC), including, but not limited to,\nimplementation of E2SSB 5213 (Chapter 242, Laws of 2024).\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2025-02\nOIC’s Interpretation of Chapter 48.200 RCW – Health care benefit managers\nSeptember 15, 2025\nPage 6\n\nPlease direct any questions about this advisory to the OIC’s Company Licensing Unit, which may be\ncontacted at clc@oic.wa.gov and (360) 725-7219.","text_length":14416}
{"slug":"wa-taa-aetna-providence-briefing-memo-aug-2024","jurisdiction":"WA","agency":"OIC","doc_type":"bulletin","citation":"WA OIC Advisory aetna-providence-briefing-memo-aug-2024","title":"Aug. 30, 2024, memorandum regarding Aetna and Providence contract negotiations","official_source_url":"https://www.insurance.wa.gov/sites/default/files/2025-03/aetna-providence-briefing-memo-aug-2024.pdf","access_class":"statutory-public","access_notes":"insurance.wa.gov; gate-zero TOP-20 WA bulletins row (no restriction located).","first_seen_at":"2026-07-20T01:47:18.601887+00:00","last_checked_at":"2026-07-20T06:36:55.915092+00:00","versions":[{"fetched_at":"2026-07-20T01:47:18.601887+00:00","version_no":1,"text_length":3822,"effective_date":null,"content_sha256_short":"7c7b4f51954e"}],"text":"Memorandum\nTo:             Interested legislators and staff\n\nFrom:           Jane Beyer, Senior Health Policy Advisor\n                Jennifer Kreitler, Provider Network Oversight Program Manager\n\nDate:           August 30, 2024\n\nSubject:        Aetna and Providence\n\nIn 2016, the Office of the Insurance Commissioner (OIC) adopted network access standards to\nensure that insurers have a sufficient number, type and distribution of health care providers and\nfacilities to meet the needs of consumers enrolled in their health plans (Chap. 284-170 WAC).\nUnder those rules, insurers must notify OIC of any changes affecting the ability of their network\nproviders and facilities to furnish covered services to enrollees, including potential contract\nterminations (WAC 284-170-230(2)). Carriers also are required to notify affected health plan\nenrollees of potential contract terminations (WAC 284-170-421(10)).\n\nOn June 10, 2024, Aetna notified the OIC of a potential termination of their contract with\nProvidence for their commercial health plans. The termination does not apply to people\nenrolled in Aetna Medicare Advantage plans. Aetna has sent notices to commercial health plan\nenrollees regarding the potential contract termination.\n\nProvidence and Aetna are engaged in contract negotiations. If an agreement is not reached,\nProvidence will no longer be an in-network provider with Aetna for their commercial health\nplans effective September 1, 2024. The termination would apply to Providence, Providence\nSwedish, PacMed and Kadlec hospitals.\n\nOIC continues to receive updates from Aetna regarding the status of contract negotiations,\nwhich are ongoing. If Aetna and Providence reach agreement on a contract, OIC will expedite\nreview of those contract submissions for approval.\n\nIn the event that a contract agreement is not reached, there is a new federal law that provides\nsome assurance of continuity of care. The law was included in the Consolidated Appropriations\nAct of 2021 (§§2799A-3 and 2799B-8 of the Public Health Service Act).\n\n Contact: Jane Beyer | 360-725-7043 | Jane.Beyer@oic.wa.gov   1\n The continuity of care provision is triggered when a provider contract with a health plan\n expires or is not renewed. When a contract termination occurs, a health plan must:\n\n     •    Notify “continuing care patients” of their right to receive transitional care for 90 days\n          with the same terms as if the provider were in-network.\n     •    Provide consumers an opportunity to notify the plan of their need for continuing care.\n     •    Permit the consumer to use the continuity of care benefit.\n\n A patient is considered a “continuing care patient” if they:\n\n     •    Are undergoing a course of treatment for a “serious and complex condition.”\n              o A “serious and complex condition” is an acute illness or condition that is serious\n                enough to require specialized medical treatment to avoid the possibility of death\n                or permanent harm; or a chronic illness or condition that is life-threatening,\n                degenerative, potentially disabling or congenital, and requires specialized\n                medical care over a prolonged period of time.\n     •    Are receiving care as a hospital inpatient or in another institution, such as a nursing\n          home or rehabilitation facility.\n     •    Are scheduled for nonelective surgery (including post-operative care following the\n          surgery.\n     •    Are pregnant.\n     •    Have a terminal illness.\n\n OIC will ensure that the health plans meet their obligations under this continuity of care law. If\n you receive any communication from consumers regarding their access to continuing care,\n please ask them to file a complaint with OIC.\n\nContact: Jane Beyer | 360-725-7043 | Jane.Beyer@oic.wa.gov   2","text_length":3822}
{"slug":"wa-taa-2024-02","jurisdiction":"WA","agency":"OIC","doc_type":"bulletin","citation":"WA OIC TAA 2024-02","title":"2024-02: The use of artificial intelligence systems in insurance","official_source_url":"https://www.insurance.wa.gov/sites/default/files/2024-09/2024-02-naic-ai-technical-assistance-advisory.pdf","access_class":"statutory-public","access_notes":"insurance.wa.gov; gate-zero TOP-20 WA bulletins row (no restriction located).","first_seen_at":"2026-07-20T01:47:18.601887+00:00","last_checked_at":"2026-07-20T06:36:55.915092+00:00","versions":[{"fetched_at":"2026-07-20T01:47:18.601887+00:00","version_no":1,"text_length":33029,"effective_date":null,"content_sha256_short":"75c41a16eee5"}],"text":"MIKE KREIDLER                                     STATE OF WASHINGTON                                   Phone: 360-725-7000\nSTATE INSURANCE COMMISSIONER                                                                                 www.insurance.wa.gov\n\n                                                               OFFICE OF\n                                                  INSURANCE COMMISSIONER\n\n                                                                                                   OF THE CODE REVISER\n                                                                                              ST ATE OF WASHINGTON\n                                                                                                      FILED\n\n                                                                                     DATE: April 22, 2024\n                                                                                     TIME: 1:36 PM\n\n                                                                                     WSR 24-10-025\n\n                                                Technical Assistance Advisory 2024-021\n\n      TO:                      All Insurers Licensed to Do Business in Washington (“Insurers”)\n\n      FROM:                    Washington State Office of the Insurance Commissioner\n\n      DATE:                    April 22, 2024\n\n      RE:                      The Use of Artificial Intelligence Systems in Insurance2\n\n      This bulletin is issued by the Washington State Office of the Insurance Commissioner (OIC) to\n      remind all Insurers that hold certificates of authority to do business in the state that decisions or\n      actions impacting consumers that are made or supported by advanced analytical and computational\n      technologies, including Artificial Intelligence (AI) Systems (as defined below), must comply with\n      all applicable insurance laws and regulations. This includes those laws that address unfair trade\n      practices and unfair discrimination. This bulletin sets forth what OIC considers best practices as to\n      how Insurers will govern the development/acquisition and use of certain AI technologies, including\n      the AI Systems described herein. This bulletin also advises Insurers of the type of information and\n      documentation that the OIC may request during an investigation or examination of any Insurer\n      regarding its use of such technologies and AI Systems.\n\n      SECTION 1: INTRODUCTION, BACKGROUND, AND LEGISLATIVE AUTHORITY\n\n      Background\n\n      1\n        This advisory is a policy statement released to advise the public of OIC’s current opinions, approaches, and likely\n      courses of action. It is advisory only. RCW 34.05.230(1).\n      2\n        This advisory is based upon a model bulletin adopted by the National Association of Insurance Commissioners (NAIC)\n      https://content.naic.org/sites/default/files/inline-files/2023-12-4%20Model%20Bulletin_Adopted_0.pdf\n\n                                            Mailing Address: PO Box 40255 Olympia, WA 98504-0255\n                                             Street Address: 5000 Capitol Blvd Tumwater WA 98501\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2024-02\nThe Use of Artificial Intelligence Systems in Insurance\nApril 22, 2024\nPage 2\n\nAI is transforming the insurance industry. AI techniques are deployed across all stages of the\ninsurance life cycle, including product development, marketing, sales and distribution, underwriting\nand pricing, policy servicing, claim management, and fraud detection.\n\nAI may facilitate the development of innovative products, improve consumer interface and service,\nsimplify, and automate processes, and promote efficiency and accuracy. However, AI, including AI\nSystems, can present unique risks to consumers, including the potential for inaccuracy, unfair\ndiscrimination, data vulnerability, and lack of transparency and explainability. Insurers should take\nactions to minimize these risks.\n\nThe OIC encourages the development and use of innovation and AI Systems that contribute to safe\nand stable insurance markets. However, the OIC expects that decisions made, and actions taken by\nInsurers using AI Systems will comply with all applicable federal and state laws and regulations.\nThe OIC recognizes the Principles of Artificial Intelligence that the NAIC adopted in 2020 as an\nappropriate source of guidance for Insurers as they develop and use AI systems. Those principles\nemphasize the importance of the fairness and ethical use of AI; accountability; compliance with\nstate laws and regulations; transparency; and a safe, secure, fair, and robust system. These\nfundamental principles should guide Insurers in their development and use of AI Systems and\nunderlie the advice set forth in this bulletin.\n\nLegislative Authority3\n\nThe regulatory advice and oversight considerations set forth in Sections 3 and 4 of this bulletin rely\non the following laws and regulations:\n\n    •   Unfair Trade Practices: The Unfair Trade Practices Act Chapter 48.30 RCW (UTPA),\n        regulates trade practices in insurance by: 1) defining practices that constitute unfair methods\n        of competition or unfair or deceptive acts and practices; and 2) prohibiting the trade\n        practices so defined or determined.\n\n    •   Unfair Claims Settlement Practices: The Unfair Claims Settlement Practices Act, WAC\n        284-30-300 through 284-30-390 (UCSPA), sets forth standards for the investigation and\n        disposition of claims arising under policies or certificates of insurance issued to residents of\n        Washington.\n\n    •   Unfair Discrimination: 48.18.480 RCW prohibits unfair discrimination between insureds\n        having substantially like insuring, risk, and exposure factors, and expense elements, in the\n\n3\n Additional requirements of insurers exist in 48 RCW and WAC 284. The cited laws and regulations are a general, non-\nexhaustive list.\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2024-02\nThe Use of Artificial Intelligence Systems in Insurance\nApril 22, 2024\nPage 3\n\n        terms or conditions of any insurance contract, or in the rate or amount of premium charged\n        therefor, or in the benefits payable or in any other rights or privileges accruing thereunder.\n\nActions taken by Insurers in the state must not violate the UTPA or the UCSPA, regardless of the\nmethods the Insurer used to determine or support its actions. As discussed below, Insurers are\nencouraged to adopt practices, including governance frameworks and risk management protocols,\nthat are designed to ensure that the use of AI Systems does not result in: 1) unfair trade practices, as\ndefined in Chapters 284-30 WAC and 48.30 RCW; or 2) unfair claims settlement practices, as\ndefined in WAC 284-30-300 through 284-30-390.\n\n    •   Corporate Governance: The Corporate Governance Annual Disclosure Act, Chapter\n        48.195 RCW (CGAD), requires Insurers to report on governance practices and to provide a\n        summary of the Insurer’s corporate governance structure, policies, and practices. The\n        content, form, and filing requirements for CGAD information are set forth in the Corporate\n        Governance Annual Disclosure Model Regulation, as adopted in WAC 284-07-700 through\n        284-07-740 (CGAD-R).\n\nThe requirements of CGAD and CGAD-R apply to elements of the Insurer’s corporate governance\nframework that address the Insurer’s use of AI Systems to support actions and decisions that impact\nconsumers.\n\n    •   Insurance Rating: The Property and Casualty Model Rating Law, RCW 48.19.020,\n        requires that property/casualty (P/C) insurance rates not be excessive, inadequate, or unfairly\n        discriminatory.\n\nThe requirements of RCW 48.19.020 apply regardless of the methodology that the Insurer used to\ndevelop rates, rating rules, and rating plans subject to those provisions. That means that an Insurer is\nresponsible for assuring that rates, rating rules, and rating plans that are developed using AI\ntechniques and Predictive Models that rely on data and Machine Learning do not result in excessive,\ninadequate, or unfairly discriminatory insurance rates with respect to all forms of casualty\ninsurance—including fidelity, surety, and guaranty bond—and to all forms of property insurance—\nincluding fire, marine, and inland marine insurance, and any combination of any of the foregoing.