Property & Casualty

Oregon General Filing Tips

GENERAL (Applies to all product lines)

For comprehensive filing instructions, use the navigation tabs above for the specific product line.

SERFF users must review the Oregon General Filing Instructions in SERFF. Insurance Division Bulletin INS 2006-05 contains the General Filing Instructions for filing policy forms, rules, and rates.

• Acronyms, Abbreviations, Initials: Please be sure to explain or define.

• Application Forms: Insurance application forms and supplementary application forms that may be used to deny a claim must be filed for prior approval pursuant to ORS 742.013 and ORS 742.003(1). Product standards checklists (e.g. #440-2442H, #440-2442, #440-3615A) are available on the Oregon Insurance Web site.

• Approved or Reviewed Paper Filings: For paper submissions, the company/insurer will receive a perforated copy which serves as the official record to be retained for a minimum of five (5) years or as long as contents are active, whichever is longer. Prior to 2011, the Division copy was retained for 30 days for public viewing. Paper filings that are kept for a longer period include rating bureaus, advisory organizations, workers' compensation, medical malpractice, Long Term Care, Medicare Supplement and other selected topics, as well as those required by federal law. All filings that were submitted via SERFF or that we have scanned into SERFF (beginning September 2011) are currently being retained indefinitely.

• ARBITRATION: Pursuant to ORS 36.600 through ORS 36.740; when the policy contains an Arbitration provision if claim settlement cannot be reached, and the parties agree to arbitration at the time of the dispute, then arbitration takes place under the laws of Oregon, and is held in the insured's county (or other location if agreed upon by both parties). Oregon law does not support mandatory binding arbitration for insurance contracts.

• Sending attachments for paper filings via email: When submitting revised or new documents via email, please use PDF documents unless otherwise directed by Division staff. The combined size of the email plus attached documents being transmitted must be under 4 MB. We are unable to open .ZIP files.

• Certificate of Compliance: OAR 836-010-0011 requires a signed current Certificate of Compliance (form #440-3894) to be attached to every filing submission. The current form may be found on the Oregon Insurance Web site under Filing Requirements or in SERFF. If making a "group" form filing for multiple insurance companies, only one Certificate of Compliance is required for the group, naming each company/insurer included in the group submission.

• Explanation of filing purpose (a.k.a. Filing Description): To aid in the review process, the state analyst needs a clear explanation of the intent or purpose of the filing submission. How is the product unique? What changes have been made in the product from previous filings? If the new filing is not replacing prior approved form(s), then explain the need for the new form(s). Too much information is better than not enough. Remember to include the marketing plan whenever you make a new product or program filing. (See advertising guidelines for Health or Life & Annuities)

  For SERFF filings this information should be placed in the Filing Description under the General Information tab, or in a cover letter or explanatory memorandum under the Supporting Documentation tab. While it is not currently possible to revise the Filing Description field, it is possible to revise a cover letter or memorandum.

• Form number (including edition date) throughout the submission: New and replaced form number references must EXACTLY match the form number shown on the actual documents submitted for approval. Any form references in the Filing Description, Forms Schedule, cover letter, explanatory memorandum, manual page Forms Index, Statement of Variability, Actuarial Memorandum, etc., must be consistent. Use spaces, parentheses, slashes, dashes, periods or dots, etc. where applicable. Paper submission Form Filing Schedule documents also must show the new and replaced form references correctly. See filing tips by line (Health, Life & Annuities, Property & Casualty) for line specific directions regarding placement of the form number on the document.

• Fraud Warning Statements: Insurance Division Bulletin 2010-03 advises a fraud warning statement is not required in Oregon. Insurance fraud is not a crime per se in Oregon. Therefore, any fraud warning statement used on an application for insurance is only allowed to state "may" be guilty of insurance "fraud". Additionally, the fraud warning should refer to intentional and materially false information. Please refer to the bulletin for more details and examples of acceptable verbiage.

• Use of "Have you ever…?" questions on applications: Oregon does not allow use of open-ended questions for product areas with statutory maximum look-back provisions, or where the question violates Federal laws or creates unfair discrimination. In addition to specific statutory provisions, OAR 836-081-0010 contains guidance related to unfair discrimination.

