ࡱ>  F?bjbj -&jj,;lfffffff```8`~a nlnl"lllomomom$ pfomkmomomom9offll9o9o9oom4flfl9oom9o9o1uff1ulbl Q`[`m1u1ul}01ud9od1u9oz8ffffREVIEW REQUIREMENTS CHECKLIST FOR LIFE, ACCIDENT & HEALTH, ANNUITY AND CREDIT LINE OF BUSINESS: LINES OF INSURANCE: CODES: ____________________________ [ ]________________________________ _____________ ____________________________ [ ]________________________________ _____________ ____________________________ [ ]________________________________ _____________ Checklist Not Applicable ( WHY__ ___________________________________________________________________________ [The in the Reference column indicates a CARFRA standard] REVIEW REQUIREMENTSREFERENCE DESCRIPTION OF REVIEW STANDARDS REQUIREMENTS LOCATION OF STANDARD IN FILINGGENERAL REQUIREMENTS (FOR ALL FILINGS)SUBMISSION PACKAGE REQUIREMENTS NO FILE OR FILING EXEMPTIONSREVIEWADVERTISING Sales with securities noticeASSOCIATION/TRUSTS/DISCRETIONARY GROUPS (Group only)ASUMPTIONS/MERGERS/REDOMESTICATIONS/DEMUSTUALIZATION, ETC.COVER PAGE (Policy jacket)  Form number Insurers identificationREADABILITY  Non-English policiesVARIABILITY OTHERLINE OF BUSINESS: ANNUITIES CODES: A01 THROUGH A10.00POLICY FORMSREQUIREMENTS RELATING TO APPLICATIONS AUTHORIZATIONFRAUDULENT STATEMENTSREPLACEMENT QUESTIONSUNDERWRITING QUESTIONS REQUIREMENTS RELATING TO POLICY FORM REVIEW:ADDITIONAL BENEFITSASSIGNMENT BENEFICIARY BONUSCERTIFICATE (Group only)CLAIM PAYMENT PROVISIONCLAIMS OF CREDITORS CLARITY Policy title & headingsCOLLECTIVE TRUSTS & COLLECTIVE FUNDING AGREEMENTSCOMMUTED VALUESCONTRACT GUARANTEES CONTRACT SUMMARYDISCLOSURES Replacement disclosure Variable account disclosure DEATH BENEFIT PROCEEDS ELIGIBILITY (Group only)ENTIRE CONTRACT FAIRNESS FEES, CHARGES, PREMIUM TAXES, OTHER TAXESGIC (Group only)GROUP QUALIFICATIONS (Group only)INCENTIVES/INDUCEMENTSINCONTESTABILITY EQUITY INDEXING LOANS MARKET VALUE ADJUSTMENTMATURITY DATE MINIMUM PREMIUM MISCELLANEOUS AMENDMENTS , ENDORSEMENT, RIDERSMISSTATEMENT OF AGE OR SEX NONFORFEITURE VALUES POLICY PROVISIONS NONFORFEITURE VALUES COMPUTATION OF VALUES OTHEROWNERSHIP PARTIAL WITHDRAWAL PARTICIPATING PROVISIONS PREMIUM DEPOSIT FUND Dollar Cost AveragingQUALIFIED PLAN REQUIREMENTS (Group only)REPORT TO POLICYOWNER RIGHT TO EXAMINE SPECIFICATIONS PAGE SETTLEMENTS SETTLEMENT OPTIONS STRUCTURED SETTLEMENTSSUICIDE SURRENDER CHARGESTWO TIERED ANNUITYUNFAIR DISCRIMINATION UNISEXVALUES SHALL BE DEFINED  Death benefit  Account value  Cash surrender value  Annuity value WAIVER OF SURRENDER CHARGES REQUIREMENTS FOR RATES:ACTUARIAL MEMORANDUM LINE OF BUSINESS: CCRC CODES: CC01 through CC01POLICY FORMSREQUIREMENTS RELATING TO APPLICATIONS AUTHORIZATIONFRAUDULENT STATEMENTSREQUIREMENTS RELATING TO