\n\n    •   Market Conduct Surveillance: The Market Conduct Surveillance Model Law Chapter\n        48.37 RCW establishes the framework pursuant to which the OIC conducts market conduct\n        actions. These are comprised of the full range of activities that the OIC may initiate to assess\n        and address the market practices of Insurers, beginning with market analysis and extending\n        to targeted examinations. Market conduct actions are separate from, but may result from,\n        individual complaints made by consumers asserting illegal practices by Insurers.\n\nAn Insurer’s conduct in the state, including its use of AI Systems to make or support actions and\ndecisions that impact consumers, is subject to investigation, including market conduct actions.\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2024-02\nThe Use of Artificial Intelligence Systems in Insurance\nApril 22, 2024\nPage 4\n\nSection 4 of this bulletin provides guidance on the kinds of information and documents that the OIC\nmay request in the context of an AI-focused investigation, including a market conduct action.\n\nSECTION 2: DEFINITIONS\n\nFor the purposes of this bulletin the following terms are defined:\n\n“Adverse Consumer Outcome” refers to a decision by an Insurer that is subject to insurance\nregulatory standards enforced by the OIC that adversely impacts the consumer in a manner that\nviolates those standards.\n\n“Algorithm” means a clearly specified mathematical process for computation; a set of rules that, if\nfollowed, will give a prescribed result.\n\n“AI System” is a machine-based system that can, for a given set of objectives, generate outputs\nsuch as predictions, recommendations, content (such as text, images, videos, or sounds), or other\noutput influencing decisions made in real or virtual environments. AI Systems are designed to\noperate with varying levels of autonomy.\n\n“Artificial Intelligence (AI)” refers to a branch of computer science that uses data processing\nsystems that perform functions normally associated with human intelligence, such as reasoning,\nlearning, and self-improvement, or the capability of a device to perform functions that are normally\nassociated with human intelligence such as reasoning, learning, and self-improvement. This\ndefinition considers machine learning to be a subset of artificial intelligence.\n\n“Degree of Potential Harm to Consumers” refers to the severity of adverse economic impact that\na consumer might experience as a result of an Adverse Consumer Outcome.\n\n“Generative Artificial Intelligence (Generative AI)” refers to a class of AI Systems that generate\ncontent in the form of data, text, images, sounds, or video, that is similar to, but not a direct copy of,\npre-existing data or content.\n\n“Machine Learning (ML)” Refers to a field within artificial intelligence that focuses on the ability\nof computers to learn from provided data without being explicitly programmed.\n“Model Drift” refers to the decay of a model’s performance over time arising from underlying\nchanges such as the definitions, distributions, and/or statistical properties between the data used to\ntrain the model and the data on which it is deployed.\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2024-02\nThe Use of Artificial Intelligence Systems in Insurance\nApril 22, 2024\nPage 5\n\n“Predictive Model” refers to the mining of historic data using algorithms and/or machine learning\nto identify patterns and predict outcomes that can be used to make or support the making of\ndecisions.\n\n“Third Party” for purposes of this bulletin means an organization other than the Insurer that\nprovides services, data, or other resources related to AI.\n\nSECTION 3: REGULATORY GUIDANCE\n\nDecisions subject to regulatory oversight that are made by Insurers using AI Systems must comply\nwith the legal and regulatory standards that apply to those decisions, including unfair trade practice\nlaws. These standards require, at a minimum, that decisions made by Insurers are not inaccurate,\narbitrary, capricious, or unfairly discriminatory. Compliance with these standards is required\nregardless of the tools and methods Insurers use to make such decisions. However, because, in the\nabsence of proper controls, AI has the potential to increase the risk of inaccurate, arbitrary,\ncapricious, or unfairly discriminatory outcomes for consumers, it is important that Insurers adopt\nand implement controls specifically related to their use of AI that are designed to mitigate the risk\nof Adverse Consumer Outcomes.\n\nConsistent therewith, all Insurers authorized to do business in this state are encouraged to develop,\nimplement, and maintain a written program (an “AIS Program”) for the responsible use of AI\nSystems that make, or support decisions related to regulated insurance practices. The AIS Program\nshould be designed to mitigate the risk of Adverse Consumer Outcomes, including, at a minimum,\nthe statutory provisions set forth in Section 1 of this bulletin.\n\nThe OIC recognizes that robust governance, risk management controls, and internal audit functions\nplay a core role in mitigating the risk that decisions driven by AI Systems will violate unfair trade\npractice laws and other applicable existing legal standards. The OIC also encourages the\ndevelopment and use of verification and testing methods to identify errors and bias in Predictive\nModels and AI Systems, as well as the potential for unfair discrimination in the decisions and\noutcomes resulting from the use of Predictive Models and AI Systems.\n\nThe controls and processes that an Insurer adopts and implements as part of its AIS Program should\nbe reflective of, and commensurate with, the Insurer’s own assessment of the degree and nature of\nrisk posed to consumers by the AI Systems that it uses, considering: (i) the nature of the decisions\nbeing made, informed, or supported using the AI System; (ii) the type and Degree of Potential Harm\nto Consumers resulting from the use of AI Systems; (iii) the extent to which humans are involved in\nthe final decision-making process; (iv) the transparency and explainability of outcomes to the\nimpacted consumer; and (v) the extent and scope of the insurer’s use or reliance on data, Predictive\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2024-02\nThe Use of Artificial Intelligence Systems in Insurance\nApril 22, 2024\nPage 6\n\nModels, and AI Systems from third parties. Similarly, controls and processes should be\ncommensurate with both the risk of Adverse Consumer Outcomes and the Degree of Potential Harm\nto Consumers.\n\nAs discussed in Section 4, the decisions made as a result of an Insurer’s use of AI Systems are\nsubject to the OIC’s examination to determine that the reliance on AI Systems are compliant with\nall applicable existing legal standards governing the conduct of the Insurer.\n\nAIS Program Guidelines\n\n1.0     General Guidelines\n\n       1.1    The AIS Program should be designed to mitigate the risk that the Insurer’s use of an\nAI System will result in Adverse Consumer Outcomes.\n\n        1.2     The AIS Program should address governance, risk management controls, and\ninternal audit functions.\n         1.3    The AIS Program should vest responsibility for the development, implementation,\nmonitoring, and oversight of the AIS Program and for setting the Insurer’s strategy for AI Systems\nwith senior management accountable to the board or an appropriate committee of the board.\n\n        1.4     The AIS Program should be tailored to and proportionate with the Insurer’s use and\nreliance on AI and AI Systems. Controls and procedures should be focused on the mitigation of\nAdverse Consumer Outcomes and the scope of the controls and procedures applicable to a given AI\nSystem use case should reflect and align with the Degree of Potential Harm to Consumers with\nrespect to that use case.\n\n        1.5    The AIS Program may be independent of or part of the Insurer’s existing Enterprise\nRisk Management (ERM) program. The AIS Program may adopt, incorporate, or rely upon, in\nwhole or in part, a framework or standards developed by an official third-party standard\norganization, such as the National Institute of Standards and Technology (NIST) Artificial\nIntelligence Risk Management Framework, Version 1.0.\n\n        1.6    The AIS Program should address the use of AI Systems across the insurance life\ncycle, including areas such as product development and design, marketing, use, underwriting, rating\nand pricing, case management, claim administration and payment, and fraud detection.\n\n        1.7   The AIS Program should address all phases of an AI System’s life cycle, including\ndesign, development, validation, implementation (both systems and business), use, on-going\nmonitoring, updating and retirement.\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2024-02\nThe Use of Artificial Intelligence Systems in Insurance\nApril 22, 2024\nPage 7\n\n       1.8     The AIS Program should address the AI Systems used with respect to regulated\ninsurance practices whether developed by the Insurer or a third-party vendor.\n\n       1.9    The AIS Program should include processes and procedures providing notice to\nimpacted consumers that AI Systems are in use and provide access to appropriate levels of\ninformation based on the phase of the insurance life cycle in which the AI Systems are being used.\n\n2.0     Governance\n\nThe AIS Program should include a governance framework for the oversight of AI Systems used by\nthe Insurer. Governance should prioritize transparency, fairness, and accountability in the design\nand implementation of the AI Systems, recognizing that proprietary and trade secret information\nmust be protected. An Insurer may consider adopting new internal governance structures or rely on\nthe Insurer’s existing governance structures; however, in developing its governance framework, the\nInsurer should consider addressing the following items:\n\n       2.1      The policies, processes, and procedures, including risk management and internal\ncontrols, to be followed at each stage of an AI System life cycle, from proposed development to\nretirement.\n\n       2.2    The requirements adopted by the Insurer to document compliance with the AIS\nProgram policies, processes, procedures, and standards. Documentation requirements should be\ndeveloped with Section 4 in mind.\n\n        2.3     The Insurer’s internal AI System governance accountability structure, such as:\n\n                a) The formation of centralized, federated, or otherwise constituted committees\n                   comprised of representatives from appropriate disciplines and units within the\n                   Insurer, such as business units, product specialists, actuarial, data science and\n                   analytics, underwriting, claims, compliance, and legal.\n\n                b) Scope of responsibility and authority, chains of command, and decisional\n                   hierarchies.\n\n                c) The independence of decision-makers and lines of defense at successive stages of\n                   the AI System life cycle.\n\n                d) Monitoring, auditing, escalation, and reporting protocols and requirements.\n\n                e) Development and implementation of ongoing training and supervision of\n                   personnel.\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2024-02\nThe Use of Artificial Intelligence Systems in Insurance\nApril 22, 2024\nPage 8\n\n        2.4    Specifically with respect to Predictive Models: the Insurer’s processes and\nprocedures for designing, developing, verifying, deploying, using, updating, and monitoring\nPredictive Models, including a description of methods used to detect and address errors,\nperformance issues, outliers, or unfair discrimination in the insurance practices resulting from the\nuse of the Predictive Model.\n\n3.0     Risk Management and Internal Controls\n\nThe AIS Program should document the Insurer’s risk identification, mitigation, and management\nframework and internal controls for AI Systems generally and at each stage of the AI System life\ncycle. Risk management and internal controls should address the following items:\n\n        3.1     The oversight and approval process for the development, adoption, or acquisition of\nAI Systems, as well as the identification of constraints and controls on automation and design to\nalign and balance function with risk.\n        3.2     Data practices and accountability procedures, including data currency, lineage,\nquality, integrity, bias analysis and minimization, and suitability.\n\n       3.3      Management and oversight of Predictive Models (including algorithms used therein),\nincluding:\n\n                a) Inventories and descriptions of the Predictive Models.\n\n                b) Detailed documentation of the development and use of the Predictive Models.\n\n                c) Assessments such as interpretability, repeatability, robustness, regular tuning,\n                   reproducibility, traceability, model drift, and the auditability of these\n                   measurements where appropriate.\n\n        3.4    Validating, testing, and retesting as necessary to assess the generalization of AI\nSystem outputs upon implementation, including the suitability of the data used to develop, train,\nvalidate and audit the model. Validation can take the form of comparing model performance on\nunseen data available at the time of model development to the performance observed on data post-\nimplementation, measuring performance against expert review, or other methods.\n\n       3.5    The protection of non-public information, particularly consumer information,\nincluding unauthorized access to the Predictive Models themselves.\n\n        3.6     Data and record retention.\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2024-02\nThe Use of Artificial Intelligence Systems in Insurance\nApril 22, 2024\nPage 9\n\n        3.7    Specifically with respect to Predictive Models: a narrative description of the model’s\nintended goals and objectives and how the model is developed and validated to ensure that the AI\nSystems that rely on such models correctly and efficiently predict or implement those goals and\nobjectives.