• HB 2007 — Oregon Family Fairness Act: House Bill 2007 effective February 4, 2008 recognizes and authorizes domestic partnerships as defined in Section 3 of the bill. Section 9, ch. 99, Oregon Laws 2007 states the general scope of legal rights and responsibilities to which domestic partnerships are subject. In addition, Senate Bill 2 (ch. 100, Oregon Laws 2007) adds sexual orientation to existing prohibitions against discrimination in employment and business. A policy form that is issued or renewed on or after April 1, 2008 and covers or applies to a spouse must also cover or apply to members of a domestic partnership. See bulletin INS 2008-02 for clarification and explanation.

• Incomplete or inaccurate submissions including clerical errors, typos, forms missing, and materials not legible (this applies to both paper and SERFF filings): Will require a response to filing errors within 24 hours.

• In all filings it is important that the contact name, telephone number (including extension if applicable), email address, and fax number, be accurate and current.

• The form number and form name/title references must be consistent throughout the filing submission and appear EXACTLY as they are on the form documents filed. This applies to both new and replaced form references in the Form Schedule tab area of SERFF, cover letter if used, explanatory memorandum if used, and the Filing Description area of the General Information tab in SERFF.

• We do not accept unsigned Transmittal Documents in paper submissions; or unsigned or modified Certificate of Compliance forms in either paper or SERFF filings.

• When a form-only filing does not include all the required information: The Division's procedure is to disapprove the filing prior to review. In the interest of good customer service, we will send our concerns to the filer via e-mail for paper filings, or as an objection letter if filed on SERFF, and ask for response within 24 hours. If the necessary materials have not been received within 24 hours, then the filing will be rejected without review. The filing may not be re-opened. A complete new filing will need to be submitted if further consideration is desired and the previously disapproved State Tracking Number needs to be referenced.

• Electronic Filing Submissions: The preferred method for making electronic filing submissions is through SERFF (the System for Electronic Rate and Form Filing).

• Multiple submissions of the same form number: The NAIC Property/Casualty product coding matrix allows for "interline" form submissions. If the same policy form will be used for multiple product offerings, it need only be filed once, as an interline submission, noting all of the lines or programs it will apply to. For example, a FRAUD WARNING STATEMENT filed as a simple endorsement that could be attached to all personal lines or all commercial lines policies, need only be sent once; thereby avoiding duplicates of the same form being assigned to more than one analyst.

• Oregon Assigned Filing Number (a.k.a., State Tracking Number): When sending correspondence in response to states concerns, show the Oregon assigned filing number in the cover letter introduction or in the heading of your email response. We track all submissions by the State Tracking number, not by the company's assigned number. Failure to include the Oregon assigned filing number in your correspondence may cause a delay in processing.

• Product Standards, and Compliance with Oregon laws: Oregon's product standards were developed to coordinate with the NAIC Product Coding Matrix, and the Interstate Compact Life & Annuities provisions.

  The current product standards checklists may be a required filing component in both SERFF and paper submissions. A given submission may require more than one product standards checklist depending on the lines of coverage represented and the type of filing (e.g., policy, endorsement, application). Be sure to include all of the current applicable checklist(s) and complete them correctly so the information marked in the checklist(s) coincides with the contract language being submitted for approval. Please refer to the Current Forms List to determine if a product standard must be attached to a filing. All of the boxes located in the checklist must be marked yes, no, N/A, or in many cases must note the applicable page/paragraph. If No or N/A is checked, be sure to explain why.

• Re-filing a previously disapproved submission: If a filing was previously disapproved or rejected and the company/insurer is resubmitting, please prominently state so in the cover letter or in the Filing Description field of the General Information tab in SERFF. Include copies of all correspondence from the previous submission along with an explanation of how the prior objections have been resolved in the new materials.

• Response Timelines:

• Initial filing objections stating the response must be received within 24-hours have not yet been assigned to an analyst. Assignment to the analyst or actuary will be made when the response is received.

• Oregon's goal is to process final disposition within 30-days of receiving a complete filing submission in the Rates & Forms unit. However it may be necessary for an additional 30 day extension when a company and the Division are negotiating concerns. To reach our goal we expect the company to provide their response materials within one (1) day to the support staff, and within ten (10) days of the date the analyst or actuary corresponds with the filer. An incomplete or untimely response on a form or accident and health rate filing could result in disapproval as an incomplete filing. When there are extenuating circumstances preventing the company from responding within the ten day turn around time, the company may contact the analyst or actuary by phone or e-mail to request a five day extension of the ten days. Support staff cannot grant an extension.

