Contact Person: |
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Gayle Neuman |
Review Requirements Checklist
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217-524-6497 |
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Effective as of 8/25/06
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Line(s) of
Business
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Code(s)
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___MEDICAL
MALPRACTICE
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11.0000
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***This checklist is
for form
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___Claims Made
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11.10000
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filings only.
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___Occurrence
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11.2000
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See separate rate/rule checklist.
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Line(s) of Insurance |
Code(s) |
Line(s) of Insurance |
Code(s) |
Line(s) of Insurance |
Code(s) |
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___Acupuncture |
11.0001 |
___Hospitals |
11.0009 |
___Optometry |
11.0019 |
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___Ambulance Services |
11.0002 |
___Professional Nurses |
11.0032 |
___Osteopathy |
11.0020 |
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___Anesthetist |
11.0031 |
___Nurse – Anesthetists |
11.0010 |
___Pharmacy |
11.0021 |
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___Assisted Living Facility |
11.0033 |
___Nurse – Lic. Practical |
11.0011 |
___Physical Therapy |
11.0022 |
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___Chiropractic |
11.0003 |
___Nurse – Midwife |
11.0012 |
___Physicians & Surgeons |
11.0023 |
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___Community |
11.0004 |
___Nurse – Practitioners |
11.0013 |
___Physicians Assistants |
11.0024 |
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___Dental Hygienists |
11.0005 |
___Nurse – Private Duty |
11.0014 |
___Podiatry |
11.0025 |
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___Dentists |
11.0030 |
___Nurse – Registered |
11.0015 |
___Psychiatry |
11.0026 |
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___Dentists – General Practice |
11.0006 |
___Nursing Homes |
11.0016 |
___Psychology |
11.0027 |
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___Dentists – Oral Surgeon |
11.0007 |
___Occupational Therapy |
11.0017 |
___Speech Pathology |
11.0028 |
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___Home Care Service Agencies |
11.0008 |
___Ophthalmic Dispensing |
11.0018 |
___Other |
11.0029 |
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Product
Coding Matrix
Link |
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NAIC
Uniform Transmittal Form |
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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. |
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NAIC Self-Certification
Pilot Program |
Newsletter Article regarding Division's Participation
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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. |
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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.) |
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Description of Review
Standards Requirements Column
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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. |
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GENERAL
REQUIREMENTS FOR ALL FILINGS |
REFERENCE |
DESCRIPTION OF REVIEW STANDARD REQUIREMENT |
LOCATION OF STANDARD IN FORM |
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LINE
OF AUTHORITY
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Must have proper Class
and Clause authority to conduct this line of business in |
To write Medical
Malpractice coverage in
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NAIC
UNIFORM TRANSMITTAL FORM |
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If insurers wish to use
the NAIC Uniform Transmittal form, in lieu of cover letters and explanatory
memorandums, the Division will accept such form, as long as the information
required in Rules 753 and 754 is included. |
If insurers wish to use
the NAIC Uniform Transmittal form, in lieu of cover letters and explanatory
memorandums, the Division will accept such form, as long as the information
required in Rules 753 and 754 is included. |
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NAIC
SELF-CERTIFICATION PILOT PROGRAM |
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Requirements for
expediting filing review in accordance with NAIC Self-Certification Pilot
Program. |
Newsletter Article regarding Division's Participation
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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. |
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GENERAL
REQUIREMENTS FOR FORM FILINGS |
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COPIES,
RETURN ENVELOPES, ETC. |
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Requirement for
duplicate copies and return envelope with adequate postage. |
Insurers that desire a
stamped returned copy of the filing must submit a duplicate copy of the
filing, along with a return envelope large enough and containing enough
postage to accommodate the return filing. |
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COVER
LETTER AND EXPLANATORY MEMORANDUM |
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Two copies of a
submission letter are required, and the submission letter must contain