\n\n4.0     Third-Party AI Systems and Data\n\nEach AIS Program should address the Insurer’s process for acquiring, using, or relying on (i) third-\nparty data to develop AI Systems; and (ii) AI Systems developed by a third party, which may\ninclude, as appropriate, the establishment of standards, policies, procedures, and protocols relating\nto the following considerations:\n\n         4.1    Due diligence and the methods employed by the Insurer to assess the third party and\nits data or AI Systems acquired from the third party to ensure that decisions made or supported from\nsuch AI Systems that could lead to Adverse Consumer Outcomes will meet the legal standards\nimposed on the Insurer itself.\n\n        4.2     Where appropriate and available, the inclusion of terms in contracts with third parties\nthat:\n\n                a) Provide audit rights and/or entitle the Insurer to receive audit reports by qualified\n                auditing entities.\n\n                b) Require the third party to cooperate with the Insurer with regard to regulatory\n                inquiries and investigations related to the Insurer’s use of the third-party’s product or\n                services.\n\n       4.3     The performance of contractual rights regarding audits and/or other activities to\nconfirm the third-party’s compliance with contractual and, where applicable, regulatory\nrequirements.\n\nSECTION 4: REGULATORY OVERSIGHT AND EXAMINATION CONSIDERATIONS\n\nThe OIC’s regulatory oversight of Insurers includes oversight of an Insurer’s conduct in the state,\nincluding its use of AI Systems to make or support decisions that impact consumers. Regardless of\nthe existence or scope of a written AIS Program, in the context of an investigation or market\nconduct action, an Insurer can anticipate to be asked about its development, deployment, and use of\nAI Systems, or any specific Predictive Model, AI System or application and its outcomes (including\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2024-02\nThe Use of Artificial Intelligence Systems in Insurance\nApril 22, 2024\nPage 10\n\nAdverse Consumer Outcomes) from the use of those AI Systems, as well as any other information\nor documentation deemed relevant by the OIC.\n\nInsurers should anticipate those inquiries to include (but not be limited to) the Insurer’s governance\nframework, risk management, and internal controls (including the considerations identified in\nSection 3). In addition to conducting a review of any of the items listed in this Bulletin, a regulator\nmay also ask questions regarding any specific model, AI System, or its application, including\nrequests for the following types of information and/or documentation:\n\n1.      Information and Documentation Relating to AI System Governance, Risk\n        Management, and Use Protocols\n\n        1.1.    Information and documentation related to or evidencing the Insurer’s AIS Program,\nincluding:\n\n                a) The written AIS Program.\n\n                b) Information and documentation relating to or evidencing the adoption of the AIS\n                   Program.\n\n                c) The scope of the Insurer’s AIS Program, including any AI Systems and\n                   technologies not included in or addressed by the AIS Program.\n\n                d) How the AIS Program is tailored to and proportionate with the Insurer’s use and\n                   reliance on AI Systems, the risk of Adverse Consumer Outcomes, and the Degree\n                   of Potential Harm to Consumers.\n\n                e) The policies, procedures, guidance, training materials, and other information\n                   relating to the adoption, implementation, maintenance, monitoring, and oversight\n                   of the Insurer’s AIS Program, including:\n\n                     i. Processes and procedures for the development, adoption, or acquisition of AI\n                        Systems, such as:\n\n                         (1) Identification of constraints and controls on automation and design.\n\n                         (2) Data governance and controls, any practices related to data lineage,\n                             quality, integrity, bias analysis and minimization, suitability, and Data\n                             Currency.\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2024-02\nThe Use of Artificial Intelligence Systems in Insurance\nApril 22, 2024\nPage 11\n\n                     ii. Processes and procedures related to the management and oversight of\n                         Predictive Models, including measurements, standards, or thresholds adopted\n                         or used by the Insurer in the development, validation, and oversight of models\n                         and AI Systems.\n\n                     iii.Protection of non-public information, particularly consumer information,\n                         including unauthorized access to Predictive Models themselves.\n\n        1.2. Information and documentation relating to the Insurer’s pre-acquisition/pre-use\ndiligence, monitoring, oversight, and auditing of data or AI Systems developed by a third party.\n\n      1.3.    Information and documentation relating to or evidencing the Insurer’s\nimplementation and compliance with its AIS Program, including documents relating to the Insurer’s\nmonitoring and audit activities respecting compliance, such as:\n\n                a) Documentation relating to or evidencing the formation and ongoing operation of\n                   the Insurer’s coordinating bodies for the development, use, and oversight of AI\n                   Systems.\n                b) Documentation related to data practices and accountability procedures, including\n                   data lineage, quality, integrity, bias analysis and minimization, suitability, and\n                   Data Currency.\n\n                c) Management and oversight of Predictive Models and AI Systems, including:\n\n                     i. The Insurer’s inventories and descriptions of Predictive Models, and AI\n                        Systems used by the Insurer to make or support decisions that can result in\n                        Adverse Consumer Outcomes.\n\n                     ii. As to any specific Predictive Model or AI System that is the subject of\n                        investigation or examination:\n\n                        (1) Documentation of compliance with all applicable AI Program policies,\n                            protocols, and procedures in the development, use, and oversight of\n                            Predictive Models and AI Systems deployed by the Insurer.\n\n                        (2) Information about data used in the development and oversight of the\n                            specific model or AI System, including the data source, provenance, data\n                            lineage, quality, integrity, bias analysis and minimization, suitability, and\n                            Data Currency.\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2024-02\nThe Use of Artificial Intelligence Systems in Insurance\nApril 22, 2024\nPage 12\n\n                        (3) Information related to the techniques, measurements, thresholds, and\n                            similar controls used by the Insurer.\n\n              d) Documentation related to validation, testing, and auditing, including evaluation of\n                 Model Drift to assess the reliability of outputs that influence the decisions made\n                 based on Predictive Models. Note that the nature of validation, testing, and auditing\n                 should be reflective of the underlying components of the AI System, whether based\n                 on Predictive Models or Generative AI.\n\n2.      Third-Party AI Systems and Data\n\n        In addition, if the investigation or examination concerns data, Predictive Models, or AI\nSystems collected or developed in whole or in part by third parties, the Insurer should also\nanticipate the OIC to request the following additional types of information and documentation.\n\n        2.1      Due diligence conducted on third parties and their data, models, or AI Systems.\n\n        2.2     Contracts with third-party AI System, model, or data vendors, including terms\nrelating to representations, warranties, data security and privacy, data sourcing, intellectual property\nrights, confidentiality and disclosures, and/or cooperation with regulators.\n\n       2.3     Audits and/or confirmation processes performed regarding third-party compliance\nwith contractual and, where applicable, regulatory obligations.\n\n      2.4    Documentation pertaining to validation, testing, and auditing, including evaluation of\nModel Drift.\n\nThe OIC recognizes that Insurers may demonstrate their compliance with the laws that regulate\ntheir conduct in the state in their use of AI Systems through alternative means, including through\npractices that differ from those described in this bulletin. The goal of the bulletin is not to prescribe\nspecific practices or to prescribe specific documentation requirements. Rather, the goal is to ensure\nthat Insurers in the state are aware of the OIC’s advice as to how AI Systems will be governed and\nmanaged and of the kinds of information and documents about an Insurer’s AI Systems that the OIC\nexpects an Insurer to produce when requested.\n\nAs in all cases, investigations and market conduct actions may be performed using procedures that\nvary in nature, extent, and timing in accordance with regulatory judgment. Work performed may\ninclude inquiry, examination of company documentation, or any of the continuum of market actions\ndescribed in the NAIC’s Market Regulation Handbook. These activities may involve the use of\ncontracted specialists with relevant subject matter expertise. Nothing in this bulletin limits the\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2024-02\nThe Use of Artificial Intelligence Systems in Insurance\nApril 22, 2024\nPage 13\n\nauthority of the OIC to conduct any regulatory investigation, examination, or enforcement action\nrelative to any act or omission of any Insurer that the OIC is authorized to perform.\n\nQuestions about this bulletin may be directed to Bryon Welch, policy@oic.wa.gov or 360-725-7171","text_length":33029}
{"slug":"wa-taa-2024-01","jurisdiction":"WA","agency":"OIC","doc_type":"bulletin","citation":"WA OIC TAA 2024-01","title":"2024-01: OIC’s Interpretation of Chap. 48.200 RCW & RCW 48.43.731 – Health care benefit managers","official_source_url":"https://www.insurance.wa.gov/sites/default/files/2024-09/technical-assistance-advisory-2024-01.pdf","access_class":"statutory-public","access_notes":"insurance.wa.gov; gate-zero TOP-20 WA bulletins row (no restriction located).","first_seen_at":"2026-07-20T01:47:18.601887+00:00","last_checked_at":"2026-07-20T06:36:55.915092+00:00","versions":[{"fetched_at":"2026-07-20T01:47:18.601887+00:00","version_no":1,"text_length":17571,"effective_date":null,"content_sha256_short":"c2cff7051bf7"}],"text":"MIKE KREIDLER                                   STATE OF WASHINGTON                                      Phone: 360-725-7000\nSTATE INSURANCE COMMISSIONER                                                                                  www.insurance.wa.gov\n\n                                                             OFFICE OF\n                                               INSURANCE COMMISSIONER\n\n                                                                                                  ICE OF THE CODE REVISER\n                                                                                                 ST ATE OF WA SHINGTON\n                                                                                                         FILED\n\n                                                                                         DATE: April 16, 2024\n                                                                                         TIME: 1:22 PM\n\n                                                                                         WSR 24-09-069\n\n                                            Technical Assistance Advisory 2024-011\n\n      TO:                  Health Carriers\n\n      FROM:                Insurance Commissioner Mike Kreidler\n\n      DATE:                April 16, 2024\n\n      SUBJECT: OIC’s Interpretation of Chap. 48.200 RCW & RCW 48.43.731 – Health care benefit\n               managers\n\n      The purpose of this Technical Assistance Advisory (“TAA”) is to provide guidance to health\n      carriers2 on the Office of Insurance Commissioner (“OIC”)’s response to the Change Healthcare\n      cybersecurity event that occurred on February 21, 2024, and the duties of health carriers and health\n      care benefit managers under Chap. 48.200 RCW and Chap. 284-180 WAC.\n\n      Background\n\n      The Legislature enacted Chap. 48.200 RCW in 2020, with the express intent to protect and promote\n      the health, safety, and welfare of Washington residents by establishing standards for regulatory\n      oversight of health care benefit managers.3 In enacting the law, the Legislature explicitly found that:\n\n          “[G]rowth in managed health care systems has shifted substantial authority over health care\n          decisions from providers and patients to health carriers and health care benefit managers. Health\n          care benefit managers acting as intermediaries between carriers, health care providers, and\n          patients exercise broad discretion to affect health care services recommended and delivered by\n          providers and the health care choices of patients. Regularly, these health care benefit managers are\n\n      1\n        This advisory is a policy statement released to advise the public of OIC’s current opinions, approaches, and\n      likely courses of action. It is advisory only. RCW 34.05.230(1).\n\n      2\n          See RCW 48.43.005 (defining “health carrier”).\n      3\n          RCW 48.200.010\n\n                                          Mailing Address: PO Box 40255 Olympia, WA 98504-0255\n                                           Street Address: 5000 Capitol Blvd Tumwater WA 98501\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2024-01\nChange Healthcare Response\nApril 16, 2024\nPage 2\n\n  making health care decisions on behalf of carriers. However, unlike carriers, health care benefit\n  managers are not currently regulated.”