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Checklists Life - Accident - Health
Life, Accident, & Health Review Requirements Checklists
Please use the up-to-date checklists provided on this page. Filings submitted with out-of-date checklists will be rejected.
NOTICE: Issuers can access all plan year 2025 checklists and documents on the ACA Issuer Page. The appropriate checklists must be used for all ACA compliant filings. Fees are nonrefundable and not transferrable.
Rate Checklists
Accident & Health Checklists
NEW FOR ALL FILINGS OFFERING MENTAL HEALTH BENEFITS: The Mental Health Parity Supporting Document template must be attached under the supporting documentation tab of all form filings offering mental health benefits. Filings without this documentation will not be reviewed.
- Checklist for Carrier External Review Notices
- Blanket Accident
- Fraternal Review Requirements
- Illinois Network Adequacy (Tiered) Collection Template - Excel
- Individual Excepted Benefit Checklist
- 2025 Large Group HMO-POS Checklist
- 2025 Large Group PPO Checklist
- 2024 Large Group HMO-POS Checklist
- 2024 Large Group PPO Checklist
- Large Group Accident Health Stand Alone Dental
- Long Term Care Traditional & Partnership Program Checklist Rev. 12-05-23
- Network Adequacy County Facilities - Excel
- Network Adequacy Exception Form
- Network Adequacy & Transparency Checklist
- Stand Alone Dental Plan - Network Adequacy Checklist
- Proposed Enrollment Template
- Medicare Supplement Checklist
- Mental Health Parity Supporting Documentation Checklist
- Short Term Limited Duration Checklist
- 2025 ACA Student Health Checklist
- 2024 ACA Student Health Checklist
MH/SUD NQTL Comparative Analysis
Phase I
Phase II
Excess Risk/Stop Loss filings are done on an INFORMATIONAL basis
Life & Annuity Review Requirement Checklists
Note: Documents must be saved as PDFs before uploading to SERFF.
- Accelerated Benefits for Terminal Illness Rev. 06-04-24
- Accelerated Benefits for Covered Condition Rev. 06-04-24
- Accidental Death Benefits Individual and Group Products Rev. 01-24-22
- Additional Benefits — Individual & Group Total Permanent Disability
- Annuity Filing checklist Rev. 3-3-22
- Individual Equity Indexed Annuity Rev. 01-24-22
- Fraternal Benefit Society Guidelines Rev. 11-03-21
- Group Annuity Rev. 3-3-22
- Group Term Life Rev. 03-08-22
- Group Universal Life Rev. 03-19-24
- Group Whole Life Rev. 05-05-22
- Individual Annuity Fixed Premium Rev. 01-24-22
- Individual Annuity Flexible Premium Rev. 03-08-22
- Individual Immediate Annuity Rev. 11-03-21
- Individual Term Life Rev. 11-03-21
- Individual Universal Life Rev. 11-30-21
- Individual Variable Annuity Rev. 03-08-22
- Individual Variable Life Rev. 11-03-21
- Individual Variable Universal Life (Flexible and Fixed Premium) Rev. 06-27-24
- Individual Whole Life Insurance Rev. 11-29-21
- General Account Modified Guaranteed Annuity Rev. 11-03-21
- Supplemental Individual Life Filing Checklist - New 12/10/20
Credit Filings Checklists
Company Filings — All Lines
Viatical Settlement Review Requirement Checklists
Mental Health/Substance Use Disorder NQTL Comparative Analysis
Reporting Template
Reporting Instructions for: