11:4-40.1 Purpose and scope

(a) The purpose of this subchapter is to implement P.L. 1995, c.73 (the Life and Health Insurance and Health Maintenance Organization Form Approval Reform Act) by setting forth standards and procedures whereby all life insurance, health insurance, and annuity forms, and rates where applicable, are to be submitted to the Commissioner for his or her approval prior to use. This subchapter also establishes a file and use system for certain forms deemed eligible by the Commissioner provided that a certification is filed that the particular form complies with the law and rules applicable to it.

(b) This subchapter shall apply to all life insurance, health insurance and annuity forms issued pursuant to N.J.S.A. 17B:17-1 et seq.; all hospital service corporation contracts issued pursuant to N.J.S.A. 17:48-1 et seq.; all medical service corporation contracts issued pursuant to N.J.S.A. 17:48A-1 et seq.; all health service corporation contracts issued pursuant to N.J.S.A. 17:48E-1 et seq.; and all health maintenance organization contracts, evidence of coverage and related forms issued pursuant to N.J.S.A. 26:2J-1 et seq. This subchapter shall not apply to any forms issued pursuant to N.J.S.A. 17B:27A-2 et seq. or 17B:27A-17 et seq., but shall apply to all forms issued pursuant to N.J.S.A. 17B:27A-7 and N.J.S.A. 17B:27A-19.

11:4-40.2 Definitions

The following words and terms, as used in this subchapter, shall have the following meanings unless the context clearly indicates otherwise:

"Annuity" means a contract not included within the definitions of life insurance or health insurance as set forth in this section, under which an insurer obligates itself to make periodic payments for a specified period of time, such as for a number of years, or until the happening of an event, or for life or for a period of time determined by any combination thereof. A contract which includes extra benefits of the kinds set forth in the definitions of life insurance or health insurance set forth in this section shall nevertheless be deemed to be an annuity if such extra benefits constitute a subsidiary or incidental part of the entire contract.

"Commissioner" means the Commissioner of the New Jersey Department of Insurance.

"Contract on a variable basis" or "variable contract" means any separate account contract providing for the dollar amount of life insurance or annuity benefits or other contractual payments or values thereunder to vary so as to reflect investment results of one or more separate accounts in which amounts with respect to any such contracts shall have been placed.

"Department" means the New Jersey Department of Insurance.

"Form" or "policy form" or "life/health/annuity form or contract" means any individual or group policy form or contract providing life insurance, health insurance or annuity benefits; any application for such a policy, contract or certificate if a written application is required and is to be made part of that policy or contract; any rider or endorsement for use with such a policy or contract; certificates of such insurance; any evidence of such insurability form; any health maintenance organization contract; and any evidence of such coverage or related form delivered or issued for delivery in this State.

"Funeral insurance policy" means a policy as defined at N.J.S.A. 17B:17- 5.1.

"Health insurance" means a contract or agreement whereby an insurer is obligated to pay or allow a benefit of pecuniary value with respect to the bodily injury, disablement, sickness, death by accident or accidental means of a human being, or because of any expense relating thereto, or because of any expense incurred in prevention of sickness, and includes every risk pertaining to any of the enumerated risks. Health insurance does not include workers' compensation coverage or stop-loss coverage.

"Insurer" means a hospital service corporation operating pursuant to N.J.S.A. 17:48-1 et seq.; a medical service corporation operating pursuant to N.J.S.A. 17:48A-1 et seq.; a health service corporation operating pursuant to N.J.S.A. 17:48E-1 et seq.; a life, health or annuity company operating pursuant to N.J.S.A. 17B:17-1 et seq.; and a fraternal benefit society operating pursuant to N.J.S.A. 17:44A-1 et seq. to the extent that it issues certificates or evidence of coverage forms containing accident or health benefits. A fraternal benefit society that issues certificates containing life insurance benefits is not considered an insurer for purposes of this subchapter.

"Life insurance" means a policy or contract whereby an insurer is obligated to pay or allow a benefit of pecuniary value with respect to the cessation of human life. Life insurance also includes the granting of endowment benefits and optional modes of settlement of proceeds of life insurance, as well as provisions for additional benefits in the event of death by accident or accidental means or in the event of dismemberment or loss of sight; or safeguarding such insurance against lapse or giving a special surrender value, or special benefit or annuity in the event that the insured shall become totally and permanently disabled, whether such provisions are incorporated in a policy or contract of life insurance or in a policy or contract supplemental thereto. Life insurance does not include worker's compensation coverage.

"Limited death benefit policy" means a policy as defined at N.J.A.C. 11:4- 21.

"Published guidelines" means guidelines published by the Commissioner on or before April 10, 1995.

"Responsible officer of the insurer" means a corporate officer of the level of vice president or higher, or of an equivalent title within the insurer's corporate structure, who is either an actuary of the insurer with responsibility for the type of form filed, or the individual with responsibility for managing the form filing process for the insurer with regard to the type of form filed.

"Separate account" means any segregated portfolio of investment or designated account of an insurer established pursuant to N.J.S.A. 17B:28-1 et seq.

"State" means the State of New Jersey.

"Stop loss or excess risk insurance" means insurance designed to reimburse a self-funded arrangement for catastrophic and unexpected expenses exceeding specified per person retention limits of no less than $25,000 per year and/or aggregate retention limits of no less than 125 percent of expected claims per year, wherein neither the employees nor other individuals are third party beneficiaries under the policy, contract or plan.

"Universal flexible-factor form" means any life insurance policy, rider or endorsement, whether participating or nonparticipating, which permits the insurer to reserve the right to modify (upward or downward) premiums, premium factors (interests, mortality, expenses), or benefits (death benefits, cash or loan values) on the basis of future anticipated or emerging experience.