\n\nHealth care benefit manager registration went into effect in Washington State on January 1,\n2022.\n\nChange Healthcare experienced a cybersecurity event on February 21, 2024. On March 18, 2024,\nOIC sent a letter to each health carrier operating in Washington state requesting copies of all executed\nand active health care benefit manager contracts with Change Healthcare, Inc., Change Healthcare\nPharmacy Solutions, Inc., and any other Change Healthcare affiliate as required by current law. The\ndue date for submission of contracts was April 6, 2024. On April 10, 2024, OIC sent a series of\nfollow-up letters to health carriers once again requiring carriers to submit any health care benefit\nmanager contracts with Change Healthcare, Inc., Change Healthcare Pharmacy Solutions, Inc., and\nany other Change Healthcare affiliate. The health carriers’ responses to the second letter are due to\nOIC on April 20, 2024.\n\nOn March 18, 2024, OIC also sent a letter to Change Healthcare, Inc. requesting copies of executed\nand active health care benefit manager contracts with each licensed health carrier for which Change\nHealthcare, Inc. performs any services described in RCW 48.200.020. Change Healthcare responded\nto that request as follows:\n\n  “Change Healthcare Pharmacy Solutions, Inc. is not contracted with a licensed health carrier, as\n  that term is defined by RCW 48.43.005. Change Healthcare Pharmacy Solutions Inc. does not\n  perform health care services, as defined in RCW 48.43.005, to any licensed health carrier.\n  Therefore, we do not have any executed or active health care benefit manager contracts to send.”\n\nThe OIC has determined that Change Healthcare, and other business entities, are intricately involved\nin the claims processing and utilization review functions of several Washington state registered or\nauthorized health carriers. However, there appears to be confusion regarding compliance obligations\nunder Chapter 48.200 RCW among some entities whose activities indirectly impact claims\nprocessing, utilization review and other services that affect utilization of benefits and patient access\nto health care services in the Washington health care marketplace. Similarly, there also appears to be\nconfusion among health carriers regarding their obligations and liability under the Insurance Code,\nTitle 48 RCW, with respect to entities with whom they directly or indirectly contract to provide health\ncare benefit management services, including claims processing and utilization review. The OIC is\nissuing this TAA to advise health carriers and health care benefit managers of the plain language of\nChap. 48.200 RCW and RCW 48.43.731 related to the duty of health care benefit managers to register\nas a condition of conducting business in Washington state and the duty of both health care benefit\nmanagers and health carriers to submit direct and indirect contracts for health care benefit\nmanagement services to the OIC.\n\nA. Only Registered Health Care Benefit Managers May Provide Services that Directly or\n   Indirectly Impact the Determination or Utilization of Benefits for, or Patient Access to,\n   Health Care Services on Behalf of Health Carriers.\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2024-01\nChange Healthcare Response\nApril 16, 2024\nPage 3\n\nRCW 48.200.020(4)(a) defines “health care benefit manager” as a person or entity providing\nservices to, or acting on behalf of, a health carrier or employee benefits programs, that directly or\nindirectly impacts the determination or utilization of benefits for, or patient access to, health care\nservices, drugs, and supplies including, but not limited to:\n\n            (i) Prior authorization or preauthorization of benefits or care;\n            (ii) Certification of benefits or care;\n            (iii) Medical necessity determinations;\n            (iv) Utilization review;\n            (v) Benefit determinations;\n            (vi) Claims processing and repricing for services and procedures;\n            (vii) Outcome management;\n            (viii) Provider credentialing and recredentialing;\n            (ix) Payment or authorization of payment to providers and facilities for services or\n                  procedures;\n            (x) Dispute resolution, grievances, or appeals relating to determinations or utilization\n                of benefits;\n            (xi) Provider network management; or\n            (xii) Disease management.\n(emphasis added)\n\nIn addition, RCW 48.200.020(4)(b) notes that \"Health care benefit manager\" includes, but is not\nlimited to, health care benefit managers that specialize in specific types of health care benefit\nmanagement such as pharmacy benefit managers, radiology benefit managers, laboratory benefit\nmanagers, and mental health benefit managers. With respect to use of the term “including but not\nlimited to,” it is clear that the list of health care benefit management services included in RCW\n48.200.020(4) is - not\n                     - exclusive. The operative language of the definition is whether an entity is\nproviding services that directly or indirectly impact the determination or utilization of benefits for,\nor patient access to, health care services, drugs, and supplies. The Legislature wisely determined that\ngiven changing and evolving business practices, an exclusive list of health care benefit management\nservices would risk becoming outdated following enactment. However, for services such as “claims\nprocessing” and “utilization review,” which are explicitly set forth in statute, there is no question that\nthese services were included in the types of services the Legislature believed could be offered directly\nor indirectly by a health care benefit manager.\n\nRCW 48.200.030 provides that to conduct business in the state of Washington, any entity satisfying\nthe definition of a health care benefit manager in RCW 48.200.020(4) must register with the\nCommissioner and annually renew their registration. WAC 284-180-220 through -240 address health\ncare benefit manager initial registration and renewal processes.\n\nRCW 48.200.040(1) prohibits a health care benefit manager from providing health care benefit\nmanagement services to a health carrier or employee benefits programs without a written agreement\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2024-01\nChange Healthcare Response\nApril 16, 2024\nPage 4\n\ndescribing the rights and responsibilities of the parties conforming to the provisions of chapter 48.200\nRCW and any rules adopted by OIC to implement or enforce that chapter, including rules governing\ncontract content. Further, RCW 48.200.040(2) requires that health care benefit managers file “every\nbenefit management contract and contract amendment between the health care benefit manager and\na health carrier, provider, pharmacy, pharmacy services administration organization, or other health\ncare benefit manager, entered into directly or indirectly in support of a contract with a carrier or\nemployee benefits programs, within 30 days following the effective date of the contract or contract\namendment.”4\n\nUnder the plain language of RCW 48.200.020 through RCW 48.200.040, whenever an entity offers\nservices that directly or indirectly impact the determination or utilization of benefits for, or patient\naccess to, health care services, drugs, and supplies, that entity is acting as a health care benefit\nmanager that must be registered with the OIC as such.5 This includes entities that directly or indirectly\ncontract with health carriers for the provision of health care benefit management services, including\nclaims processing and utilization review.\n\nB. All Contracts with Entities that Should Be Registered as Healthcare Benefit Managers\n   Must be Submitted to the OIC by both the Health Carrier and any Health Care Benefit\n   Manager.\n\nRCW 48.43.731 sets out requirements for health carriers to file with OIC every contract and contract\namendment between the carrier and a health care benefit manager within thirty days following the\neffective date of the contract or contract amendment.\n\nFurther, as noted above, RCW 48.200.040(2) requires that health care benefit managers themselves\nfile “every” benefit management contract and amendment between themselves and any health carrier,\nprovider, pharmacy, pharmacy services administration organization, or other health care benefit\nmanager, that directly or indirectly supports a contract with a carrier or employee benefits programs.\n\nThe plain meaning of the phrase “directly or indirectly” as used in RCW 48.200.040(2) encompasses\narrangements under which a carrier contracts with an intermediary entity who then subcontracts for\nhealth care benefit management services. To ignore this language would provide an opportunity for\nboth health carriers and health care benefit managers to evade the intent and purpose of the law by\ncontinuing to allow unregulated entities to make critical decisions that affect utilization of benefits\nand patient access to health care services on behalf of carriers, with no oversight by regulators, and\nno transparency to consumers.\n\nA failure by a health care benefit manager to register with the OIC does not excuse a health carrier\n\n      4\n       See also WAC 284-180-455 and WAC 284-180-460\n      5\n       There are several exceptions to the registration requirement for health care benefit managers that apply to\n      specific types of entities. Entities that believe they are exempt from the requirements to register should refer to\n      RCW 48.200.020(4)(c) to determine if they are a type of entity that falls outside of the definition of health care\n      benefit manager.\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2024-01\nChange Healthcare Response\nApril 16, 2024\nPage 5\n\nfrom its responsibilities under the Insurance Code. In fact, under RCW 48.200.050, a health carrier\ncan be held responsible for violations of the Insurance Code (Title 48 RCW) committed by any health\ncare benefit manager with whom they directly or indirectly contract concerning the coverage of,\npayment for, or provision of health care benefits, services, drugs, and supplies.6 While these\ncategories are not unlimited, there is little question that claims processing and utilization review\nactivities fall within the categories of coverage, payment, and provision of health care benefits.\nTherefore, health carriers who choose to contract, directly or indirectly, with health care benefit\nmanagers that have failed to comply with the requirements of Chapter 48.200 RCW, may themselves\nbe liable for any failings of the health care benefit manager with respect to the provision of any health\ncare benefit management services, including the processing of claims or utilization review.\n\nC. Conclusion\n\nThe plain language of Chapter 48.200 RCW requires that entities who directly or indirectly provide\nservices that affect utilization of benefits and patient access to health care services, including but not\nlimited to, claims processing and utilization review, register with the OIC as health care benefit\nmanagers. Further, all contracts to directly or indirectly provide such services on behalf of a\nWashington registered or authorized health carrier, including claim processing services, must be\nprovided to the OIC.\n\nThe OIC has identified multiple entities, including those listed below, as contracting to provide health\ncare benefit management services as corporate partners or affiliates of Change Healthcare:\n\n    •       EquiClaim\n\n    •       RelayHealth\n\n    •       Emdeon\n\n    •       Optum Rx\n\n        • OptumInsight\n\n        6\n            RCW 48.200.050(5) provides:\n               “Health carriers and employee benefits programs are responsible for the compliance of any\n               person or organization acting directly or indirectly on behalf of or at the direction of the carrier\n               or program, or acting pursuant to carrier or program standards or requirements concerning the\n               coverage of, payment for, or provision of health care benefits, services, drugs, and supplies.\n               (b) A carrier or program contracting with a health care benefit manager is responsible for the\n               health care benefit manager's violations of this chapter, including a health care benefit\n               manager's failure to produce records requested or required by the commissioner.\n               (c) No carrier or program may offer as a defense to a violation of any provision of this chapter\n               that the violation arose from the act or omission of a health care benefit manager, or other\n               person acting on behalf of or at the direction of the carrier or program, rather than from the\n               direct act or omission of the carrier or program (emphasis added).\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2024-01\nChange Healthcare Response\nApril 16, 2024\nPage 6\n\n      • McKesson\n\nAny entity, including those listed above, that directly or indirectly contracts with a Washington\nregistered or authorized health carrier to provide services that affect utilization of benefits and patient\naccess to health care services, is required by law to register as a health care service contractor with\nthe OIC. All contracts with any Washington registered or authorized health carrier must be filed with\nthe OIC by the health care benefit manager.\n\nSimilarly, all Washington registered or authorized health carriers that have direct or indirect contracts\nwith any of the entities listed above, or others, to provide health care benefit management services,\nincluding claim processing and utilization review, are required to provide those contracts to the OIC.\nThe OIC is actively reviewing submitted filings and responses to its inquiries to determine what\nadditional steps may be necessary to ensure full compliance with the plain language and clear\nlegislative intent of Chapter 48.200 RCW.\n\nPlease direct any questions about this advisory to Jennifer Kreitler, who may be contacted at\nJennifer.Kreitler@oic.wa.gov or by phone at 360-725-7127.","text_length":17571}
