CurrentMississippi Insurance DepartmentPolicy N/A

Submission Requirements for Accident and Health Policies

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Establishes filing, policy-form, rating, benefit, disclosure, and operational requirements for accident and health policies and certificates delivered or issued for delivery in Mississippi.

Policy Summary

PayerMississippi Insurance Department

PolicySubmission Requirements for Accident and Health Policies

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionFile all policy and certificate forms delivered or issued for delivery in Mississippi for review and approval as required, including applicable riders and endorsements.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

31 daysMinimum grace period

25/35 daysElectronic/paper clean-claim payment

3% monthlyInterest on late clean claims

12 monthsMaximum group pre-existing-condition period after effective date

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CurrentMississippi Insurance DepartmentPolicy N/A

Submission Requirements for Accident and Health Policies

Customize your policy alerts

Sign up for all Mississippi Insurance Department policy alerts

Know when Mississippi Insurance Department releases new policies or updates existing guidance.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Establishes filing, policy-form, rating, benefit, disclosure, and operational requirements for accident and health policies and certificates delivered or issued for delivery in Mississippi.

Policy Summary

PayerMississippi Insurance Department

PolicySubmission Requirements for Accident and Health Policies

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionFile all policy and certificate forms delivered or issued for delivery in Mississippi for review and approval as required, including applicable riders and endorsements.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

31 daysMinimum grace period

25/35 daysElectronic/paper clean-claim payment

3% monthlyInterest on late clean claims

12 monthsMaximum group pre-existing-condition period after effective date

General Policy and Benefit Requirements

General policy submission and form criteria

A policy or certificate may be delivered or issued for delivery in Mississippi only when all applicable filing, contract, rating, benefit, disclosure, and statutory requirements are satisfied.

ALL of the following

File the policy or certificate, including applicable riders and endorsements, for review and approval as required.
Submit initial premium rates with a signed actuarial memorandum documenting premium derivation, all actuarial assumptions, the expected lifetime loss ratio, and a durational loss-ratio exhibit.
File all rate increases with a signed actuarial memorandum justifying the increase, and implement the increase through an amendment or endorsement filed for approval before use.
Include required contract provisions, effective and termination dates, exceptions or reductions, form number, claims terms, and legally required notices.
Comply with applicable Mississippi benefit mandates, provider-choice provisions, continuation requirements, and product-specific standards.
Comply with applicable federal requirements, including HIPAA, the Newborn's and Mother's Health Protection Act, the Mental Health Parity Act, and the Women's Health and Cancer Rights Act.

Required and optional benefit provisions

Include required provisions and applicable benefits; optional provisions or mandates may be included or elected only as allowed by the policy requirements and governing law.

ONE OR MORE OF THE FOLLOWING APPLIES

Required policy provisions include the entire contract, time limits on certain defenses, grace period, reinstatement, notice and proof of claim, claim payment, physical examination, legal actions, and change of beneficiary terms.
Required or applicable benefits include pharmacy freedom of choice, cancer-drug coverage, newborn and handicapped-child coverage, TMJ coverage, practitioner choice, direct access to obstetricians and gynecologists, optometrist benefits when the policy provides reimbursement, and required provider definitions.
Optional provisions or mandates may address change of occupation, misstatement of age, mental illness, diabetes, mammography, child immunizations, dental anesthesia, and other listed optional provisions, subject to applicable election requirements.

Claims, pre-existing-condition, and rate criteria

Apply the following claims, pre-existing-condition, and rate requirements according to the type of policy or certificate.

ALL of the following

- EITHER
  - Electronic clean claimwithin 25 days after completed proof of loss
  - Paper clean claimwithin 35 days after completed proof of loss
- AS APPLICABLE TO THE PRODUCT

Statutory References and Operational Timeframes

Rate filing authoritiesmixed

Regulation 73-4	Requirements governing rate increases and amendments or endorsements used to implement them
Bulletin 94-1	Requirements applicable to health insurance rate increases

Mississippi statutory requirementsmixed

83-9-3	Required policy and certificate contract-form provisions
83-9-5	Required and optional policy provisions, including claims payment requirements
83-9-6	Freedom of choice of pharmacy when pharmaceutical benefits are provided
83-9-8	Cancer-drug coverage requirement, including drugs not approved by FDA
83-9-49	Pre-existing-condition exclusion requirements
83-41-203	Optometrist benefits when the policy provides reimbursement
83-41-217	Direct access to obstetricians and gynecologists as primary care physicians
83-51-11	Equal payment or reimbursement for non-participating and participating dentists
83-9-101	Rate filing and Medicare supplement requirements

Mississippi regulationsmixed

Regulation 2000-2	Federal Newborn's and Mother's Health Protection Act compliance
Regulation 2000-3	Federal Women's Health and Cancer Rights Act compliance
Regulation 2000-5	HIPAA compliance and guaranteed renewability for major medical and comprehensive policies
Regulation 99-3	Guaranty Association summary document requirement
Regulation 90-102	Mississippi long-term-care insurance policy minimum standards
Regulation 96-103	Mississippi Medicare supplement minimum standards and rate requirements

Notice of claim

ProvisionNotice of claim

Required timing30 days

Policy sectionSection 83-9-5 required provision

Claim forms

ProvisionClaim forms

Required timingMust be provided within 15 days

Policy section

Filing, Rate, Benefit, and Disclosure Actions

Documentation Required

Policy and Certificate Filing

File all accident and health policy and certificate forms, including riders and endorsements, delivered or issued for delivery in Mississippi with the Mississippi Insurance Department for review and approval. This requirement also applies to policies or certificates issued to non-Mississippi-domiciled trusts or associations and requires compliance with Mississippi laws and regulations.

