Contact Person:

Illinois Division of Insurance

320 West Washington Street

Gayle Neuman

Review Requirements Checklist

Springfield, IL 62767-0001

217-524-6497

 

 

gayle.neuman@illinois.gov

 

Effective as of 8/25/06

 

 

 

 

Line(s) of Business

 

Code(s)

 

 

 

 

___MEDICAL MALPRACTICE

11.0000

***This checklist is for rate/rule

 

 

 

___Claims Made

11.10000

     filings only.

 

 

 

___Occurrence

11.2000

     See separate form checklist.

 

 

 

 

 

 

 

 

Line(s) of Insurance

Code(s)

Line(s) of Insurance

Code(s)

Line(s) of Insurance

Code(s)

___Acupuncture

11.0001

___Hospitals

11.0009

___Optometry

11.0019

___Ambulance Services

11.0002

___Professional Nurses

11.0032

___Osteopathy

11.0020

___Anesthetist

11.0031

___Nurse – Anesthetists

11.0010

___Pharmacy

11.0021

___Assisted Living Facility

11.0033

___Nurse – Lic. Practical

11.0011

___Physical Therapy

11.0022

___Chiropractic

11.0003

___Nurse – Midwife

11.0012

___Physicians & Surgeons

11.0023

___Community Health Center

11.0004

___Nurse – Practitioners

11.0013

___Physicians Assistants

11.0024

___Dental Hygienists

11.0005

___Nurse – Private Duty

11.0014

___Podiatry

11.0025

___Dentists

11.0030

___Nurse – Registered

11.0015

___Psychiatry

11.0026

___Dentists – General Practice

11.0006

___Nursing Homes

11.0016

___Psychology

11.0027

___Dentists – Oral Surgeon

11.0007

___Occupational Therapy

11.0017

___Speech Pathology

11.0028

___Home Care Service Agencies

11.0008

___Ophthalmic Dispensing

11.0018

___Other

11.0029

 

 

Illinois Insurance Code Link

Illinois Compiled Statutes Online

 

Illinois Administrative Code Link

Administrative Regulations Online

 

Product Coding Matrix Link

Product Coding Matrix

 

NAIC Uniform Transmittal Form

50 IL Adm. Code 929

 

NAIC Uniform Transmittal Form

If insurers wish to use the NAIC Uniform Transmittal form in lieu of a cover letter/explanatory memorandum, the Division will accept such form, as long as all information required in the “Cover Letter & Explanatory Memorandum” section below are properly included.

NAIC Self-Certification Pilot Program

Newsletter Article regarding Division's Participation

 

Self-Certification form

If an authorized company officer completes the Self-Certification form, and submits such form as the 1st page of the filing, the Division will expedite review of the filing ahead of all other filings received to date.  The Division will track company compliance with the laws, regulations, bulletins, and this checklist and report such information to the NAIC.

Location of Standard within Filing Column

See checklist format below.

To expedite review of your filing, use this column to indicate location of the standard within the filing (e.g. page #, section title, etc.) 

Description of Review Standards Requirements Column

See checklist format below.

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 Division of Insurance.

 

 

FILING REQUIREMENTS FOR FORM FILINGS

 

 

REFERENCE

 

DESCRIPTION OF REVIEW STANDARD REQUIREMENT

 
LOCATION OF STANDARD WITHIN FILING

See separate form filing checklist.

 

To assist insurers in submitting compliant medical liability rate/rule filings as a result of newly-passed PA94-677 (SB475), the Division has created this separate, comprehensive rate/rule filing checklist for medical liability filings.

 

Please see the separate form filing checklist for requirements related to medical liability forms.

 

GENERAL FILING REQUIREMENTS FOR ALL RATE/RULE FILINGS

 

 

 

LINE OF AUTHORITY

 

 

 

Must have proper Class and Clause authority to conduct this line of business in Illinois.

215 ILCS 5/4

List of Classes/Clauses

To write Medical Liability insurance in Illinois, companies must be licensed to write:

  1. Class 2, Clause (c)

 

RATES AND RULES REQUIRED TO BE FILED

 

 

 

Rates/Rules Must be Filed Separately from Forms

 

 

 

Insurers shall make separate filings for rate/rules and for forms/endorsements, etc.