{"slug":"wa-taa-2023-04","jurisdiction":"WA","agency":"OIC","doc_type":"bulletin","citation":"WA OIC TAA 2023-04","title":"2023-04: Implementation of engrossed second substitute HB 1357 in the matter of modernizing the prior authorization process","official_source_url":"https://www.insurance.wa.gov/sites/default/files/2024-09/taa-2023-04.pdf","access_class":"statutory-public","access_notes":"insurance.wa.gov; gate-zero TOP-20 WA bulletins row (no restriction located).","first_seen_at":"2026-07-20T01:47:18.601887+00:00","last_checked_at":"2026-07-20T06:36:55.915092+00:00","versions":[{"fetched_at":"2026-07-20T01:47:18.601887+00:00","version_no":1,"text_length":9550,"effective_date":null,"content_sha256_short":"4b9575ea69b5"}],"text":"MIKE KREIDLER                                         STATE OF WASHINGTON                                                  Phone: 360-725-7000\nSTATE INSURANCE COMMISSIONER                                                                                                    www.insurance.wa.gov\n\n                                                                      OFFICE OF\n                                                    INSURANCE COMMISSIONER\n\n                                                                                                               OF THE CODE REVI SER\n                                                                                                          ST ATE OF WASHINGTON\n                                                                                                                  FILED\n\n                                                                                                DATE: December 20, 2023\n                                                                                                TIME: 12:06 PM\n\n                                                                                                WSR 24-02-001\n\n                                              Technical Assistance Advisory 2023-041\n\n      TO: Health carriers that offer health plans, as defined in RCW 48.43.005\n\n      FROM: Insurance Commissioner Mike Kreidler\n\n      DATE: December 20, 2023\n\n      SUBJECT: Implementation of Engrossed Second Substitute House Bill 1357 in the\n      matter of modernizing the prior authorization process\n\n      The Office of the Insurance Commissioner (OIC) is issuing this Technical Assistance\n      Advisory (TAA) to provide guidance concerning the new requirements adopted in RCW\n      48.43.830 for health carriers that utilize prior authorization processes for either health care\n      services or prescription drug services in their health plans. This guidance is designed to\n      help carriers understand their compliance obligations to the extent the new statute\n      conflicts with existing OIC rules.\n\n      Background\n\n      The Washington State Legislature passed Engrossed Second Substitute House Bill 1357\n      (E2SHB 1357 (2023)), subsequently codified as RCW 48.43.830 and effective for health\n      plans issued or renewing on or after January 1, 2024. The OIC’s rulemaking “Revising the\n      prior authorization process” (R2023-02) will address the new law and make updates to\n\n      1\n       This advisory is a policy statement released to advise the public of OIC’s current opinions, approaches, and likely courses of action. It is\n      advisory only. RCW 34.05.230(1).\n\n                                              Mailing Address: PO Box 40255 Olympia, WA 98504-0255\n                                               Street Address: 5000 Capitol Blvd Tumwater WA 98501\nOFFICE OF THE INSURANCE COMMISSIONER\n\nPage 2\n\nSubchapter D of Chap. 284-43 WAC.2 Because the prior authorization rulemaking process\nwill extend into 2024, the OIC is providing guidance in this TAA on how to comply with the\nlaw to the extent current OIC rules are inconsistent with the deadlines and requirements of\nthe new statute.\n\nRCW 48.43.830 changed current prior authorization requirements through four major\ncomponents:\n\n     •    Shortens prior authorization determination timelines;\n     •    Requires carriers to communicate prior authorization criteria clearly and share it\n          electronically;\n     •    Adds standards for clinical review criteria used in prior authorization determinations;\n          and\n     •    Requires carriers to upgrade prior authorization processes to standardized\n          interoperability.\n\nOIC Implementation and Enforcement of New Statutory Prior Authorization\nRequirements and Application Programming Interface (API) Upgrades\n\nOIC will enforce most of the provisions of E2SHB 1357, codified as RCW 48.43.830,\nbeginning on January 1, 2024, as required by the statute and described below. To the\nextent there is a conflict between the current OIC rules and the newly codified RCW\n48.43.830, the new statute overrides the OIC rule. Specifically, enforcement will relate to\nthe following:\n\nNew Prior Authorization Timelines\nRCW 48.43.830(1)(a)-(c) establishes different timelines for standard and expedited prior\nauthorization determinations. The new timelines apply to health care and prescription drug\nservices and vary based upon whether the requests are submitted in electronic or non-\nelectronic format. The OIC will enforce the new statutory prior authorization timelines that\napply to both health care services and prescription drugs within health plans issued on or\nafter January 1, 2024.\n\n2\n Because WAC 284-170-130, the Health Benefit Plan Management Subchapter A, General Provisions, Definitions section was opened\nwithin the “Consolidated health care rulemaking” (2023-7), the expedited and standard prior authorization request definitions in RCW\n48.43.830(4) were included in that rulemaking process.\nOFFICE OF THE INSURANCE COMMISSIONER\n\nPage 3\n\nFor electronic standard prior authorization requests, the timeline for determinations will be\nwithin three calendar days of the prior authorization submission, excluding holidays. For\nelectronic expedited prior authorization requests, the timeline for determinations will be\nwithin one calendar day of the prior authorization submission. If more information is\nneeded to make a prior authorization decision for either an electronic standard or an\nelectronic expedited request, the carrier must request additional information within one\ncalendar day of the prior authorization submission.\n\nFor nonelectronic standard prior authorization requests, the timeline for determinations\nwill be within five days of the submission. If more information is needed to make a prior\nauthorization decision for a nonelectronic standard prior authorization request, the carrier\nmust request additional information within five calendar days of the submission. For\nnonelectronic expedited prior authorization requests, the timeline for determinations will\nbe within two calendar days of the submission. If more information is needed to make a\nprior authorization decision for a nonelectronic expedited request, the carrier must request\nadditional information within one calendar day of the submission.\n\nWithin any of the above timeframes, if a carrier still has insufficient information to make a\nprior authorization determination, the carrier can establish a specific reasonable time frame\nfor additional information submission.3 The carrier must communicate the additional\ninformation request and the time frame to the provider and to the enrollee.4\n\nNew Prior Authorization Communication and Clinical Review Requirements\nRCW 48.43.830(1)(d) also outlines new standards for how prior authorization requirements\nare communicated, developed, and reviewed. The OIC will enforce these new prior\nauthorization requirements that apply to both health care services and prescription drugs\nwithin health plans issued or renewed on or after January 1, 2024.5 The detailed changes\nrequire carriers to:\n\n     •    Describe their prior authorization requirements in detailed, easily understandable\n          language;\n     •    Make their current prior authorization requirements and restrictions, including\n          written clinical review criteria, electronically available to providers and facilities upon\n          request;\n\n3\n  RCW 48.43.830(1)(c).\n4\n  Id.\n5\n  RCW 48.43.830(1)(d).\nOFFICE OF THE INSURANCE COMMISSIONER\n\nPage 4\n\n     •    Base their prior authorization requirements on peer-reviewed, evidence-based\n          clinical review criteria;\n     •    Ensure that their clinical review criteria accommodate new and emerging\n          information related to the appropriateness of clinical criteria with respect to black\n          and indigenous people, other people of color, gender, and underserved\n          populations; and\n     •    Evaluate and update the clinical review criteria at least annually, if necessary.\n\nNew Application Programming Interface (API) Upgrades\nFinally, RCW 48.43.830(2)(a)-(d) requires health carriers to automate prior authorization\nrequests and determination processes through an API or an interoperable electronic\nprocess (IEP). The timelines and procedures for Washington’s prior authorization process\nautomation requirements are aligned with proposed rules issued by the federal Centers for\nMedicare and Medicaid Services (CMS) Rulemaking for Advancing Interoperability and\nImproving Prior Authorization Processes (CMA-0057-P). The initial API upgrades must\nsupport prior authorization requests and determinations for health care services beginning\non January 1, 2026.6 The API or IEP upgrades for prescription drug prior authorization\nrequests are on a January 1, 2027 timeline. Therefore the OIC will enforce the requirement\nto provide this interface for health care service prior authorizations beginning on January 1,\n2026. The OIC will enforce the requirement to provide this interface for prescription drug\nprior authorizations beginning on January 1, 2027.\n\nPlease direct any questions about this advisory to Joyce Brake, Policy and Rules Manager,\nwho may be contacted at joyce.brake@oic.wa.gov or (360) 725-7041.\n\n6\n Per RCW 48.43.830(2)(c), the initial API upgrade requirements in RCW 48.43.830(2)(a) will not be enforced until this date because CMS\ndid not finalize the federal rules related to API standards in prior authorization settings by September 13, 2023.","text_length":9550}
{"slug":"wa-taa-2023-03","jurisdiction":"WA","agency":"OIC","doc_type":"bulletin","citation":"WA OIC TAA 2023-03","title":"2023-03: Single case filings for experience rated groups","official_source_url":"https://www.insurance.wa.gov/sites/default/files/2024-09/taa-2023-03.pdf","access_class":"statutory-public","access_notes":"insurance.wa.gov; gate-zero TOP-20 WA bulletins row (no restriction located).","first_seen_at":"2026-07-20T01:47:18.601887+00:00","last_checked_at":"2026-07-20T06:36:55.915092+00:00","versions":[{"fetched_at":"2026-07-20T01:47:18.601887+00:00","version_no":1,"text_length":8577,"effective_date":null,"content_sha256_short":"84e5098c90b3"}],"text":"MIKE KREIDLER                                   STATE OF WASHINGTON                                        Phone: 360-725-7000\nSTATE INSURANCE COMMISSIONER                                                                                    www.insurance.wa.gov\n\n                                                              OFFICE OF\n                                               INSURANCE COMMISSIONER\n\n                                            Technical Assistance Advisory 2023-031\n\n      TO:                      All Disability Insurers Operating in the State of Washington\n\n      FROM:                    Insurance Commissioner Mike Kreidler\n\n      DATE:                    March 8, 2023\n\n      SUBJECT:                 Single Case Filings for Experience Rated Groups\n\n      BACKGROUND AND AUTHORITY\n\n      Disability insurers in the state of Washington are required to file with the Office of the Insurance\n      Commissioner the rates charged for disability income prior to use.2\n\n      If appropriate, each rate filing must include rates, manuals of classification, manuals of rules and rates\n      and modifications thereof.3 WAC 284-58-033(2)(a). Importantly, the term “rate” or “rates” are\n      defined by rule to mean “all classification manuals, rate or rule manuals, rating plans, rating\n      schedules, minimum rates, class rates, and rating rules that insurers must file under\n      RCW 48.19.010(2) ….”4 Group disability income products are exempt from the minimum loss ratio\n      requirements of Ch. 284-60 WAC.\n\n      Under RCW 48.18.110(2), the commissioner may disapprove any form of disability insurance policy\n      if the benefits provided therein are unreasonable in relation to the premium charged. To prove that\n      rates are reasonable, justification and actuarial demonstration of anticipated loss ratio are also\n      required. WAC 284-58-033(2)(c).\n\n      For group disability insurance, carriers can file a rate manual filing that encompasses rates for many\n      groups. The rate manual includes standard rating methodology. A group’s rate covered under this rate\n      manual filing is developed through the standard rating methodology without using the group’s partial\n      or entire disability claim experience. The rate manual must account for all rules and formulas the\n      company uses to calculate the premium charged. In other words, if a group’s rate was developed from\n      the rate manual, when given the demographics of this group, the OIC would be able to replicate the\n\n      1\n        This advisory is an interpretive policy statement released to advise the public of the OIC’s current opinions, approaches,\n         and likely courses of action. It is advisory only. RCW 34.05.230(1).\n      2                                                                                                   ICE OF THE COOE REVISER\n        RCW 48.19.010(2).                                                                                STATE OF WASHINGTON\n      3\n        WAC 284-58-033(2)(a).                                                                                    FILED\n      4\n        WAC 284-58-005(11).