Health Care and Disability
What to file
All disability insurers, Health Care Service Contractors (HCSC) and Health Maintenance Organizations (HMO) must file all rates and forms prior to use.
How to file
For HCSCs and HMOs
- General filing instructions and examples:
- HCSC and HMO Q & A (PDF 75KB)
- Individual Filings (PDF 73KB)
- Standard Master Contract Filing (PDF 200KB)
- Conversion Filings (PDF 72KB)
- Short Form Filings (PDF 194KB)
- Provider Agreement (PDF 66KB)
- Closed Filings (PDF 33KB)
- Discontinued & Replacement (PDF 218KB)
- Market Withdrawal (PDF 233KB)
- NAIC Life, Accident & Health, Annuity, Credit Transmittal Form (Word 138KB)
- NAIC Life, Accident & Health, Annuity, Credit Transmittal Form Instructions (PDF)
- OIC Coding Matrix (PDF 21KB)
- 950 Form (Word 77KB)
For disability insurance
- Disability Q&A (PDF 87KB)
- NAIC Life, Accident & Health, Annuity, Credit Transmittal Form (Word 138KB)
- NAIC Life, Accident & Health, Annuity, Credit Transmittal Form Instructions (PDF)
- Actuarial Memorandum Requirements (PDF 47KB) - Word version (DOC 45KB)
For network reports
Independent Review Organization (IRO) Forms
Resources
- Analyst Checklist — HCSC (rev. 02/08) (PDF 186KB)
- Analyst Checklist - HMO (rev. 02/08) (PDF 172KB)
- Analyst Worksheet — Provider Agreement (rev. 03-15-06) (PDF 34KB)
- 2007 HCSC-Comprehensive Individual Plan (PDF 285KB)
- 2007 HCSC-Catastrophic Individual Plan (PDF 254KB)
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