Checklists for Life and Health Insurance Products

The Checklists are intended to expedite the Life & Health Division’s overall review time of new form filings. The Checklists serve as basic guides to assist the industry in preparation of new form filings prior to submission. The checklists are not a substitute for Departmental review. All forms must comply with state insurance law.

Checklists are NOT required to be submitted with a product filing, but when completed correctly they frequently facilitate the review process.

Checklists are available for many types of insurance. If a specific type of insurance is not included, contact the Life & Health Division at the email below for further guidance.

Completing a checklist

The right-hand column of each checklist is intended to be used to provide a reference (such as a page or paragraph number) from within the insurance form where the specific regulatory item is located. If an item is not applicable to the submission, place an N/A in the cell and provide an explanation why the item is not applicable. Some items listed in the checklist are for informational purposes only. Place a check in the box next to the item (if applicable) to indicate compliance with the requirement.

The Checklists are in Excel format and have been password protected to prevent changes to them except within the specified cells. If you have any questions about the checklist, contact the Life & Health Division at LHinbox@ncdoi.gov.

Clicking on a checklist will open it as an Excel file.

Health Insurance Form and Rate Filing Checklists

Association Group Questionnaire

External Review Model Evidence of Coverage Language and Written Notice

North Carolina law provides for a review of a health plan's decision to deny coverage for payment of a service (non-certification decision). N.C.G.S. § 58-50-75 gives covered persons the opportunity for an independent review of a non-certification decision by an external, Independent Review Organization (IRO). An external review either upholds the health plan's decision or overturns all or some of the decision. The health plan must accept the binding decision.

N.C.G.S. § 58-50-77 requires the insurer to provide a written notice to the covered person explaining the right to request an external review. This written notice must contain specific information. N.C.G.S. § 58-50-93 also requires insurers to describe the external review procedures in or attached to the evidence of coverage. To assist insurers in complying with the general statutes the North Carolina Department has developed suggested model contract language and notice language.

Model Evidence of Coverage (EOC) Language

Member Notice Language

Need Help With Health Claim Denied

Credit Insurance Form and Rate Filing Checklists

Life and Annuity Form and Rate Filing Checklists

Association Group Questionnaire