\n                                                                                                 DATE: March 08, 2023\n                                            Mailing Address: PO Box 40255 Olympia, WA 98504-0255 TIME: 11 :56AM\n                                            Street Address: 5000 Capitol Blvd Tumwater WA 98501\n                                                                                                  WSR 23-07-045\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2023-03\nSingle Case Filings for Experience Rated Groups\nMarch 8, 2023\nPage 2\n\ngroup’s rate from the rate manual. A group’s rate that cannot be duplicated exactly using the rate\nmanual is not filed through a rate manual filing.\n\nBy nature, “experience-rating” is the development of premium rates for a single (employer) group\nbased on that particular group’s experience. As such, an insurer filing rates for experience rated\ngroups cannot legally file one rate which applies to all experience-rated groups, as each group’s rate\ndepends on the unique group experience and the rate must be justified accordingly.\n\nThese experience rating groups, when used by an insurer to rate coverage, require particular\ndocumentation and justification of the experience rating.5 The OIC calls this a single case filing, or\nemployer group filing. A company offering an experience-rated product must therefore submit a\nsingle case rate filing which is unique to that group, as they are relying on that group’s unique\nexperience to develop the rates. For rate filing instructions of a single case employer group rate filing,\nsee Washington State SERFF Life, Health and Disability Rate Filing General Instructions (version\ndated 5/5/2022), Section VI(c)(ix)(3.2): For single employers. To be transparent and to ensure the\nsingle case filing requirements were broadly known, OIC, beginning in 2019, included its\nexpectations in its new disability filing Speed to Market tools, as well as in updates to the general\nfiling instructions for disability insurers in 2020.\n\nThe OIC has become aware, through litigation and through review of specific filings, that not all\ninsurers are complying with requirements pertaining to experience rating groups.\n\nThis publication is intended to remind disability insurers in Washington of these requirements, in\norder that any covered filings be supplemented and updated. The OIC intends for this guidance to\npromote fairness in the insurance marketplace as well as to improve regulatory compliance.\n\nEXPECTATION\n\nEach disability insurer in the state of Washington that rates any disability product on the basis of the\nexperience of a specific group must file a single case rate filing for each such experience rating group.\n\nSingle case filing requirements apply to insurers even if their rate manual was approved and permitted\nexperience rating in setting rates. A rate manual by itself is not sufficient to justify experience rating\nof a particular group. A separate single case filing is required for each experience rating group.\nInsurers that use experience rating must verify whether their approved filings meet the single case\nfiling requirement and make any additional filings necessary to reach compliance.\n\nA single case filing does not need to repeat the justification of rating factors that already provided in\nthe approved rate manual. Instead, it should be focused on the justifications for the experience rating\n\n5\n    RCW 48.19.010(2); WAC 284-58-033(2)(a); WAC 284-58-005(11).\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2023-03\nSingle Case Filings for Experience Rated Groups\nMarch 8, 2023\nPage 3\n\nand incorporate the rate manual and other aspects of the filing by reference only. The OIC expects a\nsingle case rate filing to be not more than a few pages and include an actuarial certification. Adhering\nto this guidance will also expedite OIC review of such filings.6 In order to comply with this TAA\n2023-03 and the filing requirements for experience rated group disability income products stated\nherein, regardless of whether there is any approved rate manual that might imply or include certain\nrating discretion, all disability insurers offering such coverage must review the current rate filings\nand notify the OIC of their compliance status by July 1, 2023.\n\nIn the event that a disability insurer must update filings to ensure compliance with these guidelines,\nthe disability insurer must include in the notification to the OIC the estimated timeline by which the\nrevised filings will be submitted for review. The estimated timeline must be no later than January 1,\n2024. Insurers must email such compliance notification to Rates, Forms, and Provider Networks\n(RFPN) Help Desk: rfhelpdesk@oic.wa.gov with a subject line: [Insurer’s Name] Notification of\nCompliance of Disability Income Insurance Single Case Employer Group Experience Rating\nRequirement. An insurer’s failure to provide such notification to the OIC regarding the update of a\nnon-compliant filing may result in enforcement action for failure to respond to an inquiry from the\nOIC.\n\nPlease direct the above referenced notification and any questions about this advisory to Lichiou Lee,\nChief Actuary, at Lichiou.Lee@oic.wa.gov or 360-725-7128.\n\n6\n This advisory does not modify existing filing requirements or instructions for rates or forms, which must be followed\nas applicable.","text_length":8577}
{"slug":"wa-taa-2023-02","jurisdiction":"WA","agency":"OIC","doc_type":"bulletin","citation":"WA OIC TAA 2023-02","title":"2023-02: Revised agency inquiry process","official_source_url":"https://www.insurance.wa.gov/sites/default/files/2024-09/taa-2023-02.pdf","access_class":"statutory-public","access_notes":"insurance.wa.gov; gate-zero TOP-20 WA bulletins row (no restriction located).","first_seen_at":"2026-07-20T01:47:18.601887+00:00","last_checked_at":"2026-07-20T06:36:55.915092+00:00","versions":[{"fetched_at":"2026-07-20T01:47:18.601887+00:00","version_no":1,"text_length":6259,"effective_date":null,"content_sha256_short":"20f7c885325f"}],"text":"MIKE KREIDLER                                      STATE OF WASHINGTON                                   Phone: 360-725-7000\nSTATE INSURANCE COMMISSIONER                                                                                  www.insurance.wa.gov\n\n                                                                                                          ICE OF THE CODE REVISER\n                                                                                                         STATE OF WASHINGTO N\n                                                                                                                 FILED\n                                                                OFFICE OF\n                                                                                                    DATE : January 13, 2023\n                                                  INSURANCE COMMISSIONER\n                                                                                                    TIME : 2:58 PM\n\n                                                                                                    WSR 23-03-080\n\n                                    Technical Assistance Advisory 2023-02\n\n      TO:                      Insurance Producers, Title Insurance Agents, Adjusters, or Other Persons Licensed\n                               Chapter 48\n\n      FROM:                    Insurance Commissioner Mike Kreidler\n\n      DATE:                    January 13, 2023\n\n      SUBJECT:                 Revised Agency Inquiry Process\n\n      Purpose:\n\n      The purpose of this Technical Assistance Advisory (“TAA”) is to inform individuals and entities licensed under\n      chapter 48.17 RCW that the Office of the Insurance Commissioner (“Commissioner” or “OIC”) has updated\n      our process for agency inquiries to licensees to help licensees fully comply with their obligations to provide\n      a prompt response. The standard subject line on our emails has been revised to always begin with “OIC official\n      inquiry, response required, . . .”. We will also send a certified letter to the licensee before referring licensees\n      to the OIC’s Legal Affairs division for potential administrative actions. These revisions are the result of\n      industry feedback.\n\n      Background:\n\n      RCW 48.17.475 requires “[e]very insurance producer, title insurance agent, adjuster, or other person licensed\n      under [chapter 48.17 RCW] to promptly reply in writing to an inquiry of the commissioner relative to the\n      business of insurance. A timely response is one that is received by the commissioner within fifteen business\n      days from receipt of the inquiry. Failure to make a timely response constitutes a violation of this section.”\n\n      WAC 284-17-005(1)(b) expressly provides that for all communications that are not disciplinary matters, the\n      Commissioner will use “the last email address provided by the person or business entity to the\n      commissioner,” as the “address of record” in sending notices and inquiries to those who are licensed under\n      chapter 48.17 RCW. In addition, WAC 284-17-065(2) requires that licensees provide updated email and\n      mailing addresses to the Commissioner.\n\n      OIC Process:\n\n      When the OIC sends an inquiry to a licensee, it will use the steps below to give licensees ample opportunity\n      to comply with their obligations to promptly respond before taking enforcement action.\n\n                                             Mailing Address: PO Box 40255 Olympia, WA 98504-0255\n                                              Street Address: 5000 Capitol Blvd Tumwater WA 98501\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2023-02\nGuidance for Electronic Mail Communications\nJanuary 13, 2023\nPage 2\n\nStep 1 – An initial email is sent to the licensees’ registered email account which has been provided to the OIC\nby the licensee. The subject line will read “OIC official inquiry, response required,” followed by the subject\nmatter. The email will include the information requested, the due date of 15 business days after delivery by\nthe OIC, and a notation that failing to respond to the inquiry could result in an administrative action including,\nbut not limited to, fines, probation, suspension, or revocation.\n\nStep 2 – If the licensee does not respond to the initial email by the provided due date, a second email will be\nsent with the same subject line and message, clearly noting that this is a second attempt and a revised due\ndate of an additional 15 business days.\n\nStep 3 – If the licensee does not respond to the first two emails, a third and final request will be sent via\ncertified mail to the mailing address the licensee has provided to the OIC. This is a revised and new step. This\nnotice will include an annotation that this is “third and final request for information” requesting the same\ninformation as the first two emails and notifying the licensee that failure to respond within 15 business days\nof the date the letter was sent may result in immediate referral for administrative action.\n\nStep 4 – If no response is received, a referral will be made to the OIC Legal Affairs division which could lead\nto a potential administrative action including, but not limited to, fines, probation, suspension, or revocation.\n\nPlease note, it is at all times the licensee’s responsibility to ensure that updated contact information is on file\nwith the OIC, and that all necessary steps have been taken to ensure that electronic and hard copy inquiries\ncan be promptly received and reviewed. In addition, it is the OIC’s expectation that all licensees will promptly\nrespond to the first inquiry received from the OIC, unless there is some reasonable basis for the failure to\npromptly respond. The additional notice provided in this process should not be treated as an automatic\nextension of the deadline to promptly respond to the OIC. Further, failure to timely respond to an initial email\ninquiry, without a reasonable explanation, may still be considered the basis for administrative action.\n\nPlease direct any questions about this advisory to Jeff Baughman, who may be contacted at\nJeff.Baughman@oic.wa.gov and phone number 360.725.7156.","text_length":6259}