 

 

The laws and regulations for medical liability forms/endorsements and the laws for medical liability rates/rules are different and each must be reviewed according to its own set of laws/regulations/procedures.  Therefore, insurers are required to file forms and rates/rules separately.

 

For requirements regarding form filings, see separate form filing checklist.

 

New Insurers

 

 

 

New insurers must file their rates, rules, plans for gathering statistics, etc. upon commencement of business.

 

  

 

 

215 ILCS 5/155.18

 

50 IL Adm. Code 929

“New Insures” are insurers who are:

 

·         New to Illinois.

·         New writers of medical liability insurance in Illinois.

·         Writing a new Line of Insurance listed on Page 1 of this checklist,

 

New insurers must file the following:

 

a)  Medical liability insurance rate manual, including all rates.

b)  Rules, including underwriting rule manuals which contain rules for applying rates or rating plans,

c)  Classifications and other such schedules used in writing medical liability insurance. 

d)  Statement regarding whether the insurer:

 

·         Has its own plan for the gathering of medical liability statistics; or

·         Reports its medical liability statistics to a statistical agent (and if so, which agent).

 

The Director, at any time, may request a copy of the insurer’s statistical plan or request the insurer to provide written verification of membership and reporting status from the insurer’s reported statistical agency.

 

Insurers are instructed to review all requirements in this checklist, including the requirements for applicable actuarial documentation, as well as all medical liability laws and regulations, to ensure that the filing contains all essential elements before submitting the filing to the Division.

 

Amendments to Initial Rate/Rule Filings

 

 

 

After a new insurer has filed the rates/rules/information described above, insurers must file rates/rules, or advise of changes to statistical plans, as often as they are amended.

215 ILCS 5/155.18

 

50 IL Adm. Code 929

After a new insurer has filed the rates/rules/information described above, insurers must file rates/rules/rating schedules (as described above for new business) as often as such filings are changed or amended, or when any new rates or rules are added.

Any change in premium to the company's insureds as a result of a change in the company's base rates or a change in its increased limits factors shall constitute a change in rates and shall require a filing with the Director.

Insurers shall also advise the Director if its plans for the gathering of statistics has changed, or if the insurer has changed statistical agents.

 

The Director, at any time, may request a copy of the insurer’s statistical plan or request the insurer to provide written verification of membership and reporting status from the insurer’s reported statistical agency.

 

Insurers are instructed to review all requirements in this checklist, including the requirements for applicable actuarial documentation, as well as all medical liability laws and regulations, to ensure that the filing contains all essential elements before submitting the filing to the Division.

 

EFFECTIVE DATES OF RATE/RULE FILINGS

 

 

 

Illinois is “file and use” for medical liability rates and rules.

215 ILCS 5/155.18

 

50 IL Adm. Code 929

A rate/rating plan/rule filing shall go into effect no earlier than the date the filing is received by the Division of Insurance, Property & Casualty Compliance Section, except as otherwise provided in Section 155.18.

 

ADOPTIONS OF ADVISORY ORGANIZATION FILINGS

 

 

 

Insurer must file all rates and rules on its own behalf.

50 IL Adm. Code 929

Although Rule 929 allows for insurers to adopt advisory organization rule filings, advisory organizations no longer file rules in Illinois.

 

COPIES, RETURN ENVELOPES, ETC.

 

 

 

Requirement for duplicate copies and return envelope with adequate postage.

50 IL Adm. Code 929

Insurers that desire a stamped returned copy of the filing or submission letter must submit a duplicate copy of the filing/letter, along with a return envelope large enough and containing enough postage to accommodate the return filing.

 

COVER LETTER & EXPLANATORY MEMORANDUM

 

 

 

Two copies of a submission letter are required, and the submission letter must contain the information specified.

"Me too" filings are not allowed.

Use of NAIC Uniform Transmittal form is acceptable as long as all required information is included. 

215 ILCS 5/155.18

 

50 IL Adm. Code 929

 

Company Bulletin 88-53

 

Actuarial Certification Form

 

NAIC Uniform Transmittal Form

All filings must be accompanied by a submission letter which includes all of the following information:

 

1) Exact name of the company making the filing.

