- All form filings for Accident & Health must be submitted via SERFF.
- Complete the appropriate checklist for the filing submitted.
- Product filing fees must be submitted via Electronic Funds Transfer (EFT) at the time of the filing submission.
- For addition details refer to Indiana General Instructions in SERFF.
ACA Compliant Major Medical
- 10(A) Individual Major Medical Checklist
Individual Major Medical or Pediatric Dental plans on or off the Marketplace. - 12(A) Individual HMO Checklist
HMO Individual Major Medical or HMO Individual Dental plans on or off the Marketplace. - 20(A) Small Group Checklist
Small Group Major Medical or Pediatric Dental plans on or off the Marketplace. - 22(A) Small Group HMO Checklist
HMO Small Group Major Medical or Pediatric Dental on or off the SHOP Marketplace. - 21 Large Group Checklist
Large Group Major Medical and Dental plans. - 23 Large Group HMO Checklist
HMO Large Group Major Medical and Dental plans. - 20(C) Out of State Association/Trust Product Checklist
Major Medical certificates and related forms issued to Indiana residents when the policy is issued in a state other than Indiana.
Other Than ACA Major Medical
- 10 Individual Checklist
Individual Accident and Health filings including Grandfathered Major Medical and Dental plans. - 12 Individual HMO Checklist
HMO Individual Accident and Health filings including Grandfathered Major Medical and Dental plans. - 20 Small Group Checklist
Small Group Accident and Health filings including Grandfathered Major Medical and Dental plans. - 22 Small Group HMO Checklist
Small Group Accident and Health filings including Grandfathered Major Medical and Dental plans. - 21 Large Group Checklist
Large Group Accident and Health filings including Grandfathered and Non-Grandfathered Major Medical and Dental plans. - 23 Large Group HMO Checklist
HMO Large Group Accident and Health filing including Grandfathered and Non-Grandfathered Major Medical and Dental plans. - 20(C) Out of State Association/Trust Product Checklist
Product certificates and related forms issued to Indiana residents when the policy is issued in a state other than Indiana. - 29 Blanket
Blanket products including but not limited to student blanket plans.
Medicare Supplement
Long Term Care
Questions related to submitting Accident/Health Form Filings should be directed to:
Bobbi Henn
317-232-5693
bhenn@idoi.in.gov
Kim Collins
317-232-2398
kcollins1@idoi.in.gov
Questions related to submitting Medicare Supplement Form Filings should be directed to:
Bobbi Henn
317-232-5693
bhenn@idoi.in.gov
Questions related to submitting Long Term Care Form Filings should be directed to:
Rebecca Vaughan
317-232-2187
rvaughan@idoi.in.gov