SECTION 3.4. General Submission Requirements

(a) Submission. Companies must submit one copy of the filing to the Life and Health Division at the address set forth in §3.3(a) of this title (relating to Transmittal Information). A filing submitted electronically must be submitted in such form and format as determined by the department.

(b) Contact person. A company submitting a filing to the department must:

(1) have one person designated as the contact person for that filing;

(2) provide the contact person's name, address, telephone number, and if available, email address on the transmittal checklist or transmittal form;

(3) provide, for any filing submitted by anyone other than the company, a dated letter of specific authorization which must:

(A) designate the consulting firm, actuary, legal counsel, or other person as the designated contact person for that filing; and

(B) be signed by an officer of the company or a person with authority to bind the company; and

(4) notify the department immediately of any change of information with regard to the contact person for a pending filing, regardless of whether the contact person is the company's employee or other authorized representative.

(c) Form specifications. Any filing submitted pursuant to this subchapter must comply with the following:

(1) Filings submitted in paper format must:

(A) be submitted on 8 1/2-by-11-inch paper;

(B) not be submitted in bound booklets;

(C) be legible;

(D) be in typewritten, computer generated, or printer's proof format; and

(E) not contain any color highlighting.

(2) Any form submitted must be designated by a form number that:

(A) is sufficient to distinguish it from all other forms used by the company;

(B) is located in the lower left-hand corner of the cover page or on the first page of the form if the form number is visible with the cover closed;

(C) has the additional identifying form number requirements set forth in Subchapter FF of this chapter (relating to Credit Life and Accident and Health Insurance), if the form is submitted for consideration pursuant to Insurance Code Chapter 1153; and

(D) has the additional identifying form number requirements set forth in §26.14(g) of this title (relating to Coverage), if the form is submitted for consideration pursuant to Insurance Code Chapter 1501.

(d) Specimen language and specimen fill-in material.

(1) For all forms, specimen language and fill-in material must reflect the most restrictive option available under variability. Additional descriptions of variability options must be provided upon request or as otherwise required.

(2) Life and annuity forms must be completed with fill-in material for specimen age 35. If the form is not issued at age 35, the fill-in material should be completed for the youngest age at which the form may be issued. If reduced death benefits are provided for any age at issue, the specimen form must be filled in for the age at issue for which the greatest reduction in benefits is made. The fill-in material must be for the longest premium paying period available under the form.

(e) Variable material.

(1) For all forms, any variable material in a form must be bracketed and contain a clear explanation of how the material will vary. It is acceptable for certain materials to vary due solely to the age, sex, classification of the insured, plan type such as 403(b) and IRA, telephone numbers, and addresses, depending on the manner in which the company intends to use the variations. The unique form number on a form may not be bracketed as variable.

(2) For individual life forms, the text and specifications of nonforfeiture assumptions generally cannot be considered variable material.

(f) Matrix filings. Policies, certificates, contracts, or applications may be submitted as a matrix filing. Any company submitting a matrix filing:

(1) must identify each provision with a unique form number that:

(A) is sufficient to distinguish it from all other provisions used by the company; and

(B) is located at the lower left-hand corner of the provision;

(2) may use the same provision filed under one form number for all products, provided the language is applicable to each product; however, any changes in the language to comply with the requirements for each product will require a unique form number;

(3) must list the form number for each provision on the transmittal checklist and provide a statement indicating how the provision will be used and the type of product for which the provision will be used; and

(4) must provide the certifications required in §3.6(a)(8) of this title (relating to Certifications, Attachments, and Additional Information Requirements).

(g) Insert page filings. Policies, certificates, and contracts may be submitted with insert pages, or an insert page may be filed subsequent to the approval of a policy, certificate, or contract. Any company submitting an insert page filing:

(1) must identify each insert page with a unique form number that:

(A) is sufficient to distinguish it from all other forms used by the company; and

(B) is located in the lower left-hand corner of the page;

(2) may use the same insert page filed under one form number for all products, provided the language is applicable to each product type; however, any changes in the language to comply with the requirements for each product type will require a unique form number;

(3) may use the same insert page to replace an existing page of a previously approved or exempted contract; if used in this manner, the replaced page, as originally filed, must reflect a unique form number that distinguishes it from the other pages of the form or contract;

(4) must list the form number for each insert page on the transmittal checklist and provide a statement indicating how the insert page will be used and the type of product for which the insert page will be used; and

(5) must provide the certifications required in §3.6(a)(8) of this title.