{"slug":"wa-taa-2023-01","jurisdiction":"WA","agency":"OIC","doc_type":"bulletin","citation":"WA OIC TAA 2023-01","title":"2023-01: RCW 48.17.475 Guidance for Electronic Mail Communications","official_source_url":"https://www.insurance.wa.gov/sites/default/files/2024-09/taa-2023-01.pdf","access_class":"statutory-public","access_notes":"insurance.wa.gov; gate-zero TOP-20 WA bulletins row (no restriction located).","first_seen_at":"2026-07-20T01:47:18.601887+00:00","last_checked_at":"2026-07-20T06:36:55.915092+00:00","versions":[{"fetched_at":"2026-07-20T01:47:18.601887+00:00","version_no":1,"text_length":4719,"effective_date":null,"content_sha256_short":"470c9e19c10a"}],"text":"MIKE KREIDLER                                      STATE OF WASHINGTON                                   Phone: 360-725-7000\nSTATE INSURANCE COMMISSIONER                                                                                  www.insurance.wa.gov\n\n                                                                                                            OF THE CODE REVI SER\n                                                                                                         STATE OF WASHI NGTON\n                                                                                                                FILED\n                                                                OFFICE OF\n                                                  INSURANCE COMMISSIONER                            DATE : January 13, 2023\n                                                                                                    TIME : 2:58 PM\n\n                                                                                                    WSR 23-03-079\n\n                                    Technical Assistance Advisory 2023-01\n\n      TO:                      Insurance Producers, Title Insurance Agents, Adjusters, or Other Persons Licensed\n                               Chapter 48.17 RCW\n\n      FROM:                    Insurance Commissioner Mike Kreidler\n\n      DATE:                    January 13, 2023\n\n      SUBJECT:                 RCW 48.17.475 Guidance for Electronic Mail Communications\n\n      The purpose of this Technical Assistance Advisory (“TAA”) is to summarize expectations for individuals and\n      entities licensed under chapter 48.17 RCW when it comes to handling electronic mail communications sent\n      from the Office of the Insurance Commissioner (“Commissioner” or “OIC”).\n\n      RCW 48.17.475 requires “[e]very insurance producer, title insurance agent, adjuster, or other person licensed\n      under [chapter 48.17 RCW] shall promptly reply in writing to an inquiry of the commissioner relative to the\n      business of insurance. A timely response is one that is received by the commissioner within fifteen business\n      days from receipt of the inquiry. Failure to make a timely response constitutes a violation of this section.”\n      WAC 284-17-005(1)(b) expressly provides that for all communications that are not disciplinary matters, the\n      Commissioner will use “the last email address provided by the person or business entity to the\n      commissioner,” as the “address of record” in sending notices and inquiries to those who are licensed under\n      chapter 48.17 RCW. In addition, WAC 284-17-065(2) requires that licensees provide updated email addresses\n      to the Commissioner.\n\n      Electronic mail communications (i.e., inquiries and notices) sent from the Commissioner to chapter 48.17\n      RCW licensed individuals and entities are treated by the Commissioner as received upon being sent to the\n      email address of record on file with the Commissioner. It is a licensee’s responsibility to ensure that any\n      settings or filters placed on the email account that serves as the address of record, by either the licensee or\n      vendors a licensee may contract with, do not impede inquiries and notices delivered by the Commissioner.\n      Be advised that to ensure receipt of electronic mail communications from the Office of the Insurance\n      Commissioner to your inbox in time to allow you to comply with your statutory obligations to timely respond\n      to inquiries provided by the Commissioner, you may need to add the Commissioner’s domain (@oic.wa.gov)\n      to your trusted sender lists (e.g., Safe Sender list or Whitelist) in your electronic mail client software (e.g.,\n      Microsoft Outlook, Apple Mail, or Gmail). Additionally, you should also regularly check your quarantined\n      electronic mail where you have an antivirus software application that may inadvertently quarantine official\n      communications from the Commissioner. The Commissioner will not excuse a failure to timely respond to an\n\n                                             Mailing Address: PO Box 40255 Olympia, WA 98504-0255\n                                              Street Address: 5000 Capitol Blvd Tumwater WA 98501\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2023-01\nGuidance for Electronic Mail Communications\nJanuary 13, 2023\nPage 2\n\ninquiry on the grounds that a third-party system or filter prevented the complete transmission of electronic\nmail communications to your inbox.\n\nPlease direct any questions about this advisory to Jeff Baughman, who may be contacted at\nJeff.Baughman@oic.wa.gov and phone number 360.725.7156.","text_length":4719}
{"slug":"wa-taa-2022-02","jurisdiction":"WA","agency":"OIC","doc_type":"bulletin","citation":"WA OIC TAA 2022-02","title":"2022-02: Opioid reversal medication prescriptions in life insurance underwriting","official_source_url":"https://www.insurance.wa.gov/sites/default/files/2024-09/taa-22-02.pdf","access_class":"statutory-public","access_notes":"insurance.wa.gov; gate-zero TOP-20 WA bulletins row (no restriction located).","first_seen_at":"2026-07-20T01:47:18.601887+00:00","last_checked_at":"2026-07-20T06:36:55.915092+00:00","versions":[{"fetched_at":"2026-07-20T01:47:18.601887+00:00","version_no":1,"text_length":5579,"effective_date":null,"content_sha256_short":"1602cdbb4886"}],"text":"OFFICE of the\n                       INSURANCE\n                       COMMISSIONER\n                       WASHINGTON     STATE\n\n                                   Technical Assistance Advisory 22-021\n             Opioid Reversal Medication Prescriptions in Life Insurance Underwriting\n\nThe Insurance Commissioner sent the attached letter to life insurance companies and other\ninterested parties regarding opioid reversal medication prescriptions in life insurance\nunderwriting on August 2, 2022. The technical assistance advisory consists solely of the letter\nand not this cover sheet. Please direct any questions about the advisory to Michael Walker,\nSenior Policy Analyst, who may be contacted at Michael.Walker@oic.wa.gov and phone\nnumber 360-725-7036.\n\n                                                                              OFFICE OF T HE CODE REVISER\n                                                                                STATE OF WASH INGTON\n                                                                                        FILED\n\n                                                                        DATE : September 02, 2022\n                                                                        TIME: 9:12 AM\n\n                                                                         WSR 22-18-072\n\n1\n A technical assistance advisory (TAA) is an interpretive policy statement released to advise the public of the\nOffice of the Insurance Commissioner’s current opinions, approaches, and likely courses of action. TAAs are\nadvisory only. RCW 34.05.230(1).\n     MIKE KREIDLER                             STATE OF WASHINGTON                           Phone: 360-725-7000\nSTATE IN SURANCE COMMISSIONER                                                                www. insurance.wa.gov\n\n                                                        OFFICE OF\n                                         INSURANCE COMMISSIONER\n\n      August 2, 2022\n\n      Life insurance carriers and other interested parties\n\n     I am writing to address questions that have been raised regarding the consideration of opioid\n     reversal medication prescriptions in life insurance underwriting. In summary, such underwriting\n     practices are inappropriate in Washington, and the Office of the Insurance Commissioner (OIC)\n     considers them to be a violation of the Insurance Code.\n\n     In December 2021, the University of Washington' s (UW) Addictions, Drug & Alcohol Institute\n     (ADAI), contacted the OIC to alert us to an issue they had identified in other states. Life insurance\n     companies were denying policy applications or charging higher rates due to an individual's history\n     of being prescribed opioid reversal medications. This issue has been identified in Colorado,\n     Massachusetts, New Jersey, New York, Pennsylvania, and Rhode Island. Although the practice has\n     not yet been identified in Washington, the OIC is providing this guidance in anticipation of the\n     issue, ensuring that Washington insurance consumers are provided appropriate protection from such\n     a practice.\n\n     In February oflast year, the Washington State Department of Health issued a statewide standing\n     order that authorizes pharmacists to dispense naloxone (an opioid reversal medication) to any\n     person at risk of experiencing an opioid-related overdose or any person in a position to assist a\n     person at risk of experiencing an opioid-related overdose. As of January 1, 2022, the law also now\n     mandates that hospitals and certain health professionals provide opioid reversal medication to\n     individuals presenting with symptoms of an opioid-related overdose.\n\n     As a result - and as is the case with several other states - in Washington an individual who legally\n     obtains an opioid reversal medication may not be doing so because of their own possible need, but\n     in order to provide the medication to other individuals.\n\n     In Washington, life insurance companies are permitted, within certain limits, to select those\n     individuals they want to insure as long as they have valid reasons for doing so. In addition, life\n     insurers are also permitted to consider preexisting conditions in their underwriting, so long as the\n     company can prove any differential treatment will be based on sound actuarial principles, are non­\n     discriminatory, and follow fair trade practices. This allows life insurers to charge higher risk\n     individuals more for their coverage, provided that the reasons are sound.\n\n                                   Mailing Address : PO Box 40255 Olympia , WA 98504-0255\n                                    Street Address: 5000 Capitol Blvd Tumwater WA 98501\nOFFICE OF THE INSURANCE COMMISSIONER\n\nIn the case of opioid reversal medication, neither coverage nor underwriting decisions can\nlegitimately be based upon a prescription for a medication that may well be intended for use by\nanother individual. Therefore, decisions to deny coverage or charge higher premiums based solely\non the presence of such a prescription would violate RCW 48.18.480 and 48 .30.300. Although the\nOIC is unaware of any such cases occurring to date within Washington, we are providing this\nguidance in an effort to minimize future conflicts over the issue.\n\nIf you have any questions about this issue, please contact us at (360) 725-7000 or visit our website\nfor additional resources, linked here (https://www.insurance.wa.gov/).\n\nSincerely,\n\n@7:\nMike Kreidler\n             l)C't---\"__......\n\nInsurance Commissioner","text_length":5579}
{"slug":"wa-taa-2021-05","jurisdiction":"WA","agency":"OIC","doc_type":"bulletin","citation":"WA OIC TAA 2021-05","title":"TAA 2021-05: OIC's Implementation of the Federal No Surprises Act","official_source_url":"https://www.insurance.wa.gov/sites/default/files/2024-09/taa-2021.pdf","access_class":"statutory-public","access_notes":"insurance.wa.gov; gate-zero TOP-20 WA bulletins row (no restriction located).","first_seen_at":"2026-07-20T01:47:18.601887+00:00","last_checked_at":"2026-07-20T06:36:55.915092+00:00","versions":[{"fetched_at":"2026-07-20T01:47:18.601887+00:00","version_no":1,"text_length":17927,"effective_date":null,"content_sha256_short":"507edae26480"}],"text":"MIKE KREIDLER                                    STATE OF WASHINGTON                                    Phone: 360-725-7000\nSTATE INSURANCE COMMISSIONER                                                                                 www.insurance.wa.gov\n\n                                                                                                    ICE OF if HE CODE REVI SER\n                                                                                                   ST AH OF WASH INGTON\n                                                                                                            FIL ED\n\n                                                                                              DATE: November 01,. 2021\n                                                              OFFICE OF                       TIME: 7:38 AM\n                                                 INSURANCE COMMISSIONER\n                                                                                              WSR 21-22-073\n                                           Technical Assistance Advisory 2021-051\n\n      TO:                      Health Carriers\n\n      FROM:                    Insurance Commissioner Mike Kreidler\n\n      DATE:                    November 1, 2021\n\n      SUBJECT:                 OIC’s Implementation of the Federal No Surprises Act\n\n      The purpose of this Technical Assistance Advisory (“TAA”) is to provide guidance for health\n      carriers2 on the Office of Insurance Commissioner (“OIC”)’s implementation of the Federal No\n      Surprises Act.3\n\n      Background\n\n      Washington’s Balance Billing Protection Act (“BBPA”) bans balance billing for emergency services\n      provided by an out-of-network (“OON”) hospital or provider, and surgical and ancillary\n      nonemergency services provided by an OON provider at in-network hospitals or ambulatory surgical\n      facilities.4 Balance billing refers to the practice of OON providers or facilities billing enrollees5 for\n      health care services provided to the enrollee after the provider or facility’s billed amount is not fully\n      reimbursed by the health carrier, exclusive of permitted enrollee cost-sharing.6 The BBPA requires\n      that the OON provider and health carrier negotiate OON payments in good faith without involving\n      the enrollee.7 Under the BBPA, the enrollee is only responsible for in-network cost-sharing, which\n      must be applied toward the enrollee’s deductible and maximum out-of-pocket payment obligation.8\n\n      Congress recently passed the Federal No Surprises Act (“FNSA”), which also bans balance billing,\n      but applies to a broader scope of plans and services than Washington’s BBPA. This new law, enacted\n      as part of the broader Consolidated Appropriations Act of 2021, takes effect for health plans,\n\n      1\n        This advisory is a policy statement released to advise the public of OIC’s current opinions, approaches, and\n        likely courses of action. It is advisory only. RCW 34.05.230(1).\n      2\n        See RCW 48.43.005(28) (defining “health carrier”).\n      3\n        See Consolidated Appropriations Act (“CAA”), 2021, Pub. L. No. 116-260, 134 Stat. 1182 (2020) (enacting\n        several new laws, including the No Surprises Act at div. BB, tit. I, 134 Stat. at 2757-2890).\n      4\n        RCW 48.49.020(1).\n      5\n        For ease of reading, “enrollee” includes plan participant and beneficiary.\n      6\n        See RCW 48.43.005(5) (defining “balance bill”); see also Requirements Related to Surprise Billing; Part I,\n        86 Fed. Reg. 36,872, 36,873 (Sept. 13, 2021) (defining “balance billing”).\n      7\n        RCW 48.49.030(2).