POLICY FORM REVIEW:ADDITIONAL BENEFITSCANCELLATION/EVICTIONCLARITYDEFINITIONSDISCLOSURESENTIRE CONTRACTEXCLUSIONS & LIMITATIONSFEESFREE LOOKOTHER REQUIREMENTSREFUNDSTERMINATIONREQUIREMENTS FOR RATES:FACILITY FINANCIAL STATEMENT RESERVESLINE OF BUSINESS: CREDIT CODES: CR01 through CR07POLICY FORMSREQUIREMENTS RELATING TO APPLICATIONS AUTHORIZATIONHIV CONSENTGENETIC TESTINGCONDITIONS FOR FURNISHING EVIDENCE OF INSURABILITY FRAUDULENT STATEMENTSUNDERWRITING QUESTIONS REQUIREMENTS RELATING TO POLICY FORM REVIEW:AMENDMENTSCLAIM PAYMENT PROVISIONDEFINITIONSELIGIBILITYENTIRE CONTRACT EXCLUSIONS & LIMITATIONSFAIRNESSGRACE PERIODINCONTESTABILITY LEGAL ACTION MISSTATEMENT OF AGE NOTICE OF CLAIM OTHER REQUIREMENTSPAYMENT OF CLAIM PRE-EXISTING CONDITIONSPROOF OF LOSS RENEWABLESCHEDULE OF BENEFITSTIME LIMIT ON CERTAIN DEFENSES TIME PAYMENT OF CLAIMS REQUIREMENTS FOR RATES:ACTUARIAL MEMORANDUM Actuarial Justification Justification for rates Loss Ratios Prima Facie rate deviations Prima Facie rate schedules Truncated/critical period  UnderwritingLINE OF BUSINESS: HEALTH CODES: H01 through H21POLICY FORMSREQUIREMENTS RELATING TO APPLICATIONS AUTHORIZATIONHIV CONSENTGENETIC TESTINGEVIDENCE OF INSURABILITY FRAUDULENT STATEMENTSREPLACEMENT QUESTIONSUNDERWRITING QUESTIONS REQUIREMENTS RELATING TO POLICY FORM REVIEW:ADDITIONAL BENEFITSAMBULANCEAMENDMENTSARBITRATIONAUTOPSYAVOCATIONAL OR OCCUPATIONAL EXCLUSION RIDERSBENEFIT REIMBURSEMENTCERTIFICATECHANGES IN BASIC COVERAGECHEMICAL DEPENDENCY/MENTAL CONDITIONSCHILDREN NOT RESIDING WITH PARENTCLAIM FORMS CLAIM PAYMENT PROVISIONCOORDINATION OF BENEFITSCREDITABLE COVERAGECUSTOMARY & REASONABLEDEFINITIONSDOMESTIC PARTNERS & CHILDREN OF DOMESTIC PARTNERS COVERAGEELIGIBILITYEMERGENCYENTIRE CONTRACT EXCLUSIONS & LIMITATIONSFAIRNESSGRACE PERIOD GRIEVANCEHEALTH BENEFIT PLANHIPAAINCONTESTABILITYLATE ENROLLEELEGAL ACTION MANDATED BENEFITSMISSTATEMENT OF AGE NEWBORNSNOTICE OF CLAIM OTHER REQUIREMENTSOUTLINE OF COVERAGEPAYMENT OF CLAIM PORTABILITYPRE-EXISTING CONDITIONSPRESCRIPTIONSPROOF OF LOSS REFUNDSREINSTATEMENTRENEWABLESCHEDULE OF BENEFITSSURGICAL SERVICESTERMINATION, NOTICETIME LIMIT ON CERTAIN DEFENSES TIME OF PAYMENT OF CLAIMS UNFAIR DISCRIMINATIONUTILIZATION REVIEWWAITING PERIODWOMENS HEALTH CAREREQUIREMENTS FOR RATES:ACTUARIAL MEMORANDUM Actuarial Certification Justification for rates Loss Ratios Reserving method UnderwritingLINE OF BUSINESS: HEALTH ORGANIZATIONS CODES: HOrg01 through HOrg03POLICY FORMSREQUIREMENTS RELATING TO APPLICATIONS AUTHORIZATIONHIV CONSENTGENETIC TESTINGEVIDENCE OF INSURABILITY FRAUDULENT STATEMENTSREPLACEMENT QUESTIONSUNDERWRITING QUESTIONS REQUIREMENTS RELATING TO POLICY FORM REVIEW:ADDITIONAL BENEFITSAMBULANCEAMENDMENTSARBITRATIONAUTOPSYAVOCATIONAL