11:4-40.3 Life/health/annuity form approval standards

(a) All life, health and annuity forms shall comply with the standards set forth in this subchapter and in any other applicable statutes, rules and published guidelines before being delivered or issued for delivery in this State.

(b) No form delivered or issued for delivery in this State shall contain provisions which are unjust, unfair, inequitable, misleading or contrary to law or to the public policy of this State.

11:4-40.4 General requirements

(a) All insurers submitting forms or other correspondence to the Department pursuant to this subchapter shall comply with the following general procedures:

1. All individual health, group health, blanket, prepaid legal contracts, group life and service corporation forms and other related correspondence submitted or resubmitted for approval or for file and use pursuant to this subchapter shall be submitted to the Department at the following address:

New Jersey Department of Insurance

Health Bureau

20 West State Street

PO Box 470

Trenton, NJ 08625-0470

2. All individual life, credit life and health, mortgage guaranty, separate account, variable contract and annuity forms and other related correspondence pursuant to this subchapter submitted or resubmitted for approval or for file and use shall be submitted to the Department at the following address:

New Jersey Department of Insurance

Life Bureau

20 West State Street

PO Box 470

Trenton, NJ 08625-0470

3. All submissions and resubmissions of forms to the Department shall include a self-addressed, stamped envelope.

4. For purposes of computing time limits in this subchapter, "days" shall mean calendar days, except that when the last day of any specified time period is a Saturday, Sunday or State holiday, then the time period shall end on the next following business day. With regard to any specified time period relating to documents or correspondence transmitted between the Department and the insurer, the Department shall rely on one of the following:

i. The date appearing on a clear, legible postmark affixed by the United States Postal Service;

ii. The legible date of receipt from the sender appearing on the transmission documents of a private delivery service; or

iii. In the absence of either (a)4i or ii above, the actual date of receipt by the Department.

11:4-40.5 Life/health/annuity form approval procedures

(a) No insurer shall deliver or issue for delivery in this State any form unless the form has been approved by the Commissioner pursuant to the procedures set forth in this subchapter, except for those forms eligible for submission to the Commissioner pursuant to the file and use system described in this subchapter at N.J.A.C. 11:4-40.8 and 40.9.

(b) An insurer seeking approval of a form shall submit a complete form filing to the Department, which shall include the items set forth below:

1. A properly completed Initial Submission Data Form as set forth at Exhibit A in the Appendix to this subchapter, incorporated herein by reference;

2. A specimen copy of the form in duplicate;

3. A cover letter in duplicate, which shall include the following:

i. The insurer's identity;

ii. The form number(s) of the form(s) being submitted. If several forms are being submitted, the form numbers may be included as an attachment to the cover letter;

iii. A general description of the nature of the form(s), including, but not limited to, the specific market and issue ages;

iv. The identity of one individual authorized as the insurer's contact person for the form(s) being filed;

v. A statement as to whether the form was previously submitted to the Department, including the date and status of any such submission; and

vi. For rider forms or endorsements, an explanation of the manner in which the rider or endorsement affects the mortality basis or premiums for the base policy;

4. A certification signed by a responsible officer of the insurer that the forms comply with all laws, rules, bulletins and published guidelines applicable to the particular type of form. The certification may be included in the text of the cover letter described in (b)3 above if the cover letter is signed by a responsible officer of the insurer;

5. A readability certification if required pursuant to N.J.S.A. 17B:17- 21d;

6. An actuarial memorandum which complies with the requirements of any applicable statutes, rules or published guidelines, and premium rates if required by this subchapter or other law or rule, for the particular type of form being submitted;

7. The appropriate service fee set forth at N.J.A.C. 11:1-32 if required;

8. Any additional items required to be submitted for forms as specifically set forth at other sections of this subchapter; and

9. Where the form submitted is a rider, endorsement, insert page or supplemental form, a listing of the policy form number(s) and approval date(s) of the policy form(s) with which the form submitted is to be used and a specimen copy of an approved policy form.

(c) The Department shall, within 25 days of receipt, return an incomplete filing to the insurer with a notice indicating that the filing is being returned with no action by the Department, and that time for the Department's substantive review for approval of the form and/or rate filing has not commenced.

(d) A form/rate filing shall be deemed approved upon the expiration of 60 days following submission of the filing to the Commissioner unless the Department approves or disapproves the filing in writing within that 60-day period. If approval is deemed, the insurer shall notify the Department in writing prior to use of its intent to use the form.

1. The Department's written disapproval of a filing shall include the following:

i. The specific reasons for the disapproval, which shall be limited to only the standards set forth in this subchapter at N.J.A.C. 11:4-40.3, and in any laws, rules, bulletins or published guidelines applicable to the particular type of form being disapproved; and

ii. A Resubmission Data Form for use by the insurer in resubmitting the disapproved filing.

2. A form filing which is disapproved by the Department prior to the expiration of the 60-day disapproval period shall be deemed withdrawn at the expiration of the 60-day period following notice of disapproval unless the insurer resubmits the disapproved form filing within the 60-day period pursuant to the procedures set forth in (e) below.

(e) An insurer may resubmit a form filing which has been disapproved by the Commissioner pursuant to (d) above. The resubmission shall include the items set forth below:

1. A properly completed Resubmission Data Form;

2. A cover letter in duplicate, which shall include all the information required to be included in the initial submission cover letter as set forth at (b) above, in addition to the Department submission number;

3. The revised form(s) or page(s) only, if practicable, of the disapproved form(s). One copy shall be marked to show the changes from the prior submission, and one copy shall be unmarked. The resubmission shall also include a marked copy of any revised support material (for example, a periodic report);

4. A certification signed by a responsible officer of the insurer that the resubmission is the same as the original form filing, with the exception of the item(s) identified as modified or new; and

5. The resubmission shall completely respond to all the objections raised in the Department's disapproval of the initial or previous submission; otherwise, the Department shall return the resubmission as incomplete.