The term policy includes riders and endorsements.
File policies and/or certificates before delivery or issuance for delivery in Mississippi.

Documentation Required

Initial Rate Filing Documentation

At the initial filing of each policy and/or certificate, submit the premium rates with a signed actuarial memorandum showing the derivation of premiums, all actuarial assumptions, and expected lifetime experience.

Include a durational loss-ratio exhibit.
File initial premiums for all health insurance policies and/or certificates under Section 83-9-101 and Regulation 96-103, as amended.

Defined Policy Terms

Policy

Defined termPolicy

IncludesThe policy itself

Also includesAny riders and/or endorsements

Applicable accident and health policy

Defined termApplicable accident and health policy

Mississippi connectionA policy or certificate delivered in or issued for delivery in Mississippi

Specialized productsIncludes Medicare supplement, long-term care, credit life, and credit disability coverage

Documentation Required

Required Policy-Form Provisions

Ensure each policy and/or certificate contains the required form information and statutory provisions. The policy, attached application, and all riders or endorsements must be identified as the entire policy or contract, and required time periods and claims language must be stated accurately.

Show the policy effective date and termination date; state all exceptions and reductions; and place the form number in the lower-left corner.
Include the entire-contract provision, including that attached papers form the contract and no agent may waive or alter its provisions.
Include the two-year time limit on certain defenses; reinstatement; a minimum grace period of 31 days (7 days for weekly premiums and 10 days for monthly premiums); and change-of-beneficiary provisions.
Include notice of claim within 30 days, claim forms within 15 days, proofs of loss within 90 days, payment of claims, and the physical-examination provision. Do not mention autopsy.
For clean claims after completed proof of loss, provide payment within 25 days for electronic claims and 35 days for paper claims. Include the revised Section 83-9-5(1)(h) language, except subparagraph 2 when no periodic benefits are provided; late-payment interest is 3% per month and the insured may bring an action for treble damages.
Specify that legal actions may not be limited to less than 3 years.

Billing Rule

Benefit and Access Compliance

Build mandated benefits, access rights, continuation protections, and product-specific benefit rules into the applicable policy or certificate. Apply the requirements based on the product type and whether coverage is individual or group, including all applicable federal mandates.

Provide pharmacy freedom of choice; do not exclude cancer drugs solely because they are not FDA-approved. Treat alcoholism as any other illness under group policies, without requiring benefits to exceed $1,000 per calendar year.
Provide coverage for newly born children from birth and for handicapped children; provide the required TMJ benefit up to a $5,000 lifetime maximum. Include optional benefits when elected or required, including anesthesia for dental treatment of children or mentally handicapped adults, child immunizations, mental illness, diabetes, and mammography. Mental illness coverage remains subject to federal mandates and the insured's permitted election or declination.
Apply pre-existing-condition limits: group health policies may not exceed 6 months before and 12 months after the effective date; individual health policies may not exceed 12 months before and 12 months after. Limited-benefit and specified-disease policies are exempt from these limits, but departmental limits apply to them: individual policies no more than 60 months before and 24 months after; group policies no more than 12 months before and 12 months after. Medicare Supplement and long-term care policies may not exceed 6 months before and 6 months after.
Cover optometrist benefits when the policy reimburses those services; provide continuation for physically handicapped and mentally retarded persons in individual and group medical policies; and provide direct access to obstetricians/gynecologists as primary care physicians.
Define physician to include nurse practitioners and chiropractors. Chiropractor benefits may not be limited unless benefits for all other specialties are also limited.
Provide freedom of choice of dental practitioners and mental, nervous, or emotional-disorder practitioners. Reimbursement for non-network dental services may not differ from network reimbursement; for dental services, non-participating dentists must receive the same payment or reimbursement as participating dentists, and no dentist may be barred from becoming participating.
Impose no aggregate limit on accidental-death benefits; do not coordinate individual policies against other insurance; ensure return-of-premium benefits provide values before the end of the period for which 100% of premiums will be returned and submit the required actuarial memorandum; and do not subrogate until the insured has been made whole.

Note

Required Disclosures and Product-Specific Compliance

Provide the required federal and Mississippi disclosures and comply with guaranty-association, conditional-receipt, arbitration, renewal, and product-specific standards. Policies must satisfy the applicable requirements for Medicare Supplement, long-term care, major medical, comprehensive, limited-benefit, specified-disease, and other accident and health products.

Comply with HIPAA, the Newborn's and Mother's Health Protection Act, the Mental Health Parity Act, and the Women's Health and Cancer Rights Act. Major medical and comprehensive policies must be guaranteed renewable as required by HIPAA.
At delivery, provide the Mississippi Guaranty Association summary document in the prescribed form describing its general purposes and current limitations.
If using a conditional receipt, comply with Regulation 79-001. Binding-arbitration provisions must comply with the Departmental Guidelines and Requirements for Approval of Binding Arbitration Provisions in Insurance Policies.
Comply with Mississippi long-term-care minimum standards under Regulation 90-102 and Mississippi Medicare Supplement minimum standards under Section 83-9-101 et seq. and Regulation 96-103, as amended.
For Medicare Supplement and long-term care policies, observe the applicable six-month pre-existing-condition limits and file the required rates and signed actuarial memorandum.
Give the insured 10 days to examine the policy; ensure the insured is not bound by a statement unless the application is attached to and made part of the policy.