OR OCCUPATIONAL EXCLUSION RIDERSBENEFIT REIMBURSEMENTCERTIFICATECHANGES IN BASIC COVERAGECHEMICAL DEPENDENCY/MENTAL CONDITIONSCHILDREN NOT RESIDING WITH PARENTCLAIM FORMS CLAIM PAYMENT PROVISIONCOORDINATION OF BENEFITSCREDITABLE COVERAGECUSTOMARY & REASONABLEDEFINITIONSDOMESTIC PARTNERS & CHILDREN OF DOMESTIC PARTNERS COVERAGEELIGIBILITYEMERGENCYENTIRE CONTRACT EXCLUSIONS & LIMITATIONSFAIRNESSGRACE PERIOD GRIEVANCEHEALTH BENEFIT PLANHIPAAINCONTESTABILITY LATE ENROLLEELEGAL ACTION MANDATED BENEFITSMISSTATEMENT OF AGE NEWBORNSNOTICE OF CLAIM OTHER REQUIREMENTSOUTLINE OF COVERAGEPAYMENT OF CLAIM PORTABILITYPRE-EXISTING CONDITIONSPRESCRIPTIONSPROOF OF LOSS REFUNDSREINSTATEMENTRENEWABLESCHEDULE OF BENEFITSSURGICAL SERVICESTERMINATION, NOTICETIME LIMIT ON CERTAIN DEFENSES TIME PAYMENT OF CLAIMS UNFAIR DISCRIMINATIONUTILIZATION REVIEWWAITING PERIODWOMENS HEALTH CAREREQUIREMENTS FOR RATES:ACTUARIAL MEMORANDUM Actuarial Certification Justification for rates Loss Ratios Reserving method UnderwritingLINE OF BUSINESS: LIFE CODES: L01 THROUGH L08POLICY FORMSREQUIREMENTS RELATING TO APPLICATIONS AUTHORIZATIONHIV CONSENTGENETIC TESTINGCONDITIONS FOR FURNISHING EVIDENCE OF INSURABILITY FRAUDULENT STATEMENTSREPLACEMENT QUESTIONSUNDERWRITING QUESTIONS REQUIREMENTS RELATING TO POLICY FORM REVIEW:ADVANCE PAYMENT OF PREMIUM ARBITRATION ASSIGNMENT BENEFICIARY CLAIM PAYMENT PROVISIONCLAIMS OF CREDITORS CLARITY Policy title & headingsCONTINUATION (Group only)CONVERSION DEATH BENEFIT PROCEEDS DISCLOSURES Credit disclosure Replacement disclosure Variable account disclosureDOMESTIC PARTNERS & CHILDREN OF DOMESTIC PARTNERS COVERAGE ELIGIBILITY (Group only)Entire Contract EXCLUSIONS  AVOCATIONAL OR OCCUPATIONAL EXCLUSION RIDERS  WAR RISK FAIRNESS POLICY FEEGrace Period INCENTIVES/INDUCEMENTSINCONTESTABILITY INDETERMINATE PREMIUM INDEXINGILLUSTRATIVE REPORTS  STATEMENT OF POLICY COST & BENEFITS LIFE ILLUSTRATIONINSURABLE INTERESTJUVENILE NONSMOKER CLASSIFICATION LIMITED POLICIES Limited pay Modified benefit Modified premium LOANS  Policy loan interest rateMISCELLANEOUS AMENDMENTS , ENDORSEMENT, RIDERSMISSTATEMENT OF AGE MISSTATEMENT OF SMOKING NONFORFEITURE OPTIONSNONFORFEITURE VALUES POLICY PROVISIONS NONFORFEITURE VALUES COMPUTATION OF VALUES OTHEROWNERSHIP PARTICIPATING PROVISIONS PAYMENT PLANPARTIAL WITHDRAWAL PAYMENT IN PROCEEDSPREMIUM DEPOSIT FUNDPREMIUMS Cost of Insurance Premium RecalculationRATED CLASS ISSUANCE RE-ENTRY OR REQUALIFICATION TERM REINSTATEMENT RENEWABILITY RIGHT TO EXAMINE SETTLEMENT SETTLEMENT OPTIONS SPECIFICATIONS PAGE SIMULTANEOUS DEATH SUICIDE SURRENDER CHARGESTERMINATION (Group only)UNFAIR DISCRIMINATION UNISEXVALUES DEFINED  Accumulation values Cash values Separate