• Responses that include changes from the original submission: When sending a response, indicate in the cover letter if the subject form number is being revised, replaced, or if any new forms are added that were not in the original submission material. If making substantial changes to a paper filing, you may need to send a revised FORMS FILING SCHEDULE (PC FFS-1), or FORMS FILING ATTACHMENT (LH FFA-1). You may also need to amend or revise your filed Rules/Rates manual if form references are contained therein that may be affected by changes to the forms submission.

• Revision of Previously Approved Forms: When filing revised forms, we require the previously approved forms to be annotated or highlighted with the specific changes made; or a side-by-side comparison of the old and new versions noting the changes; or a red-line version (Health filings require a redlined version). All revised policy forms must either have a new form number assigned or a new revision (edition) date. See OAR 836-010-0011(4).

• SERFF Filings: All communication other than status requests must be documented in the SERFF system. Status requests should not be sent in SERFF – email dcbs.ratesforms@state.or.us or call 503-947-7983 when checking review status.

• See the Oregon General Filing Instructions in SERFF regarding responses to state objections and the Placement Location of Items filed. The SERFF Industry User Manual provides step-by-step instructions for responding to state objection letters.

• See the Oregon General Filing Instructions in SERFF regarding SERFF attachments. They need to be PDF pipeline ready; meet ADOBE readability requirements; and meet our three megabyte (3MB) size limitation per PDF.

• Amendments should not be used to respond to an objection letter. This option should only be used if you have forgotten to attach something or need to correct an attachment prior to the state review process.

• Policy document forms should not contain blank pages. It is acceptable to state, "This page intentionally left blank".

• For Life and Health Filings, a Statement of Variability (SOV) or an Explanation of Variables (EOV) must be attached to a schedule item under the Form Schedule tab in SERFF, and have its own unique form number in the bottom left hand corner.

  The SOV must be attached as a separate schedule item on the Form Schedule.

  For stop loss, provider excess, or travel form filings, the SOV or EOV should be attached as a separate item to the Supporting Documentation tab area of SERFF.

• All new or replacement form numbers under the Form Schedule tab in SERFF must show the entire document number with edition date EXACTLY as it appears on the document. The entire reference will appear in the Form Number field. For tracking purposes in Oregon, the version or edition is considered part of the form number.

• Each Line Item or Schedule Item should contain only one PDF attachment unless otherwise directed by Division staff. We cannot approve a Schedule Item that contains unacceptable attachments. If multiple forms or documents are combined in a single schedule item, then we cannot approve that Schedule Item if it includes non-approvable materials.

• Highlighted, annotated, side-by-side comparison, red-line versions, John Doe, or previously approved versions of forms, should be attached in the Supporting Documentation tab. We prefer red-lined versions of revised forms for ease of review.

• When providing a revised form in response to a state reviewer's objection, send a "revised schedule item" according to the Industry User Manual instructions. Do not send the previous version with the new version.

• Note to Reviewer – DO NOT attach documents to a Note to Reviewer. All documents must be able to be PDF pipelined. All documents should be added as a response to an objection, or as an amendment to the filing.

• Change to Effective Date – Send a Note to Reviewer on the closed SERFF filing to request your change of effective date. Include the reason for the change and the new date(s) being requested.

• Additional Paper Filing Guidelines:

• We require the company provide two complete sets of a paper filing submission; this also applies to paper responses to state inquiries or objections. If you e-mail a response, we expect to receive two hard copies via mail delivery. We will return one complete perforated set of the filing upon review completion and the company must retain this material for a minimum of five (5) years or as long as the contents of the filing are active, whichever is longer. (see Bulletin 2006-5 regarding filing retention).

• All paper filings must include one large postage paid return envelope with the initial filing materials so we can mail the perforated documents back after review is completed. It is not necessary to send additional envelopes with responses, unless the filing becomes so large you need to send a bigger envelope for the return copy.

• Transmittal documents are only required on paper filing submissions: We require use of the current NAIC transmittal forms on all non-SERFF filing submissions of forms, rules, and rates. See the Oregon Insurance Web site above for a link to the current NAIC versions.

  Oregon law does not require the NAIC transmittal on SERFF filings and using the transmittal forms is a duplication of effort for the filer. SERFF v5 allows all pertinent information to be placed under the appropriate tab areas. Please do not use NAIC transmittal documents on SERFF filing submissions.

  • Exception for Workers Compensation (WC) Filings: Regardless of whether a WC filing is submitted via SERFF or on paper, OAR 836-042-0015(2) requires WC filings to be accompanied by Transmittal documents.