Life, Accident & Health

Insurance policies offered in South Carolina are to be readable and fair in relation to the coverage offered and must ensure prices charged for such coverage should be calculated in accordance with all state laws.  The Life, Accident, and Health Unit staff review and analyze individual and group policy rates, rules, and forms for these lines of insurance and for health maintenance organizations (HMOs).  Filings made with the LA&H Unit are generally completed within 30 to 90 days, unless additional information is needed.

Summary
Statutes & Regulations
Bulletins & Positions
PPACA Resources (Updated 6/3/14)
Filing Resources



Summary

The following Instructions and checklists are intended to be used as a tool by the insurer to properly prepare and submit filings to the South Carolina Department of Insurance. Please know that improper and/or incomplete filings will result in a rejection or disapproval of the filing.  

All rate, rule, and/or form filings must be submitted via the State Electronic Rate Form Filing system (SERFF). For more information on SERFF, please call 1-816-783-8787 or email serffmkttg@naic.org. Additional information is also available by visiting www.serf.com.

Filings must be submitted by insurer and by line of business.

The South Carolina Department of Insurance will review filings for compliance; however it remains the responsibility of the insurer to adhere to all applicable federal and State of South Carolina insurance laws, regulations and policies.

Statutes and Regulations

South Carolina Code of Laws, Title 38: Insurance
South Carolina Code of Regulations, Chapter 69: Department of Insurance

Key Statutes and Regulations
Definitions 
  • SC Code Section 38-1-20
Accident and Health 
  • Title 38, Chapter 71
  • Regulation 69-17
  • Regulation 69-34
  • Regulation 69-43
Credit Accident and Health 
  • SC Code Section 37-4-203
Credit Life 
  • SC Code Section 37-4-203
Group Life Insurance 
  • Title 38, Chapter 65
  • Regulation 63-12.1
  • Regulation 69-40
Health Maintenance Organizations 
  • Title 38, Chapter 33
  • Regulation 69-22
Insurance Contracts Generally 
  • Title 38, Chapter 63
  • Regulation 63-12.1
  • Regulation 69-30
Long Term Care Insurance 
  • Title 38, Chapter 72
  • Regulation 69-44
Medicare Supplement Insurance 
  • Regulation 69-46


Bulletins and Positions

For a complete listing of bulletins and orders, click here.

Key Bulletins and Orders
  • Bulletin 8-84: SCID 1504 Form
  • Bulletin 89-1: Group policies issued outside of this sate which extend coverage to residents of this state 
  • Bulletin 2003-12: Interpretive Bulletin Relating to the Use of Endorsements, Amendments and Riders for all Individuals and Group Policies
  • Bulletin 2003-13: List of "Exempt" Policy Forms, Filing Procedures for "Exempt" and "Prior Approval"
  • Bulletin 2006-08: Service and Administrative Fees
  • Bulletin 2007-11: Service and Administrative Fees
  • Bulletin 2009-22: Retaliatory Fees
  • Bulletin 2011-04: Compliance with the External Review Requirements of the Patient Protection and Affordable Care Act
  • Bulletin 2011-09: Mandatory Use of SERFF for all Insurance Rate, Rule, and Form Filings
  • Bulletin 2012-06: Reduced Agent Compensation for Medicare Supplement Policies Sold
  • Bulletin 2013-08Autism Spectrum Disorder Maximum Benefit for Coverage of Behavioral Therapy for Calendar Year 2014
  • Bulletin 2013-11: Service and Policy Fees
  • Order Number 2013-02: Rates for Credit Accident and Health Insurance Sold in Conjunction with Loans Subject to 1966 S.C. Act No. 988 - Approved Rate for 2014 Basic Statistical Plan
  • Order Number 2013-03: Rates for Credit Accident and Health Insurance Sold in Conjunction with Consumer Credit Transactions Subject to the South Carolina Consumer Protection Code Other Than Loans Made Under 1966 S.C. Act No. 988 - Approved Rates for 2014 Basic Statistical Plan
  • Bulletin 2014-10: Notice of Tentative Credit accident and Health Insurance Rates and Opportunity to Request a Hearing
  • Bulletin 2014-11Notice of Tentative Credit accident and Health Insurance Rates and Opportunity to Request a Hearing
Position Highlights
  • Enrollment Forms are required for all group policy filings.
  • SCID 1504 Form is required for all individual filings and group rate filings
  • This Department takes exception to wording which indicates that the statements of the applicant are other than representations. Hence the word “certify” must be deleted

PPACA Resources


2014 Market Reforms


Filing Procedures and Requirements
Resources

Transitional Policy for Non-grandfathered Health Insurance Coverage

Bulletins
Resources
  • List: Companies Participating in Transitional Relief Pursuant to Bulletin 2013-12

Immediate Market Reforms

Filing Procedures and Requirements
  • Bulletin 2011-03: New Rate Filing Procedures to Comply with 45 CFR Part 154
  • Bulletin 2011-11: Application of New Rate Filing Procedures to Comply with 45 CFR Part 154 to Association-based Coverage
Resources

LA&H Filing Resources

Filing Checklists