(f) A complete form filing resubmission shall be deemed approved upon the expiration of 30 days following resubmission of the filing to the Commissioner unless the Department approves or disapproves the resubmission in writing within that 30-day period. If approval is deemed, the insurer shall notify the Department in writing prior to use of its intent to use the form.

1. The Department's written disapproval of a form filing resubmission shall include the specific reasons for disapproval of the resubmission, which shall be limited to only the objections specifically stated in the Department's initial disapproval of the form filing except to the extent that the resubmission contains new provisions not included in the initially disapproved form filing or any changes or modifications to any substantive provisions of the form filing.

(g) If the Department issues a written disapproval of a resubmitted form filing prior to the expiration of the 30-day disapproval period, the filing shall be deemed withdrawn at the expiration of the 30-day period following disapproval unless the insurer resubmits a disapproved form filing within the 30-day period pursuant to the procedures set forth in this subsection.

11:4-40.6 Individual life and annuities variable form approval procedures

(a) In addition to those items set forth at N.J.A.C. 11:4-40.5, insurers seeking approval of individual life and annuities variable forms shall include, if applicable, the following items in the submission to the Department:

1. A prospectus;

2. An actuarial memorandum which discusses the derivation of cash values and all current and maximum charges deducted in determining the separate account values; and

3. A periodic report which satisfies all reporting requirements set forth at N.J.A.C. 11:4-45.

11:4-40.7 Valuation and non-forfeiture interest rates form approval procedures

(a) In addition to those items set forth at N.J.A.C. 11:4-40.5, insurers seeking approval of valuation and non-forfeiture interest rate changes to previously filed forms shall include, if applicable, the following items in the submission to the Department:

1. If the interest rate and/or non-forfeiture values appearing on the form change as a result of the new interest rate, the submission shall include the new page(s) bearing distinct identifying form numbers for filing;

2. A revised actuarial memorandum reflecting the change in interest rate or a statement that the new rate does not affect the memorandum currently on file;

3. Pursuant to N.J.S.A. 17B:25-19h(x), an insurer is not required to refile other provisions of the form to file the changes described in (a)1 and 2 above; and

4. The interest rate and non-forfeiture values may be filed as variable to the extent they are equal to or determinable from the maximum interest rate, and cash values calculated using that rate, as described in N.J.S.A. 17B:25-19. Insurers shall place variable brackets around the appropriate item(s) on the revised policy page(s).

(b) The Department shall acknowledge a submission indicating a change in the valuation interest rate and amending actuarial data related to reserve calculations. If a form actually refers to, or contains provisions depending on, the valuation interest rate, the submission shall be treated as a refiling of policy pages to change the interest rate pursuant to (a)1 and 2 above.

11:4-40.8 Certificate of assumption form approval procedures

(a) In addition to those items set forth at N.J.A.C. 11:4-40.5, insurers seeking approval of certificates of assumption shall include, if applicable, the following items in the submission to the Department:

1. A clear indication whether the assuming and ceding insurers are authorized in this State for the lines of business being assumed;

2. A general description of the type of business being assumed;

3. A list of the forms and filing dates with which the certificate will be used, together with a copy of the Department's filing letters applicable to these forms;

4. For forms intended for use with group business, the provisions of the form must be consistent with both the group contract and certificate form;

5. Evidence of approval of both the transaction and the forms, if required, by the state of domicile of the assuming and ceding insurers;

6. All communications between either the assuming or ceding insurer with the policyholders, including letters, memoranda, identification cards, advertisements or other material;

7. Affirmative consent of the owner is not required, but if obtained, the consent form shall be part of the submission. The certificate of assumption form shall not include a provision indicating that consent of the policyholder is deemed or implied as the result of some positive or negative action;

8. A certification by the assuming insurer that it will adhere to all conditions and representations which were part of the original filing of the forms being assumed;

9. Certifications by the assuming and ceding insurers that any communications by a policyholder with the ceding insurer will have the same legal status as a communication which is sent directly to the assuming insurer. Additionally, the ceding insurer shall certify that it will maintain systems to forward all communications of this nature to the assuming insurer;

10. The certificate of assumption form shall include the following:

i. An appropriate title, such as Certificate of Assumption;

ii. The business address of both the ceding and assuming insurers;

iii. Clear directions regarding the submission of payments and claims; and

iv. The signature of an officer of the insurer, and a statement that the form is to be attached to and made part of the policy; and

11. If health insurance or credit insurance is being assumed, the assuming insurer shall agree that rate revisions will be based on the experience since the original issue date. It is the responsibility of the assuming insurer to obtain and maintain the necessary experience data.

11:4-40.9 File and use eligibility

(a) An insurer may deliver or issue for delivery in this State a form providing life, health or annuity benefits, and accompanying rates if applicable, without obtaining prior approval from the Commissioner pursuant to this subchapter provided the form is set forth in this section as a type eligible for file and use and is filed with the Commissioner pursuant to the procedures set forth at N.J.A.C. 11:4-40.10.