(h) Limited, partial refilings. Limited, partial refilings must contain the change and any additional actuarial information necessary for a comprehensive review of the filing(s).

(i) Outline of coverage. An outline of coverage must be filed with each individual accident and health policy, group or individual Medicare supplement policy and/or certificate, or group or individual long-term care policy and/or certificate.

(j) Supplemental coverages.

(1) Individual accident and health forms submitted pursuant to §3.3080 of this title (relating to Supplemental Coverage) must be accompanied by the certification required in §3.6(a)(7) of this title;

(2) Group life forms submitted pursuant to Insurance Code §1131.051 or §1131.053 must be accompanied by the certification required in §3.6(a)(7) of this title.

(k) Complete submission of policy or contract forms. For a submission to be considered complete, the submission must include the following:

(1) the toll-free notice unless the company is exempt under §1.601(c) of this title (relating to Notice of Toll-Free Telephone Numbers and Information and Complaint Procedures) or has on file a toll-free notice which is current with the requirements set forth in §1.601 of this title;

(2) the application, if applicable;

(3) in the case of group policies or contracts, the certificate;

(4) any rider which will or can be included in all issues of the form; and

(5) disclosures and other information, if applicable.

(l) Riders included with filing. For any rider included with the policy or contract filing, indicate whether the rider is to be used:

(1) only with the policy being filed; or

(2) with other clearly identified previously approved or exempted forms.

(m) Previously approved or exempted forms. Any previously approved or exempted form (e.g., application or rider) to be used with the policy or contract filing need not be resubmitted; however, the filing must indicate the type of form (e.g., rider, policy, application, etc.), form number, and the approval or exemption date of the previously approved or exempted form. If there is a change in the use of the previously approved or exempted form, the filing must state the form number of the form(s) with which the previously approved or exempted form was designed to be exclusively used, as well as the updated forms list.

(n) Appropriate use of previously approved or exempted forms. The company is responsible for assuring the appropriate use of previously approved or exempted forms. This includes the appropriate use of any riders or other forms such as matrix and insert pages.

(o) Submission of a certificate for policies or contracts issued outside of Texas. A copy of the master policy or contract issued outside of Texas must accompany any life, annuity, credit, or accident and health certificate filed for review or filed as exempt, along with certification and evidence that the master policy for the group was lawfully issued and delivered in a state in which the company was authorized to do insurance business.

(p) Rates. Initial and subsequent rate filings must include all specific descriptions and required information as follows:

(1) policy forms for which the rate filing applies must be specified on the transmittal checklist or the transmittal form, as applicable;

(2) credit life and credit accident and health filings submitted under Insurance Code Chapter 1153 and Subchapter FF of this chapter must include the rate information;

(3) group and individual Medicare supplement filings submitted under Insurance Code §1652.101 and Subchapter T of this chapter (relating to Minimum Standards for Medicare Supplement Policies) must include the applicable rate schedule and experience by plan;

(4) group and individual long-term care forms submitted under Insurance Code Chapter 1651 and Chapter 3, Subchapter Y of this title (relating to Standards for Long-Term Care Insurance Coverage Under Individual and Group Policies) must include the rate schedule;

(5) all individual accident and health filings submitted under Insurance Code Chapter 1701 must include the rate schedule; and

(6) rate schedules submitted must be accompanied by the actuarial information set forth in subsection (q) of this section.

(q) Actuarial information.

(1) Each life filing, including riders, insert pages, or limited partial refilings, which changes the nonforfeiture values of a particular policy or certificate must be accompanied by the information set forth in subparagraphs (A) - (C) of this paragraph:

(A) The mathematical formulas and sample calculations for the items set forth in clauses (i) - (iv) of this subparagraph.

(i) net premiums for the specimen age and plan of insurance;

(ii) specimen nonforfeiture calculations necessary to verify consistency between the nonforfeiture values and the text of the form for years one, 20, and 50;

(iii) terminal reserves for the specimen age and plan; and

(iv) any other calculations necessary to verify nonforfeiture values and reserves.

