LAH Review Requirement Checklist - Illinois Division of Insurance

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Contact Person:	Illinois Division of Insurance		320 West Washington Street
Cindy Colonius	Review Requirements Checklist		Springfield, IL 62767-0001
217-782-4572
Cindy.Colonius@Illinois.gov			Effective 1/01/08
Line(s) of		Line(s) of
Business		Insurance
Name Change Endorsement Guidelines		All life, accident and health products
Click here for interactive version of this document to be down loaded and submitted with this filing	Word Document - Alteration of this document will result in rejection of the filing
Illinois Insurance Code Link	Illinois Compiled Statutes Online
Illinois Administrative Code Link	Administrative Regulations Online
Product Coding Matrix	Product Coding Matrix

REVIEW REQUIREMENTS	REFERENCE	DESCRIPTION OF REVIEW STANDARDS REQUIREMENTS	LOCATION OF STANDARD IN FILING
		NOTE: These brief summaries do not include all requirements of all laws, regulations, bulletins, or requirements, so review actual law, regulation, bulletin, or requirement for details to ensure that forms are fully compliant before filing with the Department of Insurance.
FORM FILING REQUIREMENTS	REFERENCE	DESCRIPTION OF REVIEW STANDARDS REQUIREMENTS	LOCATION OF STANDARD IN FILING
Uniform Transmittal Document (Etrans)	50 IL Adm. Code 916	Form filings must now be submitted either by SERFF or CD-ROM. Please visit the Division's web site for the Universal Transmittal Document (Etrans) by clicking this link. Scroll down to "Universal Transmittal Document Software (Etrans)"
Cover Letter and Letter of Submission	50 IL Adm. Code 916.40 (b)	Letters of submission must generally describe the intent and use of the form being filed and, if applicable, how it will be used with any previously approved form(s).
REQUIRED GENERAL PROVISIONS
Unique Form Number	50 IL Adm. Code 916.40 b)	A unique form number must be on each form in the lower left hand corner.
Letter of Submission	50 IL Adm. Code 916.40 b)	The filing must contain a letter of submission giving a detailed description of the purpose of the policy form and the proposed effective date of the name change.
Name of the Company	215 ILCS 5/143	The new company name and home office address must appear on the form.
Proper Descriptive Title	215 ILCS 5/143	The endorsement must have the descriptive title, “Name Change Endorsement”.
COMPANY REQUIREMENTS
Financial Requirements for Domestic Companies	215 ILCS 5/29 215 ILCS 5/30 215 ILCS 5/31 215 ILCS 5/142 215 ILCS 5/408	Name change endorsements cannot be approved for domestic companies until the Financial/Corporate Unit has finalized the name change transaction.
Financial Requirements for Foreign Companies	Article VI of the Illinois Insurance Code 215 ILCS 5/109 215 ILCS 5/115 215 ILCS 5/116 215 ILCS 5/408	Name change endorsements cannot be approved for foreign companies until all requirements of the Illinois Insurance Code have been filed with the Financial/Corporate Unit.
GENERAL INFORMATION
Separate filings for each line of insurance	50 IL Adm. Code 916	The endorsement must be filed and approved for each line of insurance affected by the name change.
Certification signed by officer of the company	215 ILCS 5/143	Each filing should include a statement signed by an officer of the company certifying that the only change being made to the previously approved forms is the company name, address, etc. This procedure avoids filing all previously approved forms with the new name.
Identification of filing	215 ILCS 5/143	Please indicate in the state and company tracking numbers that the filing is a name change for ease of tracking purposes.