(b) The following types of non-variable individual life insurance forms shall be eligible for file and use pursuant to this section:

1. Scheduled premium term policies without cash values, other than universal/flexible-factor forms, multiple-life forms with survivorship benefits, limited death benefit forms, policies with re-entry options, single premium forms, field issued forms or funeral insurance;

2. Accidental death benefit;

3. Business exchange/substitute insured;

4. Cost of living benefit;

5. Option to purchase additional insurance;

6. Waiver of premium;

7. Spouse and/or child rider;

8. Individual retirement account (IRA) endorsement; and

9. Applications.

(c) The following types of non-variable individual annuity forms shall be eligible for file and use pursuant to this section:

1. Immediate annuities, other than structured settlement, field issued forms or funeral insurance;

2. Scheduled premium deferred annuities, other than structured settlement, field issued forms or funeral insurance;

3. Flexible premium deferred annuities, other than structured settlement, field issued forms or funeral insurance;

4. Individual retirement account (IRA) endorsement;

5. Waiver of premium; and

6. Applications.

(d) The following types of individual health insurance forms shall be eligible for file and use pursuant to this section:

1. Business buyout, keyperson and overhead expense disability income policies;

2. Medical expense conversion policies in which a portion of the premium is chargeable to or subsidized by the group policy from which conversion is made;

3. Benefit riders for use with the type of policies set forth at (d)1 and 2 above; and

4. Applications other than those used with medicare supplement and long-term care policies.

(e) The following types of non-variable group life insurance forms shall be eligible for file and use pursuant to this section:

1. Policies and certificate forms which provide life insurance benefits only, and which do not provide cash values or loan values other than funeral expense;

2. Retired lives reserve contracts;

3. Benefit riders for use with the type of policies set forth at (e)1 and 2 above; and

4. Applications and evidence of coverage forms.

(f) The following types of group health insurance forms shall be eligible for file and use pursuant to this section:

1. Policies, certificates and evidence of coverage which provide only temporary disability benefits pursuant to N.J.S.A. 34:15-1 et seq.;

2. Policies and certificates which provide only disability income benefits for loss due to both accident and sickness and which are sold exclusively to employer groups;

3. Benefit riders for use with the type of policies set forth at (f)1 and 2 above; and

4. Applications and evidence of coverage forms.

(g) The following types of group annuities forms shall be eligible for file and use pursuant to this section:

1. Contracts;

2. Certificate forms; and

3. Applications.

(h) In the month of September or October of each year, the Department shall conduct a hearing pursuant to P.L. 1995, c.73 for the purpose of determining the specific types of forms eligible for file and use pursuant to this section.

1. The hearing shall be preceded by a notice of hearing published in the New Jersey Register at least 30 days prior to the date of the hearing, which notice shall include information concerning the date by which, and the person to whom, written public comment may be made. Notice shall also be provided to persons who have previously requested receipt of such notice.

2. The notice published in the New Jersey Register and as otherwise provided pursuant to (h)1 above shall also request that persons who wish to testify at the hearing provide the Department with timely notice of this intention, including a brief summary of the subject matter of their testimony.

3. The notice shall indicate whether the hearing shall address the merits of maintaining all forms currently on the file and use eligibility list, or whether the hearing will consider only specific additions, deletions or clarifications regarding the list.

4. The hearing shall be conducted by a hearing officer designated by the Commissioner. The length of testimony permitted at the hearing and the receipt of questions from the floor will be within the discretion of the hearing officer.

5. A transcript of the hearing shall be made and a copy thereof shall be made available to any interested person upon request and payment of the appropriate fee.

6. The record of the hearing shall include the following:

i. Timely-received written public comments;

ii. The transcript of the hearing; and

iii. Any other information which the hearing officer may deem relevant.

7. The record and transcript of the hearing shall be public records pursuant to N.J.S.A. 47:1A-1 et seq. except to the extent that any information is submitted pursuant to a statute or rule providing for confidentiality.

8. Upon review of the file and use eligibility list hearing record, the Commissioner shall determine within 30 days whether any modifications should be made by rule to the current list.

9. If the Commissioner determines during the term of a duly promulgated file and use eligibility list that changed conditions require a modification of the list, the Commissioner may amend the list by rule following a hearing conducted pursuant to this subsection.

11:4-40.10 File and use procedures

(a) An insurer seeking to file and use a form specified at N.J.A.C. 11:4- 40.9 to be eligible for file and use shall, in addition to the items set forth at N.J.A.C. 11:4-40.5(b), submit the following to the Department:

1. A certification memorandum signed and acknowledged by a responsible officer of the insurer, which shall include the following:

i. A statement that the certification is filed pursuant to P.L. 1995, c.73, section 17;

ii. A statement that the responsible officer signing the certification memorandum is authorized to execute the document;

iii. A statement that the responsible officer signing the certification memorandum is familiar with the insurer's filing and all laws, regulations, bulletins and published guidelines applicable to the particular type of form, and that the form complies with all laws, regulations, bulletins and published guidelines applicable to the particular type of form;

iv. A statement that the insurer intends for the Department to rely on the certification in accepting the filing made pursuant to this subsection;

v. A statement that the responsible officer signing the certification memorandum is aware of the penalties for submitting an improper certification or false filing;

vi. A statement that the responsible officer signing the certification memorandum has supervised and is responsible for the completion and submission to the Department of the checklist required for the particular type of form; and

vii. A statement that the insurer shall not use the form before receipt of the form is acknowledged by the Department.

(b) The Department shall provide the insurer with a written acknowledgement that the Department received the form and a proper certification.

(c) Upon receipt of the written acknowledgment described in (b) above, the insurer may use the form in this State.

(d) If the Commissioner determines that the form submitted to the Department by the insurer pursuant to (a) above fails to comply with any law, or regulation, bulletin or published guideline applicable to the particular type of form, the Department shall notify the insurer in writing of the specific reasons for objecting to the form, and may disapprove the form for further use in this State.