 

2) Federal Employer Identification Number (FEIN) of the company making the filing.

 

3)  Unique filing identification number – may be alpha, numeric, or both.  Each filing number must be unique within a company and may not be repeated on subsequent filings.  If filing subsequent revisions to a pending filing, use the same filing number as the pending filing or the revision(s) will be considered a new filing.

 

4)  Identification of the classes of medical liability insurance to which the filing applies (for identifying classes, refer to Lines of Insurance shown on Page 1 of this checklist, in compliance with the NAIC Product Coding Matrix).

 

5)  Notification of whether the filing is new or supersedes a present filing.  If filing supersedes a present filing, insurer must identify all changes in superseding filings, and all superseded filings, including the following information:

 

·         Copy of the complete rate/rule manual section(s) being changed by the filing with all changes clearly highlighted or otherwise identified.

·         Written statement that all changes made to the superseded filing have been disclosed.

·         List of all pages that are being completely superseded or replaced with new pages.

·         List of pages that are being withdrawn and not being replaced.

·         List of new pages that are being added to the superseded filing.

·         Copies of all manual pages that are affected by the new filing, including but not limited to subsequent pages that are amended solely by receiving new page numbers.

 

6) Effective date of use.

 

7) Actuarial certification (see Actuarial Certification section below).  Insurers may use their own form or may use the sample form developed by the Division.

 

8)  Statement that the insurer, in offering, administering, or applying the filed rate/rule manual and/or any amended provisions, does not unfairly discriminate.

 

Companies under the same ownership or general management are required to make separate, individual company filings. Company Group ("Me too") filings are unacceptable.

If insurers wish to use the NAIC Uniform Transmittal form in lieu of a cover letter/explanatory memorandum, the Division will accept such form, as long as all information required in this section is properly included.

 

FORM RF-3 Summary Sheet

 

 

 

For any rate change, duplicate copies of Form RF-3 must be filed, no later than the effective date.

50 IL Adm. Code 929

 

Form RF-3 Summary Sheet

For any rate level change, insurers must file two copies of Form RF-3 (Summary Sheet) which provides information on changes in rate level based on the company’s premium volume, rating system, and distribution of business with respect to the classes of medical liability insurance to which the rate revision applies.  Such forms must be received by the Division’s Property & Casualty Compliance Section no later than the stated effective date of use.

 

Insurers must report the rate change level and premium volume amounts on the “Other” Line and insert the words “Medical Liability” on the “Other” descriptive line.  Do not list the information on the "Other Liability" line.

 

If the Medical Liability premium is combined with any other Lines of Business (e.g. CGL, commercial property, etc.), the insurer must report the effect of rate changes to each line separately on the RF-3, indicating the premium written and percent of rate change for each line of business. 

 

The RF-3 form must indicate whether the information is "exact" or "estimated."

 

PAYMENT PLANS

 

 

 

Quarterly premium payment installment plan required as prescribed by the Director.

215 ILCS 5/155.18

A company writing medical liability insurance in Illinois shall offer to each of its medical liability insureds the option to make premium payments in quarterly installments as prescribed by and filed with the Director.  Such option must be offered in the initial offer of the policy or in the first policy renewal occurring after January 1, 2006.  Thereafter, the insurer need not offer the option, but if the insured requests it, must make it available.  Such plans are subject to the following minimum requirements:

 

·         May not require more than 40% of the estimated total premium to be paid as the initial payment;

 

·         Must spread the remaining premium equally among the 2nd, 3rd, and 4th installments, with the maximum set at 30% of the estimated total premium, and due 3, 6, and 9 months from policy inception, respectively;

 

·         May not apply interest charges;

 

·         May include an installment charge or fee of no more than the lesser of 1% of the total premium or $25;

 

·         Must spread any additional premium resulting from changes to the policy equally over the remaining installments, if any.  If there are no remaining installments, the additional premium may be billed immediately as a separate transaction; and

 

·         May, but is not required to offer payment plan for extensions of a reporting period, or to insureds whose annual premiums are less than $500.  However, if offered to either, the plan must be made available to all within that group.

 

DEDUCTIBLES