(B) An actuarial memorandum as specified in clauses (i) and (ii) of this subparagraph, as applicable:

(i) for universal life and interest sensitive forms:

(I) an actuarial memorandum must provide the mortality table, guaranteed interest rates, maximum surrender charges, maximum expense charges, maximum risk rates (cost of insurance rates), maximum loads, and maximum fees at issue. Upon a change in basic coverage, bands and risk classes for all ages must be provided.

(II) actuarial proof must be provided that:

(-a-) cash surrender values meet the minimum requirements of Insurance Code Chapter 1105;

(-b-) cash surrender values will always equal or exceed the minimum values required by law; and

(-c-) provide a comparison table of all guaranteed cash surrender values, standard nonforfeiture law minimum cash surrender values, guaranteed death benefits, and reserves. Such comparison should be based on the fill-in issue age (usually age 35) as defined in subsection (d) of this section, a premium which will provide coverage to the latest available maturity date, the minimum issue amount, minimum guaranteed interest rates, maximum guaranteed cost of insurance rates (mortality rates), maximum guaranteed charges, and a month-by-month calculation of the values shown in the comparison for the first and fiftieth years.

(ii) for variable life forms, actuarial information must be provided as required by §3.804 of this title (relating to Insurance Contract and Filing Requirements), and as required by this section.

(C) A statement must be provided certifying that all policies or certificates, in addition to the specimen language and fill-in material, will have premiums, reserves, and nonforfeiture values calculated in a manner consistent with the information furnished with the specimen language and fill-in material. Any qualifications to such certification must be specified, including any variation in formulas at different ages at issue or at time of a change.

(2) For each annuity filing, an actuarial memorandum must be provided to meet the minimum requirements of Insurance Code Chapter 1107 and specify the guaranteed interest rates, the maximum surrender charges, and any other maximum charges applicable in the determination of nonforfeiture values. If the company intends to change the guaranteed interest rates specified in the form, notification must be submitted to the department prior to the change. The notification must specify the new guaranteed interest rate and the date when the new guaranteed interest rate will be effective for new issues of a specified policy form, as required by §3.1004 of this title (relating to Policy Form Review).

(A) For variable annuities, the actuarial information must provide the information required in this paragraph and the information required by §3.705 of this title (relating to Contract Requirements), to the extent such material is applicable.

(B) For policies or contracts that contain a market-value adjustment, the actuarial memorandum must:

(i) identify the name of the separate account;

(ii) indicate the basis for the market-value adjustment formula and that the formula provides reasonable equity to both the contract holder and the company;

(iii) detail that the reserve liabilities are established in accordance with actuarial procedures that recognize that assets of the separate account are based on market values, the variable nature of the benefits provided, and any mortality guarantees;

(iv) include a table of minimum guaranteed policy values and cash surrender values which:

(I) are based on the longest guaranteed investment period,

(II) reflect both upward and downward market-value adjustments; and

(III) show that the minimum guaranteed values prior to the adjustment are not less than the minimum nonforfeiture values required by law; and

(v) provide a numerical illustration reproducing the values shown in the table for the first, second, and third years of investment, and at the end of the guaranteed investment period.

(3) Group and individual Medicare supplement (including Medicare SELECT) rate filings must be accompanied by supporting actuarial information as required by Subchapter T of this chapter.

(4) Group and individual long-term care:

(A) rate filings must be accompanied by supporting actuarial information as required by Subchapter Y of this chapter; and

(B) annual reports must include the rates, rating schedule, and supporting documentation as required by Insurance Code §1651.053(c).

(5) Individual accident and health premium rate increases which result in any policyholder experiencing an increase in premium rate greater than or equal to 50% in any 12-month period must be accompanied by actuarial information which includes, at a minimum, the items of information specified in subparagraphs (A) - (E) of this paragraph. For the purpose of this paragraph, an increase in premium rate greater than or equal to 50% in any 12-month period means the cumulative increase with respect to such premium considered over a 12-month period.

(A) The form number or numbers to which the submitted rate increase applies.

(B) The planned effective date of the increased rate.