(e) If the Commissioner determines that the certification submitted to the Department by the insurer pursuant to (a) above is an improper certification, the insurer shall be subject to the following penalties specifically determined by the Commissioner in consideration of the severity of the violation based on the potential adverse impact to the public and whether it is the insurer's first such violation:

1. A fine not to exceed $50,000; and

2. A maximum penalty of $1,000 per contract or certificate issued with a form determined to be improperly certified pursuant to this subsection.

i. For purposes of this subsection, an "improper certification" means a certification that provides any misrepresentation or false statement material to a certification form.

(f) If, following notice and a hearing pursuant to the Administrative Procedure Act, N.J.S.A. 52:14B-1 et seq. and the Uniform Administrative Procedure Rules, N.J.A.C. 1:1, an insurer is found by the Commissioner to be in violation of any of the requirements of this section, the form may be disapproved and the insurer may be barred from participating in the certification process pursuant to this section for a period not to exceed one year. These penalties are in addition to any penalties that may be imposed pursuant to any other law or regulation applicable to the particular insurer for such violation(s).

11:4-40.11 Service fees

A form submitted by an insurer to the Commissioner for either prior approval or file and use pursuant to this subchapter shall be accompanied by the service fee(s) set forth at N.J.A.C. 11:1-32 unless the insurer is exempt from the payment of such fees pursuant to section 13 of P.L. 1995, c.156, enacted on June 30, 1995.

EXHIBIT A

ATTACHMENT 1

INSTRUCTIONS FOR INITIAL SUBMISSION DATA FORMS

The Initial Submission Data Form requires that you provide codes for the Category, Coverage Type, and Request Type. These codes are attached.

Submission No:

Leave Blank-For Department Use.

NAIC Code:

5 Digit NAIC Code. All companies are identified in the system by NAIC code rather than name.

Company Name:

This may be abbreviated, but should not conflict with the 5 digit NAIC Code.

Group Code:

This is the NAIC 3 digit group code for related groups of companies.

Date Sent:

Date mailed or submitted to delivery service.

Date Received:

Leave Blank-For Department Use.

Service Fee Submitted:

Total Service Fee Required pursuant to N.J.A.C. 11:4-36.5.

Check Number; Check Date:

Self-Explanatory.

Category:

Refer to Attachment 2. Enter the code which represents the category of the submission. The category represents the section of the statute under which the form is filed. For example, Category A corresponds to N.J.S.A. 17B:25-18.

Number of Forms Submitted:

This is the number of lines you will fill in on the lower part of the sheet.

Policy Form Data:

This information must be filled in for each policy form (separately numbered item) contained in the submission.

Policy Form Number:

This is the unique identifying form number. The Department will observe any spaces and punctuation marks in the number.

Where the submission refers to a policy form number (i.e., rate or factor change, or advertising) use the policy form number even if that form itself is not being submitted for filing.

Coverage Type:

Refer to Attachment 2 for listing of coverage types. The listing is organized by general types of coverage. In particular:

Codes 01 through 0Z are for individual life policies.

Codes A1 through AZ are for variable life policies.

Codes 11 through 1Z are for riders/endorsements to individual life.

Codes B1 through BZ are for riders/endorsements to variable life.

Codes 21 through 2Z are for individual annuities.

Codes C1 through CZ are for individual variable annuities.

Form Type:

Choose the form type which best describes the form. In some cases, the "form type" refers to the type of action requested: for a rate change on a health insurance policy which was previously approved, indicate RC for rate change, not PP for policy. Note that RC refers to health insurance or credit insurance; FR or PM refers to changes in non-guaranteed elements for life insurance.

Request Type:

Enter the appropriate two digit code. For the initial filing of a (health or credit) policy which also requires rates, still use 01. For a (health or credit) rate revision, use 05. For a change in factors or premiums on life policies, use 12.

Rate Change (%):

For rate changes, enter the (overall) % increase requested.

ATTACHMENT 2

CATEGORY OF FORM CODES

CODE

A       INDIVIDUAL LIFE AND ANNUITIES

        (Fraternals use FR)

B       INDIVIDUAL HEALTH (Sold By Ins. Co.)

        (Fraternals use FR)

        (Service Corporations use S)

CR      CREDIT LIFE AND HEALTH INSURANCE

FR      FRATERNAL BENEFIT SOCIETY CONTRACTS

G       GROUP HEALTH

        (Service Corporations use S)

J       PRE-PAID LEGAL CONTRACTS

L       GROUP LIFE AND ANNUITIES

        (Forms that are both Group Life and Group Health use L; Group annuities

          issued in the general account also use L.)

MG      MORTGAGE GUARANTEE INSURANCE

MI      ANY OTHER INSURANCE

S       SERVICE CORPORATIONS

V       VARIABLE AND SEPARATE ACCOUNT CONTRACTS

        (Individual or Group; Life and Annuities)

FORM TYPE CODES

CODE

AA      APPLICATION

AD      ADVERTISING MATERIAL

AS      ASSUMPTION AGREEMENT

CC      CERTIFICATE

CI      CERTIFICATE INSERT PAGES (MORE THAN 1)

CR      CERTIFICATE AND RATES

DG      DISCRETIONARY AUTHORITY REQUEST

EE      ENDORSEMENT OR AMENDMENT

EN      ENDORSEMENT OR AMENDMENT (NO CHARGE)

FE      FUNERAL EXPENSE PRE-NEED AGREEMENT

FR      FACTOR REVISIONS

FU      FOLLOW UP

IC      CERTIFICATE INSERT PAGE

ID      ID CARD (STUDENT POLICIES)

IL      INFORMATIONAL

IP      POLICY INSERT PAGE

NA      NO AUTHORITY

NC      RATE CHANGE (NO CHARGE)

NF      NONFORFEITURE OR RESERVE RATE CHANGE

NI      NOTICE OF PROPOSED INSURANCE

PI      POLICY INSERT PAGES (4 OR MORE PAGES)

PM      PREMIUM REVISIONS

PN      POSTING NOTICE

PP      POLICY

PR      POLICY AND RATES

RC      RATE CHANGE

RM      RATE MANUAL

RN      RATE CHANGE--NEW ISSUES ONLY

RR      RIDER

SC      SERVICE CORP. FORM

SF      SPECIAL FORMS

SR      SUPPLEMENTAL RATES

VW      VARIABLE WORDING

Notes:  Form Type AS refers to assumption agreement between insurers, not a

          certificate of assumption.