\n      8\n        See RCW 48.43.005(18) (defining “cost sharing”); RCW 48.49.003(2)(b); RCW 48.49.030.\n\n                                           Mailing Address: PO Box 40255 Olympia, WA 98504-0255\n                                            Street Address: 5000 Capitol Blvd Tumwater WA 98501\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2021-05\nFederal No Surprises Act\nNovember 1, 2021\nPage 2\nbeginning on or after January 1, 2022.9 It applies to nearly all private health plans offered by\nemployers (including grandfathered health plans and the Federal Employees Health Benefits\nProgram), as well as individual health insurance policies offered both on and off the Exchange.10 In\naddition to prohibiting balance billing for emergency services, the FNSA extends balance billing\nprotections to post-stabilization services,11 nonemergency services furnished by OON providers at\nin-network facilities without the enrollee’s informed consent,12 and services furnished by air\nambulance providers.13\n\nBeyond banning balance bills by OON providers and facilities, the FNSA limits enrollee cost-sharing\nan enrollee must pay the issuer.14 Enrollees who receive OON care will only have to pay the\ncost-sharing amount that they would have paid if the provider had been in-network.15 This limitation\napplies to emergency services, nonemergency services without the patient’s informed consent, and\nair ambulance services.16 It similarly limits cost-sharing when an enrollee relied on their issuer’s\nprovider directory’s listing of a provider as in-network, and that information turned out to be\nincorrect.17 Any cost-sharing subject to the FNSA must be counted towards an enrollee’s in-network\ndeductible and annual out-of-pocket maximum.18\n\nAdditionally, Congress set up a regulatory framework for OON provider payment and dispute\nresolution, and added transparency measures, provider directory requirements, and continuity of care\nrequirements.\n\nOIC Enforcement\n\nAside from a few deferments described in the next section, OIC will enforce the FNSA provisions\npertaining to health carriers for health plans starting on or after January 1, 2022.19 This includes the\nfollowing provisions of FNSA:\n\n    •   Prohibition on balance billing for emergency services and nonemergency services under\n        FNSA that are broader than the BBPA’s scope of services protected from balance billing,\n        including post-stabilization care.20\n\n9\n  See CAA, 2021, Pub. L. No. 116-260, div. BB, tit. 1 (No Surprises Act), sec. 102, 134 Stat. 1182, 2758-2797\n   (2020); 86 Fed. Reg. at 36,877.\n10\n   Id.\n11\n   86 Fed. Reg. at 36,880.\n12\n   Id. at 36,882; section 102 of the No Surprises Act.\n13\n   See section 105 of the No Surprises Act; 86 Fed. Reg. at 36,876.\n14\n   See section 102 of the No Surprises Act. For ease of reading, “issuers” in reference to the FNSA includes\n   group health plans, health insurance issuers, and Federal Employees Health Benefits Program carriers.\n15\n   Id.\n16\n   See sections 102 and 105 of the No Surprises Act; 86 Fed. Reg. at 36,883.\n17\n   See section 116(b) of the No Surprises Act.\n18\n   See 86 Fed. Reg. at 36,877.\n19\n   See WAC 284-43-0140 (“Health carriers shall comply with all Washington state and federal laws relating\n   to the acts and practices of carriers and laws relating to health plan benefits.”)\n20\n   See, e.g., 86 Fed. Reg. at 36,880.\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2021-05\nFederal No Surprises Act\nNovember 1, 2021\nPage 3\n   • Prohibition on balance billing for grandfathered health plans.21\n\n     •   Requirements for in-network cost-sharing for enrollees that relied on an issuer’s databases,\n         response protocols, or provider directory representations that a provider was in-network.22\n\n     •   Prohibition on balance billing for “continuing care patients” for 90 days after a provider\n         becomes OON.23\n\n     •   Providing methods for calculating enrollee cost-sharing and provider payments, and dispute\n         resolution, for: (1) plans subject to OIC jurisdiction but not the BBPA, e.g., grandfathered\n         health plans; and (2) services subject to the FNSA but not the BBPA, e.g., nonemergency\n         services provided by neonatologists and intensivists.24\n\n     •   Requirements for external review to determine whether balance billing protections are\n         applicable when there is an adverse determination by an issuer.25\n\nThe FNSA preempts state laws only when those laws impose a requirement that “prevents the\napplication” of the FNSA.26 Based upon this principle and a few FNSA provisions expressly deferring\nto state law, OIC will continue to enforce related state laws in four areas: (1) BBPA provisions that\nexceed FNSA provisions;27 (2) provider directories;28 (3) calculation of enrollee cost-sharing;29 and\n(4) OON provider payment and dispute resolution processes.30\n\nAs a result, beginning January 1, 2022, until the effective date of any new legislation amending the\nBBPA, OIC will enforce the following state law provisions:\n\n     •   Requirements on providers or insurers that go beyond what is required under the new federal\n         law, including:\n\n         o Prohibitions on asking an enrollee to waive their rights.31\n\n21\n   Id. at 36,877.\n22\n   See section 116(b) of the No Surprises Act.\n23\n   See section 113 of the No Surprises Act.\n24\n   See section 103 of the No Surprises Act; 86 Fed. Reg. at 36,886-7; Interim Final Rules, Requirements Related\n   to      Surprise     Billing;     Part    II    (proposed       Sept.     30,     2021),     available    at:\n   https://www.cms.gov/files/document/cms-9908-ifc-surprise-billing-part-2.pdf (implementing independent\n   dispute resolution provisions); see also RCW 48.43.005(44) and WAC 284-43B-010(2)(l) (defining\n   “surgical or ancillary services,” which are granted balance billing protection under RCW 48.49.020(1)).\n25\n   See section 110 of the No Surprises Act.\n26\n   See 42 U.S.C. § 300gg-23(a)(1); 86 Fed. Reg. at 36,886.\n27\n   Id.\n28\n   See section 116(a) of the No Surprises Act (deferring to state laws relating to provider directories).\n29\n   86 Fed. Reg. at 36,885.\n30\n   Id.\n31\n   RCW 48.49.030(1), (5).\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2021-05\nFederal No Surprises Act\nNovember 1, 2021\nPage 4\n       o Requirement that a health carrier must indicate in the Health Insurance Portability and\n          Accountability Act (“HIPAA”) standard 271 transaction whether an enrollee’s health plan\n          is subject to the BBPA.32\n\n         o Requirement that a health carrier must indicate in the HIPAA standard 835 transaction\n           whether a claim was processed in accordance with the BBPA.33\n\n     •   Requirements for provider directories.34\n\n     •   BBPA’s methods for calculating enrollee cost-sharing and OON provider payments, and\n         dispute resolution.35\n\nDeferred Enforcement\n\nOIC will defer enforcement against some entities due to jurisdictional limitations, and with respect\nto some provisions of FNSA in alignment with deferment recently announced by the Departments of\nHealth and Human Services, Labor, and Treasury (collectively referred to as “the Departments”).\n\nDue to jurisdiction limitations, OIC will defer to other state or federal agencies for enforcement\nregarding the following entities:\n\n     •   Air ambulances;36\n\n     •   Self-funded group health plans that have not elected to participate in the BBPA; and\n\n     •   Health providers and facilities.37\n\nAdditionally, OIC will defer enforcement for some of the FNSA provisions in accordance with the\ndeferred enforcement policy announced by the Departments, Aug. 20, 2021, in a set of Frequently\nAsked Questions (“FAQs”).38 In accordance with these FAQs, OIC will defer enforcement for the\nfollowing FNSA provisions:\n\n32\n   WAC 284-43B-040(1)(a).\n33\n   WAC 284-43B-040(1)(b).\n34\n   See WAC 284-170-260; RCW 48.49.090(1); RCW 48.49.070(3); RCW 48.49.080(3).\n35\n   RCW 48.49.030; RCW 48.49.040; WAC 284-43B-020; WAC 284-43B-030; WAC 284-43B-035.\n36\n   See 86 Fed. Reg. at 36,885.\n37\n   Pursuant RCW 48.49.100, OIC will continue to give providers and facilities an opportunity to cure violations\n   of RCW 48.49.020 or 48.49.030.\n38\n   See “FAQs About Affordable Care Act and Consolidated Appropriations Act, 2021 Implementation Part 49\n   (“FAQs”),” Aug. 20, 2021, available at: https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-\n   documents/FAQs%20About%20ACA%20%26%20CAA%20Implementation%20Part%2049_MM%20508\n   _08-20-21.pdf. Additionally, the Departments announced deferment of a few non-FNSA provisions, namely\n   the requirement that issuers publish machine-readable files relating to prescription drug pricing. Id. at 1\n   (citing 85 Fed. Reg. 72,158 (Nov. 12, 2020); 26 C.F.R. § 54.9815-2715A3(b)(1)(iii), 29 C.F.R. § 2590.715-\n   2715A3(b)(1)(iii), and 45 C.F.R. § 147.212(b)(1)(iii)). Deferment will be until regulations to fully implement\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2021-05\nFederal No Surprises Act\nNovember 1, 2021\nPage 5\n   • Requirements for making available a price comparison tool (by internet website, in paper\n       form, or telephone). Deferment will be up until plan years (in the individual market, policy\n       years) beginning on or after January 1, 2023.39\n\n    •   Requirements for providing an Advanced Explanation of Benefits.40 Deferment will be until\n        regulations fully implementing this requirement are adopted and applicable.41\n\nOIC will continue to enforce any state law counterpart to these FNSA provisions, including, but not\nlimited to the following:\n\n    •   Requirements for transparency tools for price and quality information.42\n\n    •   Requirements for enrollee notification upon termination of a provider by a health carrier.43\n\nThe Departments also detailed provisions of the FNSA44 that issuers must implement using a good\nfaith, reasonable interpretation of the law, without the guidance of regulations. OIC will enforce the\nfollowing provisions in the same manner as announced by the Departments:\n\n    •   Requirements to include on any insurance identification card issued to enrollees, any\n        applicable deductibles, any applicable out-of-pocket maximum limitations, and a telephone\n        number and website address for individuals to seek assistance.45\n\n    •   Requirements to establish a process to update and verify the accuracy of provider directory\n        information and to establish a protocol for responding to requests by telephone and electronic\n        communication from an enrollee about a provider’s network participation status.46\n\n   this requirement are adopted and applicable. Id. at 1-2 (describing deferment). The Departments will defer\n   enforcement of the requirement to publish the remaining machine-readable files until July 1, 2022. Id. at 2.\n   OIC will similarly defer enforcement.\n39\n    Id. at 3-4 (citing Internal Revenue Code (“Code”) § 9819, Employee Retirement Income Security Act\n   (“ERISA”) § 719, and Public Health Service (“PHS”) Act § 2799A-4, as added by section 114 of the No\n   Surprises Act).\n40\n   Id. at 6 (citing Code § 9816(f), ERISA § 716(f), and PHS Act § 2799A-1(f), as added by section 111 of the\n   No Surprises Act).\n41\n   Id. at 7 (describing deferment).\n42\n   See RCW 48.43.007.\n43\n   WAC 284-170-421(10).\n44\n   Additionally, the Departments detailed a few non-FNSA provisions it will expect issuers to implement using\n   a good faith, reasonable interpretation of the law, including requirements prohibiting gag clauses. See FAQs\n   at 7 (citing Code § 9824, ERISA § 724, and PHS Act § 2799A-9, as added by section 201 of division BB,\n   title II, of CAA). OIC will enforce these provisions in the same manner as the Departments.\n45\n   Id. at 4-5 (citing Code § 9816(e), ERISA § 716(e), and PHS Act § 2799A–1(e), as added by section 107 of\n   the No Surprises Act).\n46\n   Id. at 7-8 (citing Code § 9820(a) and (b), ERISA § 720(a) and (b), and PHS Act § 2799A-5(a) and (b), as\n   added by section 116(a) of the No Surprises Act). However, given the deferment to state law in section\nOFFICE OF THE INSURANCE COMMISSIONER\n\nTechnical Assistance Advisory 2021-05\nFederal No Surprises Act\nNovember 1, 2021\nPage 6\n   • Prohibition on cost-sharing when an enrollee relied on the issuer’s provider directory or\n       response protocol.47\n\n    •   Requirements to make certain disclosures regarding balance billing protections to enrollees.48\n\n    •   Requirements to apply continuity of care protections.49\n\nConsumer Notice\n\nOIC developed a consumer notice for balance billing rights that satisfies both the FNSA and the\nBBPA.50 OIC’s consumer notice should be used for fully insured health plans, PEBB/SEBB plans,\nand self-funded ERISA plans that have opted into the BBPA. Under the BBPA, this notice must be\nprovided to enrollees in any communication that authorizes nonemergency surgical or ancillary\nservices at an in-network facility.51 Also, the issuer must indicate on the enrollee’s explanation of\nbenefits whether the service is subject to balance billing protections.52 OIC will continue to enforce\nthese BBPA consumer notice requirements against health carriers.\n\nPlease direct any questions about this advisory to Jane Beyer, Senior Health Policy Advisor, who\nmay be contacted at janeb@oic.wa.gov and phone number 360-725-7043.\n\n   116(a) of the No Surprises Act, OIC will only enforce these FNSA provisions against health carriers for\n   plans and services not subject to the BBPA but subject to OIC’s jurisdiction, e.g., grandfathered health plans.\n47\n   Id.\n48\n   Id. at 8-9 (citing Code § 9820(c), ERISA § 720(c), and PHS Act § 2799A-5(c), as added by section 116(c)\n   of the No Surprises Act).\n49\n   Id. at 9 (citing Code § 9818, ERISA § 718, and PHS Act § 2799A-3 and 2799B-8, as added by section 113\n   of the No Surprises Act).\n50\n   https://www.insurance.wa.gov/surprise-billing-and-balance-billing-protection-act; see also Code § 9820(c),\n   ERISA § 720(c), and PHS Act § 2799A-5(c), as added by section 116(c) of the No Surprises Act.\n51\n   See WAC 284-43B-050(2)(a)(i).\n52\n   See WAC 284-43B-050(4)(a).","text_length":17927}