specified information. "Me too" filings are not allowed. If insurers wish to use the NAIC Uniform Transmittal form, the
Division will accept such form, as long as the information required in Rule
753 is included. |
All filings must be
accompanied by a forms submission letter, in duplicate, which includes: 1)
the name of the advisory organization or company making the filing. 6)
effective date of use. 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, the
Division will accept such form, as long as the information required in Rule
753 is included. |
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FILING
SUBMISSION |
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When forms must be
filed. |
Forms must be received
by the Division no later than their effective date of use. |
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Final printed forms
must be filed. |
Typed or printer's
proof copies may be submitted for review, but must be re-filed in printed
form. Statements, provisions, or endorsements may not be typed or
superimposed on a policy or endorsement. |
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Requirements for
company FEIN and filing numbers. |
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Company must include
all Federal Employer Identification Numbers (FEINs) for companies making the
filing. Companies must assign a filing number which may be alpha,
numeric, or both, but may not exceed 15 characters. Each filing number must be unique within a company and may not
be repeated on subsequent filings. Please refer to Company Bulletin 88-53 for specific
information and guidance. |
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Forms under one filing
number must have common coverage relationship. |
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All forms under an
assigned filing number must have some common coverage relationship (e.g. all
forms in an auto filing must pertain only to auto, etc.). Please refer to Company Bulletin 88-53 for specific
information and guidance. |
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NO
FILE OR FILING EXEMPTIONS |
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Medical malpractice
forms issued to "industrial insureds" are not required to be filed
in However, such forms must comply with all laws, regulations,
bulletins, etc. unless specifically exempted by the law, regulation,
bulletin, etc. |
Medical malpractice
forms issued to "industrial insureds," as defined in Section
121-2.08 are not required to be filed in Per Section 121-2.08, "industrial insured" is an
insured: a) which procures the insurance of any risk or risks other
than life and annuity contracts by use of the services of a full time
employee acting as an insurance manager or buyer or the services of a
regularly and continuously retained qualified insurance consultant; b) whose aggregate annual premiums for insurance on all risks,
except for life and accident and health insurance, total at least $100,000;
and c) which either (i) has at least 25 full time employees, (ii)
has gross assets in excess of $3,000,000, or (iii) has annual gross revenues
in excess of $5,000,000. However, Section 143(2) only exempts such forms from filing
with the Director of Insurance. Section 143(2) does not exempt such forms
from complying with all other Illinois insurance laws, regulations,
bulletins, etc. unless specifically exempted by the law, regulation,
bulletin, etc. Therefore, unless specifically exempted by the law,
regulation, bulletin, etc. forms must comply with all laws, regulations,
bulletins, etc. and may be checked for compliance via other regulatory
processes such as consumer complaints, market conduct exams, etc. |
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Manuscript endorsements
are not required to be filed. |
Insurers are not
required to file riders or endorsements prepared to meet special, unusual,
peculiar, or extraordinary conditions applying to an individual risk. Because Section 143(3) exempts only riders or endorsements,
policy forms applying to an individual risk must still be filed. In addition,
because Section 143(3) exempts only endorsements applying to an individual
risk, if a company uses the same endorsement on more than one risk, such form
no longer qualifies for the filing exemption and must be filed. |
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SIDE
BY SIDE COMPARISON |
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Form changes must be
highlighted. |
Changes from currently
filed forms must be highlighted. |
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THIRD
PARTY FILERS AUTHORITY |
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Insurer may authorize
an advisory organization to make a form filing on its behalf. Insurer may change or delay the effective date of an advisory
organization form filing by properly notifying the Division. Insurer may authorize attorneys, consulting firms, etc. to
submit form filings to the Division, as long as the filing includes proper
authorization. |
Insurer may authorize
an advisory organization, of which it is a member or subscriber, to file
forms on its behalf, as long as the insurer has on file with the Division a
forms authorization letter, in duplicate, which includes: Insurer may change or delay the effective date of an advisory
organization form filing by notifying the Division. The notice shall include
the insurer name, FEIN number, line of insurance, advisory organization name
and filing number, and effective date desired. Insurer may authorize attorneys, consulting firms, etc. to
submit form filings to the Division, as long as the filing includes a notice,
signed by an authorized company officer, giving authority for the entity to