        RC is for individual health or credit insurance.

FR is for factor revision of a non-guaranteed element.

        PM is for a premium revision to an indeterminate premium policy.

REQUEST TYPE CODES

CODE

01      FILE A FORM

02      WITHDRAW A FORM

03      ACKNOWLEDGE A FORM

05      FILE A RATE CHANGE

06      WITHDRAW A RATE CHANGE

07      FILE SUPPLEMENT RATES

08      WITHDRAW SUPPLEMENTAL RATES

09      ACKNOWLEDGE A RATE CHANGE

10      ACKNOWLEDGE SUPPLEMENTAL RATES

11      INFORMATIONAL SUBMISSION

12      APPROVE FACTOR OR PREMIUM REV.

13      WITHDRAW FACTOR OR PREMIUM REV.

99      OTHER

COVERAGE TYPE CODES

INDIVIDUAL LIFE

CODE    COVERAGE TYPE

01      Level Premium Whole Life--Non-Par

02      Level Premium Whole Life--Par

03      Whole Life--Indeterminate Premiums

04      Interest Sensitive Whole Life--Level Death Benefit

05      Interest Sensitive Whole Life--Recalculated DB

06      Universal Life--Flexible Premium

07      Single Premium Life

08      Funeral Expense (Single or Limited Pay)

09      Universal Life--Minimum Guaranteed Premium Period

0A      Level Premium Term

0K      Level Premium Term--Indeterminate Premium

0B      Increasing Premium Term

0M      Increasing Premium Term--Indeterminate Premium

0C      Modified Premium Whole Life (Jumping Juvenile)

0D      Graded Premium Whole Life

0N      Graded Premium Whole Life--Indeterminate Premium

0E      Deposit Term

0F      Limited Death Benefit

0H      Field Issue (Any Policy Design)

0O      Joint (First to Die)--Universal Life

0G      Joint (First to Die)--Whole Life

0P      Joint (First to Die)--Whole Life--Indeterminate Premium

0Q      Joint (First to Die)--Term

0R      Joint (First to Die)--Term--Indeterminate Premium

0J      Joint (First to Die) (other)

0S      Last Survivor--Universal Life

0T      Last Survivor--Whole Life

0U      Last Survivor--Whole Life--Indeterminate Premium

0L      Last Survivor (other)

0V      Decreasing Term

0W      Decreasing Term--Indeterminate Premium

0Y      Combination of Coverage--Individual Life

0Z      Other Individual Life

Notes:  Combination of Coverage code is used when a rider, endorsement or

          application are intended for use with more than one Coverage Type.

        Code Endowment or Limited Pay policies as if they are whole life.

        Code 0B and 0M includes term policies that are level premium for a

          period and then increases.

        Some Funeral Expense Policies are limited death benefit. Code them as

          08 rather than 0F.

        In Coding a factor or premium change list each form in which there is a

          change. For Form Type use FR or PM. For Request Type use 12. If the

          change requires an endorsement, there should be a separate form

          record for the endorsement.

COVERAGES PROVIDED BY RIDER OR ENDORSEMENT

(Type of form must be RR or EE)

CODE    COVERAGE TYPE

11      Waiver of Premium (Form RR or EE)

12      Disability Income (Form RR or EE)

13      Accidental Death (Form RR or EE)

14      Payor Benefit (Form RR or EE)

15      Term Insurance (Form RR or EE)

16      Paid up Insurance (Form RR or EE)

17      Insurance on Family Members (Form RR or EE)

18      Insurability Option (Form RR or EE)

19      CPI Option (Form RR or EE)

1A      Premium Deposit (Form RR or EE)

1B      Designated Lives (Form RR or EE)

1C      Accelerated Death Benefit (Form RR or EE)

1D      Non-life Options (e.g. LTC) (Form RR or EE)

1E      Exclusions (Form RR or EE)

1F      Policy Split (for JL) (Form RR or EE)

1G      Change of Insured (Form RR or EE)

1H      Pension Plan Qualification (Form RR or EE)

1I      Dividend Option (Form RR or EE)

1J      Persistency Bonus (Form RR or EE)

1K      Change in Non-Forfeiture Interest Rate (Form RR or EE)

1L      Other Non-Forfeiture Change (Form RR or EE)

1M      Assumption Certificate (Form RR or EE)

1N      Name Change/Merger/Redomicile (Form RR or EE)

1O      Modified Maturity Date

1P      Estate Protector (4 year term)

1Z      Other (Form RR or EE)

VARIABLE LIFE INSURANCE (INDIVIDUAL OR GROUP)

CODE    COVERAGE TYPE

A1      Level Premium Variable Life--Non-Par

A2      Level Premium Variable Life--Par

A3      Indeterminate Premium Variable Life--Par

A4      Interest Sensitive Variable Life--Level Death Benefit

A5      Interest Sensitive Variable Life--Recalculated DB

A6      Variable Universal Life

A7      Single Premium Variable Life (Any policy design)

A9      Variable Universal Life--Minimum Guaranteed Premium Period

AC      Group Variable Life (COLI)

AG      Group Variable Life--All other

AH      Field Issue (Any Variable Policy Design)

AJ      Joint (First to Die) (Any Policy Design)

AL      Last Survivor (Any Policy Design)

AY      Combination of Coverage (Variable Life)

AZ      Other Individual Variable Life

Notes:  Joint variable policies would be coded AJ or AL regardless of policy

          design.