Account valuesREQUIREMENTS FOR RATES:ACTUARIAL MEMORANDUM  Justification for reduced rates Nonforfeiture demonstration Reserving method Underwriting XXX RequirementsLINE OF BUSINESS: LONG TERM CARE CODES: LTC01 through LTC06POLICY FORMSREQUIREMENTS RELATING TO APPLICATIONS AUTHORIZATIONHIV CONSENTGENETIC TESTINGEVIDENCE OF INSURABILITY FRAUDULENT STATEMENTSREPLACEMENT QUESTIONSUNDERWRITING QUESTIONS REQUIREMENTS RELATING TO POLICY FORM REVIEW:ADDITIONAL BENEFITSADULT DAY CAREADVANCE PAYMENT OF PREMIUMAMENDMENTSARBITRATIONAUTOPSYDEFINITIONSELIGIBILITYENTIRE CONTRACT EXCLUSIONS & LIMITATIONSGRACE PERIOD GRIEVANCEHOME HEALTH CAREINCONTESTABILITY LEGAL ACTION MANDATED BENEFITSMISSTATEMENT OF AGE NOTICE OF CLAIM NURSING HOMEOTHER REQUIREMENTSOUTLINE OF COVERAGEPAYMENT OF CLAIM PRE-EXISTING CONDITIONSPROOF OF LOSS REINSTATEMENTRENEWABLESCHEDULE OF BENEFITSTERMINATION, NOTICETIME LIMIT ON CERTAIN DEFENSESTIME PAYMENT OF CLAIMS UNFAIR DISCRIMINATIONWAITING PERIODREQUIREMENTS FOR RATES:ACTUARIAL MEMORANDUM Justification of rates Loss Ratios Reserving method UnderwritingLINE OF BUSINESS: MEDICARE SUPPLEMENT CODES: MS01 through MS06POLICY FORMSREQUIREMENTS RELATING TO APPLICATIONS AUTHORIZATIONHIV CONSENTGENETIC TESTINGEVIDENCE OF INSURABILITY FRAUDULENT STATEMENTSREPLACEMENT QUESTIONSUNDERWRITING QUESTIONS REQUIREMENTS RELATING TO POLICY FORM REVIEW:AMENDMENTSARBITRATIONCLAIM FORMS CLAIM PAYMENT PROVISIONCREDITABLE COVERAGEDEFINITIONSELIGIBILITYENTIRE CONTRACT EXCLUSIONS & LIMITATIONSGRACE PERIOD INCONTESTABILITY LEGAL ACTION MISSTATEMENT OF AGE NOTICE OF CLAIM OTHER REQUIREMENTSOUTLINE OF COVERAGEPAYMENT OF CLAIM PRE-EXISTING CONDITIONSPRESCRIPTIONSPROOF OF LOSS REFUNDSREINSTATEMENT RENEWABLESCHEDULE OF BENEFITSTERMINATION, NOTICETIME LIMIT ON CLAIMS TIME LIMIT ON CERTAIN DEFENSES WAITING PERIODREQUIREMENTS FOR RATES AND RATING PLANS:ACTUARIAL MEMORANDUM  Actuarial Certification Justification for rates Loss Ratio Reserving method UnderwritingLINE OF BUSINESS: MULTI-LINE CODES: ML01 through ML02POLICY FORMSREQUIREMENTS RELATING TO APPLICATIONS SAME AS LIFE AND HEALTH CHECKLISTSREQUIREMENTS RELATING TO POLICY FORM REVIEW:SAME AS LIFE AND HEALTH CHECKLISTSREQUIREMENTS FOR RATES:SAME AS LIFE AND HEALTH CHECKLISTSLINE OF BUSINESS: VIATICAL SETTLEMENT CODES: VS01POLICY FORMSREQUIREMENTS RELATING TO APPLICATIONSAUTHORIZATION FRAUD WARNINGPHYSICIANS REPORTREQUIREMENTS RELATING TO POLICY FORM REVIEW:DISCLOSURES ESCROW/TRUST AGREEMENTPOWER OF ATTORNEYCHANGE OF BENEFICIARYRIGHT TO RESCINDOTHERREQUIREMENTS FOR RATES:PRICING MEMORANDUM PAGE  PAGE 1 89hi~'+,0eijn       4 8 9 = I J K O P T Z ^ _ c CJOJQJB*CJhphOJQJ5B*hph CJOJQJ5B*CJhph6 j5CJ$5NNO?0HUh$If 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