act on the insurer's behalf on any issues related to the filing. |
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FORMS
-- POLICY PROVISIONS
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AMBIGUOUS
& MISLEADING |
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The Director may
disapprove a form filing if it contains inconsistent, ambiguous, or
misleading clauses. |
Director may disapprove
any form that contains inconsistent, ambiguous, or misleading clauses. |
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APPLICATIONS |
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Applications must be
filed. |
Applications must be
filed. |
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ARBITRATION |
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Requirements for
arbitration provisions. |
Any controversy or
claim arising out of or relating to the contract, or the breach thereof, may
be settled within a reasonable time limit by arbitration administered by the
American Arbitration Association in accordance with the Uniform Arbitration
Act 710 ILCS 5/1. The arbitration may be binding on both parties, or non-binding
upon the insured, but in all instances must be entered into on a voluntary
basis, as the insured must have the option of filing a lawsuit. Any forms
that contain provisions to the contrary are deemed to contain exceptions and
conditions that unreasonably or deceptively affect the risks that are
purported to be assumed by the policy, in violation of Section 143(2) and
will be disapproved accordingly. |
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Final arbitration
decisions must be recognized by and binding on insurers. |
All final arbitration
decisions rendered in relation to disputes or controversies arising out of
injuries allegedly caused by reason of hospital or health care provider
malpractice must be recognized by licensed insurers, and all findings of
facts relating to liability and awards of damages in relation thereto which
are part of the final arbitration decision shall be binding on such insurers.
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Arbitration agreement
not grounds for refusing to offer medical liability insurance. |
Insurer shall not
refuse to offer insurance to a physician, hospital or other health care
provider on the grounds that the physician, hospital or health care provider
has entered or intends to enter an arbitration agreement pursuant to the
"Malpractice Arbitration Act" [710 ILCS 15/1 et seq.]. |
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BANKRUPTCY
PROVISIONS |
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Policies that contain
liability coverage must include a bankruptcy provision. |
All policies containing
liability coverage must include a provision stating that insolvency or
bankruptcy of the insured shall not release the company from its duties to
pay under the policy. |
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BLANK
ENDORSEMENTS |
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Blank endorsements are
acceptable for filing, with exceptions. |
Blank endorsements may
be filed, but may not be used to decrease coverage, increase rates or
deductibles, or negatively alter any terms or conditions of coverage, unless
such change is at the sole request of the insured. Any forms that contain
provisions to the contrary are deemed to contain exceptions and conditions
that unreasonably or deceptively affect the risks that are purported to be
assumed by the policy, in violation of Section 143(2) and will be disapproved
accordingly. |
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CANCELLATION
& NON-RENEWAL |
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May not refuse to issue
a policy on sole basis of previous refusal, cancellation or nonrenewal by any
insurer. |
No company shall refuse
to issue a policy on the sole basis that the insured or applicant for such
policy was previously refused issuance or renewal of a policy by an insurer,
or such insured's policy was cancelled on a prior date by any insurer. |
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Loss information
requested for underwriting. |
No prospective insurer
shall request the insured to provide more detailed loss information than
required by it to underwrite the same line or class of insurance. |
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Loss information
required to be provided. |
Insurer shall provide
the following loss information to the first named insured within 30 days of
the insured's request, and at the same time as any notice of cancellation or
nonrenewal, except where the policy has been cancelled for nonpayment of
premium, material misrepresentations or fraud on the part of the insured: a) on closed claims, date and description of occurrence, and
total amounts of payments; b) on open claims, date and description of occurrence, total
amount of payments and total reserves, if any; and c) for any occurrence not included in (a) or (b), the date and
description of occurrence and total reserves, if any. Insurer shall provide additional loss information, including
specific loss reserves, to the first named insured as soon as possible, but
in no event later than 20 days of receipt of named insured's mailed or
delivered written request for such information at the request of a
prospective insurer. Insurer shall automatically extend coverage under the existing
policy, at the same terms and conditions by the same number of days it takes
the insurer to provide the insured with this additional information. |
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Policy must contain
cancellation provision. |
Policy must include a
cancellation provision setting out the manner in which the policy may be
cancelled. | |||