        A1 and A2 correspond to traditional design Variable Contracts; A4, A6

          and A7 should categorize most modern variable contracts.

        Combination of Coverage code is used when a rider, endorsement or

          application are intended for use with more than one Coverage Type.

COVERAGES PROVIDED BY RIDER OR ENDORSEMENT (VARIABLE)

(Type of form must be RR or EE)

CODE    COVERAGE TYPE

B1      Waiver of Premium (Form RR or EE) (Var.)

B2      Disability Income (Form RR or EE) (Var.)

B3      Accidental Death (Form RR or EE) (Var.)

B4      Payor Benefit (Form RR or EE) (Var.)

B5      Term Insurance (Form RR or EE) (Var.)

B6      Paid up Insurance (Form RR or EE) (Var.)

B7      Insurance on Family Members (Form RR or EE) (Var.)

B8      Insurability Option (Form RR or EE) (Var.)

B9      CPI Option (Form RR or EE) (Var.)

BA      Premium Deposit (Form RR or EE) (Var.)

BB      Designated Lives (Form RR or EE) (Var.)

BC      Accelerated Death Benefit (Form RR or EE) (Var.)

BD      Non-life Options (e.g. LTC) (Form RR or EE) (Var.)

BE      Exclusions (Form RR or EE) (Var.)

BF      Policy Split (for JLs) (Form RR or EE) (Var.)

BG      Change of Insured (Form RR or EE) (Var.)

BH      Pension Plan Qualification (Form RR or EE) (Var.)

BI      Dividend Option (Form RR or EE) (Var.)

BJ      Persistency Bonus (Form RR or EE) (Var.)

BK      Change in Non-forfeiture Interest Rate (Form RR or EE) (Var.)

BL      Other Non-forfeiture change (Form RR or EE) (Var.)

BM      Assumption Certificate (Form RR or EE) (Var.)

BN      Name Change/Merger/Redomicile (Form RR or EE) (Var.)

BO      Modified Maturity Date (Var.)

BP      Estate Protector (4 year term) (Var.)

BQ      General Account Option (Var.)

BZ      Other (Form RR or EE) (Var.)

INDIVIDUAL ANNUITIES

CODE    COVERAGE TYPE

21      Single Premium Deferred

22      Flexible Premium Deferred

23      Fixed Premium Deferred

24      Immediate

25      Structured Settlement

26      Market Value Adjusted Annuity

2A      Pension Plan Endorsement

2B      Waiver of Premium

2C      Waiver of Surrender Charge

2H      Field Issue (Individual Annuities)

2J      Persistency Bonus (Form RR or EE)

2K      Change in Non-forfeiture Interest Rate

2L      Other Non-forfeiture change

2M      Assumption Certificate

2N      Name Change/Merger/Redomicile

2Y      Combination of Coverage (Individual Annuities)

2Z      Other (Individual Annuities)

INDIVIDUAL VARIABLE ANNUITIES

CODE    COVERAGE TYPE

C1      Single Premium Deferred (Var.)

C2      Flexible Premium Deferred (Var.)

C3      Fixed Premium Deferred (Var.)

C4      Immediate(Var.)

C5      Structured Settlement (Var.)

C6      Market Value Adjusted Annuity (Var.)

CA      Pension Plan Endorsement (Var.)

CB      Waiver of Premium (Var.)

CC      Waiver of Surrender Charge (Var.)

CH      Field Issue (Individual Variable Annuities)

CJ      Persistency Bonus (Var.) (Form RR or EE)

CK      Change in Non-forfeiture Interest Rate (Var.)

CL      Other Non-forfeiture change (Var.)

CM      Assumption Certificate (Var.)

CN      Name Change/Merger/Redomicile (Var.)

CQ      General Account Option

CY      Combination of Coverage (Individual Variable Annuities)

CZ      Other (Individual Variable Annuities)

Notes:  Combination of Coverage code is used when a rider, endorsement or

          application are intended for use with more than one Coverage Type.

GROUP ANNUITIES (NON-VARIABLE)

CODE    COVERAGE TYPE

31      Single Premium Deferred (Group)

32      Flexible Premium Deferred (Group)

33      Fixed Premium Deferred (Group)

34      Immediate (Group)

35      Structured Settlement (Group)

36      Market Value Adjusted Annuity (Group)

3A      Pension Plan Endorsement (Group)

3B      Waiver of Premium (Group)

3C      Waiver of Surrender Charge (Group)

3K      Change in Non-forfeiture Interest Rate (Group)

3L      Other Non-forfeiture change (Group)

3M      Assumption Certificate (Group)

3N      Name Change/Merger/Redomicile (Group)

3Y      Combination of Coverage (Group Annuities)

3Z      Other (Group)

GROUP VARIABLE ANNUITIES

CODE    COVERAGE TYPE

D1      Group Variable Qualified, Single Case

D2      Group Variable Qualified, Multiple Case

D3      Group Variable Non-Qualified, Single Case

D4      Group Variable Non-Qualified, Multiple Case

D5      Group Separate Account, Renewable Int. Guarantee, Single Case

D6      Group Separate Account, Renewable Int. Guarantee, Mult. Case

D9      Group Variable Contract, all others

DA      New or Modified Separate Account for GVA (RR or EE)

DB      Group IRA (RR or EE)

DC      Group Variable, Federal Requirement (RR or EE)

DD      New Jersey approved, Separate Account Plan of Operation

DE      Synthetic GIC

DY      Combination of Coverage (Group Variable Annuities)

DZ      Group Variable, all others (RR or EE)

Notes:  Combination of Coverage code is used when a rider, endorsement or

          application are intended for use with more than one Coverage Type.