(C) The schedule or schedules of rates to be used.

(D) A concise explanation of the rating process, including assumptions, claims data, methodology, and formulas used in development of gross premium rates.

(E) A statement of actual and projected experience as a basis for the rate adjustments.

(6) Discretionary group filings must be accompanied by supporting actuarial information as required by Insurance Code §1131.064 and §1251.056.

(r) Filing Fee.

(1) The appropriate filing fee for filings for approval (excluding prepaid legal filings) are set forth in subparagraphs (A) - (J) of this paragraph.

(A) For each contract or policy, including Certification Form for Prototype Forms Figure Number 45, its certificate, approved or exempted application, and all approved or exempted riders filed as part of the entire policy or contract, a fee of $100 is required.

(B) For a filing of applications filed separately from the policy or contract to which it will be attached, a fee of $100 is required.

(C) For a filing of riders filed separately from the policy or contract to which it will be attached, a fee of $100 is required.

(D) For a filing of rates filed separately from the policy(ies) or contract(s) to which it is applicable, that require approval by the department as specified in §3.1(9) of this title (relating to Scope), a fee of $100 is required.

(E) For a filing of alternate face pages with constitution and bylaws, articles of incorporation, or trust agreements, a fee of $100 is required.

(F) For a filing of insert pages filed subsequent to the original approval of a policy, a fee of $100 is required.

(G) For filings which normally would be considered exempt, but which, due to certain reasons specified in Subchapter Z of this chapter (relating to Exemption from Review and Approval of Certain Life, Accident, Health, and Annuity Forms and Expedition of Review) are required to be submitted to the department for approval, a fee of $100 is required.

(H) For filing a resubmission of a previously disapproved form, a fee of $50 is required.

(I) For each refiling of a previously withdrawn form, a fee of $50 is required.

(J) For a filing of matrix provisions, due to the ability to create multiple contracts or policies from matrix provisions, a fee of $50 per form with a maximum fee of $500 is required.

(2) The appropriate filing fee for a filing exempt under Subchapter Z of this chapter is set forth in subparagraphs (A) - (H) of this paragraph, as follows:

(A) For each exempt policy or contract filed simultaneously with its certificate, application, and exempt riders which are filed as part of the entire policy or contract, a fee of $50 is required.

(B) For a filing of exempt applications filed separately from the exempt policy or contract to which it will be attached, a fee of $50 is required.

(C) For a filing of exempt riders filed separately from the exempt policy or contract to which it will be attached, a fee of $50 is required.

(D) For a filing of rates filed separately from the exempt policy or contract to which it is applicable, and which is not subject to approval by the department as specified in §3.1(11)(A) of this title, a fee of $50 is required.

(E) For a filing of outlines of coverage filed separately from the exempt policy or contract to which it is applicable, and which is not subject to approval by the department as specified in §3.1(11)(A) of this title, a fee of $50 is required.

(F) For a filing of alternate face pages filed subsequent to the original approval of a policy for use with multiple employer trusteed arrangements as defined in Insurance Code §1131.053 and §1251.053, a fee of $50 is required.

(G) For a filing of exempt insert pages filed separately from the exempt policy or contract to which it is applicable, a fee of $50 is required.

(H) For a filing of exempt matrix provisions to be used with only exempt products, a fee of $50 per form with a maximum fee of $500 is required.

(3) The appropriate filing fees for filings other than those specified in paragraphs (1) and (2) of this subsection are set forth in subparagraphs (A) - (C) of this paragraph, as follows:

(A) For a filing of outlines of coverage filed separately from the policy or contract to which it is applicable, and which is subject to review by the department, a fee of $50 is required.

(B) For a filing of PPO disclosures filed separately from the policy or contract to which it is applicable, and which is subject to review by the department, a fee of $50 is required.

(C) For a filing of Accident and Health or Life rates filed separately from the policy or contract to which it is applicable, and which is subject to review by the department, a fee of $50 is required.

(4) Filings as described in §3.1(11)(B) of this title require no filing fee.

Source Note: The provisions of this §3.4 adopted to be effective June 1, 2003, 28 TexReg 3954; amended to be effective May 11, 2022, 47 TexReg 2758