Chapter 101. Rules Governing Life and Health Forms Filings
14VAC5-101-10. Purpose.
A. The purpose of this chapter is to provide uniform standards for filing forms in accordance with §§ 38.2-316, 38.2-3725, and 38.2-6003 of the Code of Virginia and to establish rules to expedite the review and approval of all forms relating to life, accident and sickness, annuity, credit life, credit accident and sickness, viatical settlements, and legal services plans filed under Chapter 44 (§ 38.2-4400 et seq.) of Title 38.2 of the Code of Virginia that are delivered or issued for delivery in the Commonwealth of Virginia.
B. Any rate filing submitted to the commission that corresponds with a form subject to this chapter shall comply with the applicable filing requirements of this chapter.
C. Medicare supplement and long-term care marketing communications that are required to be filed with the commission pursuant to § 38.2-3609 of the Code of Virginia and 14VAC5-200-160 shall comply with the applicable filing requirements of this chapter.
D. Policyholder notification letters required to be filed with the commission pursuant to 14VAC5-200-75 D shall comply with the applicable filing 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 36, Issue 9, eff. January 1, 2020.
14VAC5-101-20. Applicability and scope.
This chapter shall apply to all companies licensed in this Commonwealth to write the types of insurance covered by this chapter.
Statutory Authority
§§ 12.1-13 and 38.2-223 of the Code of Virginia
Historical Notes
Derived from Virginia Register Volume 36, Issue 9, eff. January 1, 2020.
14VAC5-101-30. Definitions.
The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:
"Approval" means a disposition applied to a form indicating that it has been filed by a company, reviewed and approved by the commission, and that it may be used in this Commonwealth for the purpose with which it was approved.
"Commission" means the State Corporation Commission.
"Company" means any entity licensed in the Commonwealth to transact the business of insurance or viatical settlements.
" File for use" means a disposition applied to a form that is required to be filed with the commission but does not require approval and may be used in this Commonwealth for the purpose with which it was filed.
"Filing description" means a cover letter or electronic summary of the contents of a form filing.
"Form" means a policy, rider, endorsement, amendment, application, enrollment form, certificate of insurance, evidence of coverage, group agreement, supplemental agreement, or any other form required to be filed with or approved by the commission.
"Policy" means an insurance policy, contract, certificate, evidence of coverage, or other agreement of insurance and includes any attached rider or endorsement.
"SERFF" means the National Association of Insurance Commissioners System for Electronic Rate and Form Filing, or its successor.
Statutory Authority
§§ 12.1-13 and 38.2-223 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 9, eff. January 1, 2020.
14VAC5-101-40. Source of filing.
All filings shall be transmitted electronically through SERFF or submitted in writing to the commission. The filing shall be submitted by the company representative having forms filing responsibilities or by a third-party consulting or legal firm authorized by the company to file its forms. Proof of authorization for any third-party filing shall be included.
Statutory Authority
§§ 12.1-13 and 38.2-223 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 9, eff. January 1, 2020.
14VAC5-101-50. General filing requirements.
A. The commission may set filing deadlines as needed. Deadlines shall be strictly enforced.
B. A form is considered filed with the commission on the date the filing is received.
C. Each filing shall be accompanied by a filing description that shall include:
1. The type of insurance form, including a description of the form and the market for which the form is intended. Intentions to concentrate on a specialized market should be noted.
2. The form number of each form that is being filed.
3. An indication that the form is new, or if replacing, revising, or modifying a previously approved form, the exact changes that are intended.
4. An identification of any change in benefits and an indication of whether the change affects premium rates for the form.
5. An indication if approval of a form submitted has been withdrawn by another regulatory body and the reasons for such a withdrawal.
D. Any form to be used in only the group or only the individual market shall be separately filed.
E. Except for an application or enrollment form, each filing shall pertain to only one type of insurance. Combinations of types of insurance in one filing are otherwise prohibited, unless specifically allowed by law.
F. Any form filed that is to be used with a previously approved form, including an application, shall identify the form number, approval date, and SERFF or state tracking number in the new filing.
G. Any amendment, endorsement, or rider that intends to revise a previously approved form shall be accompanied by the previously approved form filed as supporting documentation.
Statutory Authority
§§ 12.1-13 and 38.2-223 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 9, eff. January 1, 2020.
14VAC5-101-60. Form requirements.
The following requirements shall be met for each form submitted for review or approval:
1. The form number shall appear in the lower left-hand corner of the first page of each form. It shall consist of numbers, letters, or a combination of both. The form number shall distinguish the form from all other forms used by the company.
2. The full licensed name of the company, including the address of the home office, shall appear in prominent print at the top of the cover page of any policy, application, or enrollment form. Examples of prominent print include print that is in all capital letters, bold, enlarged font, contrasting color, underlined, or otherwise differentiated from the other type in the form. The full licensed name of the company shall appear in prominent print on all other forms.
3. A marketing name or logo also may be used on the form, provided that the marketing name or logo does not mislead as to the identity of the company.
4. The cover page of a policy also shall include the address of an office that will administer the policy if different from the home office, a company telephone number, and company website address.
5. Each form shall be submitted in the final form in which it is to be marketed or issued, sufficiently completed in "John Doe" fashion to indicate how it is intended to be used.
6. Each form that is to be used in an electronic version shall be filed in a format that matches the electronic version exactly.
Statutory Authority
§§ 12.1-13 and 38.2-223 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 9, eff. January 1, 2020.