GROUP LIFE

CODE    COVERAGE TYPE

40      Group Life (Term)

41      Group Life (Permanent/Paid-Up)

42      Single Premium Group Life

43      Group Life (Universal)

44      Group Life (Limited Death Benefits)

45      Group Life (Interest Sensitive)

46      Group Life and Medical Expense

47      Group Life and Other Health (AD&D)

4C      Group Accelerated Death Benefit

4F      Funeral Expense

4M      Assumption Certificate (Group Life)

4N      Name Change/Merger/Redomicile (Group Life)

4Z      Other (Group Life)

INDIVIDUAL HEALTH

CODE    COVERAGE TYPE

50      Individual Major Medical

51      All other Medical Expense (Individual)

52      Individual Medicare Supplement

53      Individual Disability Income

54      Individual Long Term Care

55      Individual Accident Only

56      Individual Limited Benefit

57      Individual Business Buyout

58      Individual Overhead Expense

59      Individual Key Person

60      Individual HospitalConfinement

64      Individual Conversion

65      Individual Legal Insurance

6C      Individual Health (Combination type of form)

6M      Assumption Certificate (Ind. Health)

6N      Name Change/Merger/Redomicile (Ind. Health)

6Z      Other (Individual Health)

INDIVIDUAL HEALTH (SERVICE CORP.)

CODE    COVERAGE TYPE

S0      Individual Major Medical (Service Corp.)

S1      All other Medical Expense (Individual) (Service Corp.)

S2      Individual Medicare Supplement (Service Corp.)

S3      Individual Hospital Confinement (Service Corp.)

S4      Individual Long Term Care (Service Corp.)

S5      Individual Accident Only (Service Corp.)

S6      Individual Limited Benefit (Service Corp.)

SZ      Service Corp. Individual Health (Other)

GROUP HEALTH

CODE    COVERAGE TYPE

70      Group Medical Expense

71      Group Medicare Supplement (Includes Out-Of-State)

72      Group Long Term Disability Income

73      Group Short Term Disability Income

74      Group Long Term Care

75      Group Dental

76      Group Accident Only

77      Group Blanket Insurance

78      Group Student Coverage

79      Group Stop Loss Coverage (Excess Coverage)

7D      Group SEH Benefit Decrease

7H      Group HIV Coverage

7S      Group SEH Renewals

80      Group Hospital Confinement

81      Group Prescription Drug Coverage

82      Out-Of-State (Group Health)

83      Group Overhead Expense

84      Group Temporary Disability Benefits

85      Group Preferred Provider

86      Group Legal Insurance

87      Group Vision Care

88      Assumption Certificate (Group Health)

89      Name Change/Merger/Redomicile (Group Health)

8Z      Other (Group Health)

GROUP HEALTH (SERVICE CORP.)

CODE    COVERAGE TYPE

U0      Group Medical Expense (Service Corp.)

U1      Group Medicare Supplement (Service Corp.)

U4      Group Long Term Care (Service Corp.)

U5      Group Dental (Service Corp.)

U6      Group Accident Only (Service Corp.)

U7      Group Blanket Insurance (Service Corp.)

U8      Group Student Coverage (Service Corp.)

U9      Group Stop Loss Coverage (Excess Coverage) (Service Corp.)

UZ      Other (Group Health Service Corp.)

Notes:  Use the form number on the face page of a policy or certificate when

          type of form is PP or CC (A complete policy or certificate).

          (Complete Applications, Endorsements, and Riders with multiple pages

          can be coded the same way.)

        When the submission contains multiple insert pages (not a complete

          policy or certificate) only the first form number should be coded

          followed by the suffix et al. Use the Form Type CI or PI.

INDIVIDUAL CREDIT

CODE    COVERAGE TYPE

90      Credit Life--Single Premium

91      Credit Health--Single Premium

92      Credit Life--MOB

93      Credit Health--MOB

94      Credit L & H--Truncated Coverage

95      Credit L & H--Leases

96      Mortgage Life

97      Mortgage Health

98      Other Credit (Riders & Endorsements)

99      Critical Period Coverage (Individual Credit)

9Y      Combination of Coverage (Individual Credit)

GROUP CREDIT

CODE    COVERAGE TYPE

9A      Credit Life--Single Premium (Group)

9B      Credit Health--Single Premium (Group)

9C      Credit Life--MOB (Group)

9D      Credit Health--MOB (Group)

9E      Credit L & H--TruncatedCoverage (Group)

9F      Credit L & H--Leases (Group)

9G      Mortgage Life (Group)

9H      Mortgage Health (Group)

9I      Other Credit (Riders & Endorsements) (Group)

9J      Critical Period Coverage (Group Credit)

9K      Combination of Coverage (Group Credit)

MORTGAGE GUARANTEE

CODE    COVERAGE TYPE

MG      Mortgage Guarantee

Notes:  Use codes other than 98 or 9I to classify policies, certificates, and

          notices which apply to a particular sort of insurance.

        Use codes 98 and 9I for forms that apply to all sorts of coverage

          (i.e., certificates of assumption).

        Combination of Coverage code is used when a rider, endorsement or

          application are intended for use with more than one Coverage Type.