14VAC5-101-70. Readability.
A. Each form submitted for review or approval shall be written in simplified language, logically and clearly arranged, printed in a legible format, and understandable to a person of average intelligence without special insurance knowledge or training.
B. A policy of more than three pages shall include a table of contents listing the principal sections and provisions and the pages on which they are found.
C. Defined words and terms shall be placed in a separate definition section that is clearly identified. A word or term that is used only in one section may be defined within that section.
D. A policy shall be divided into logically arranged sections with an appropriately named caption or heading for ease in locating desired content. Captions and headings shall be clearly set apart from the general text.
E. Any form submitted for review or approval shall be printed in at least 10-point type size.
F. Any policy shall achieve a minimum Flesch reading ease score of 50 or an equivalent score using another comparable test, unless otherwise specified by statute. The commission may approve an alternative to the Flesch reading ease score if it is determined to be comparable. The Flesch reading ease score shall be identified in the certificate of compliance for each policy.
G. A company may request an exception to the Flesch reading ease score. This request shall identify the specific reasons why the minimum standards have not been met and provide details of the policy's Flesch reading ease score test. The commission may except the policy if, in its sole discretion, it finds that a lower score: (i) will provide a more accurate reflection of the readability of the policy; (ii) is warranted by the nature of a particular policy or type or class of policies; or (iii) is caused by certain policy language that is drafted to conform to the requirements of any state or federal law, regulation, or agency interpretation.
Statutory Authority
§§ 12.1-13 and 38.2-223 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 9, eff. January 1, 2020.
14VAC5-101-80. Variability.
A. Use of variable bracketed information shall be limited. All variable information shall be clear, easily understood, and fully explain each use of the variable language.
B. Administrative information, such as officer names, titles and signatures, contact information, or company logo may be presented as variable bracketed text.
C. Different types of benefits may be variable only for inclusion or exclusion within the form. The use of brackets within brackets is not permitted, except when variability is necessary to identify a period of time or other numeric value.
D. Each instance of variable text shall appear in brackets on a form and shall be separately and completely explained in detail in a Statement of Variability document. Each explanation of variability shall appear in the same order that it appears on the form.
E. Requests for revisions to a Statement of Variability contained in a previously approved filing shall be accomplished by notification in the original filing.
Statutory Authority
§§ 12.1-13 and 38.2-223 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 9, eff. January 1, 2020.
14VAC5-101-90. Multiple employer welfare arrangements (MEWA) filings.
Any multiple employer welfare arrangement (MEWA) that has registered with the commission as a licensed insurance company in accordance with 14VAC5-410-40 shall also meet the form and rate filing requirements of §§ 38.2-316 and 38.2-316.1 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 36, Issue 9, eff. January 1, 2020.
14VAC5-101-100. Out-of-state filings.
A. Any company that wishes to deliver a certificate of insurance to any person located in this Commonwealth in connection with a policy issued outside of Virginia shall indicate the type of group (i) as defined in § 38.2-3318.1 or 38.2-3521.1 of the Code of Virginia as applicable or (ii) a nondefined or discretionary group to which the policy is issued.
1. If the group is defined in accordance with § 38.2-3318.1 or 38.2-3521.1 of the Code of Virginia as applicable, the company shall file for use any form that will be delivered in Virginia along with documentation that substantiates that the issuing state's filing requirements have been met. In addition, a certification from the company is required indicating that the group insurance coverage marketed to residents of this Commonwealth will comply with the provisions of § 38.2-3318.1 or 38.2-3521.1 of the Code of Virginia as applicable.
2. If the group is nondefined or discretionary and the state of issue has substantially similar laws to Virginia in accordance with subsection B of this section, the company shall file for use any form that will be delivered in Virginia along with documentation that substantiates that the issuing state's filing requirements have been met. In addition, a certification from the company is required indicating that the group insurance coverage marketed to residents of this Commonwealth complies with the requirements of subsection B this section.
3. If the group is nondefined or discretionary and the state of issue does not have substantially similar laws to Virginia, the company shall file for approval any form that will be delivered in this Commonwealth in accordance with § 38.2-316 of the Code of Virginia.
B. Laws of another state are substantially similar to Virginia if the commission finds that:
1. The policy is not contrary to Virginia's public policy and is in the best interest of the citizens of Virginia;
2. The issuance of the policy will result in economies of acquisition or administration; and
3. The benefits are reasonable in relation to the premiums charged.
Statutory Authority
§§ 12.1-13 and 38.2-223 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 9, eff. January 1, 2020.
14VAC5-101-110. Certificate of compliance.
Each form filing shall include a statement identical to the following that is signed by an officer of the company:
The Flesch reading ease score of the filed policy form is _________.
I represent that a review of the enclosed form has been conducted, and I certify that, to the best of my knowledge and belief, each form submitted is consistent and complies with the requirements of Title 38.2 of the Code of Virginia and the applicable rules and regulations. I understand that a failure to comply with these requirements will result in a disapproval of the filing.
| _______________________________ Signature of Officer | |
| _______________________________ Printed Name | |
| _______________________________ Title |
Statutory Authority
§§ 12.1-13 and 38.2-223 of the Code of Virginia.
Historical Notes
Derived from Virginia Register Volume 36, Issue 9, eff. January 1, 2020.
14VAC5-101-120. 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 36, Issue 9, eff. January 1, 2020.