[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-288970-105":53,"doc-detail-288970-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","form-filing-checklist-short-term-major-medical-individual-group","Form Filing Checklist - Short Term Major Medical Individual & Group","","Form Filing Checklist - Short Term Major Medical Individual & Group provides guidance for submitting Short Term Limited Duration and related major medical policy forms to the Wisconsin Office of the Commissioner of Insurance (OCI). It summarizes compliance expectations for SERFF filings, including association requirements, prohibitions on misleading language, rate and actuarial memorandum attachments, transmittal documentation, filing descriptions, readability scoring, and final-format statements. It also covers STLD federal notice timing, face-page disclosures, policy contract provisions, terminations, claim methodology, and other required rider and contractual elements.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/form-filing-checklist-short-term-major-medical-individual-group/288970/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/form-filing-checklist-short-term-major-medical-individual-group/288970.png","ImageObject",442,249,{"name":88,"@type":89},"Bintang","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-09","2026-09-17",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",7,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What is the purpose of the Form Filing Checklist for Short Term Major Medical policies?","Question",{"text":109,"@type":110},"It serves as a guide for submitting various policy forms to the Office of the Commissioner of Insurance (OCI). It is a summary, not an OCI directive, and is intended to help ensure filings include the referenced required information.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"Which documents must be attached for certain SERFF filing requirements, such as rates and actuarial information?",{"text":114,"@type":110},"For rates, the checklist requires attaching an Actuarial Memorandum that includes a schedule of rates and anticipated loss ratios on an earned incurred basis. It also notes SERFF incorporates the required transmittal documents and references SERFF help instructions.",{"name":116,"@type":107,"acceptedAnswer":117},"What must Short Term Limited Duration (STLD) policies include regarding federal notice and duration?",{"text":118,"@type":110},"STLD policies must include the required federal STLD notice with policy and enrollment materials, with an effective date stated as 9/1/2024 in the checklist. The checklist also requires that STLD may be issued for no more than 3 months after consideration of renewals/extensions, with total duration not exceeding 4 months.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},288970,1789967239,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":136,"language":137,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":138,"faqs":139,"seo_title":140,"seo_description":61,"update_tm":141,"read_time":73},962085564381,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","State of Wisconsin Office of the Commissioner of Insurance July 2024  \nForm Filing Checklist-Short Term Major Medical Individual & Group  \nTOIs: H15I/H15I.002–Individual  \nH15G/H15G.004-Group  \nDISCLAIMER  \nForm filing checklists are intended only as guides for submitting various policy forms to the Office of the Commissioner of Insurance (OCI). The checklists are summaries and are not intended as an OCI directive nor an interpretation of technical legal questions. Although efforts have been made to ensure that the checklists are current and accurate, information is subject to change on a regular basis without prior notice.  \nThe cites in the second column reference Wisconsin statutes, unless they begin with “Ins”,(which indicates a Wisconsin  \nadministrative code [regulation]) or contain CFR (which is a federal regulation) .  \n\n| General Requirements for SERFF Filings |  |  |\n| --- | --- | --- |\n| Filing Requirement | Reference | Comments |\n| Associations | 601.42 | If product offered through an Association, attach bylaws and/or constitution under Supporting Documentation, along with marketing materials. |\n| No Misleading Language | 631.20(2)(a) | Forms may not be inequitable, unfairly discriminatory, misleading, deceptive, obscure or encourage misrepresentation. |\n| Rates | Ins 3.13(6)(a) | Attach under Supporting Documentation, the Actuarial Memorandum that includes a schedule of rates and anticipated loss ratios on an earned incurred basis. |\n| Transmittal Document | Ins 6.05(4)(a)1 | SERFF incorporates the required transmittal documents. The “Help” link in SERFF provides access to instructions and tutorials. |\n| Filing Description (SERFF) | Ins 6.05(4)(a)3a | Explain the purpose of the form filing. Indicate if the filing is new, or a revision of a previously filed form. If related to a previously filed form, provide a brief explanation of changes, and attach a red-lined copy under the Supporting Documentation Tab. |\n| Certificate of Compliance and Readability | Ins 6.05(4)(a)2\u003Cbr>Ins 6.05: Appendix A Ins 6.07 (4) | Include information identified in the SERFF Submission Requirements and instructions. Under the Form Schedule Tab, provide a Readability score for each form filed. |\n| Statement of Variability | Ins 6.05(4)(a)5 | Each form must be in its final format exactly as it will be offered for issuance or delivery in the state of Wisconsin. Exceptions include hypothetical data and other appropriate variable material that may be bracketed. Include a written description identifying the range of any variable language or material. |\n| MHP Attestation Form | 601.42 | Required to be submitted with all group form filings, and with individual policy form filings if the individual policy forms contain mental health substance abuse benefits. |\n| Policy Requirements |  |  |\n| Face Page | Reference | Comments |\n| Short Term Limited Duration (STLD) Notice | 45 CFR §144.103 | Effective 9/1/2024: All Short Term Limited Duration policies are to include the required federal STLD notice with policy and enrollment materials. See Fed  Register page 23353 |\n| Several Liability Clause | 631.31\u003Cbr>631.41 | If two or more insurers together issue the policy, include explanation of several liability. |\n\n\n| Policy Requirements |  |  |\n| --- | --- | --- |\n| Face Page | Reference | Comments |\n| Corporate Legal Name | 631.31\u003Cbr>631.64 | Show full corporate name on face page of policy and full address of its home office somewhere in policy |\n| Right to Return Disclosure | 631.32\u003Cbr>632.73\u003Cbr>Ins 3.13(2)(j)2 & 3 | Include information about the 10 day “free look” period on face page of policy or conspicuously attached to the first page. |\n| Riders & Endorsements | Ins 3.13(3) | Provide notice about relevant riders and endorsements. |\n| Important Notice Concerning Statements in the Application for Your Insurance | Ins 3.28(5)(d) | Notice required on face page of policy, concerning statements made in the application. |\n| Claim Methodology Disclosure | Ins","cbCaimnBYbbUvuqt","https://ap.wps.com/l/cbCaimnBYbbUvuqt","pdf",229411,6,"English","# General Requirements for SERFF Filings\n## Policy Requirements (Face Page)\n## General Contract","[{\"question\":\"What is the purpose of the Form Filing Checklist for Short Term Major Medical policies?\",\"answer\":\"It serves as a guide for submitting various policy forms to the Office of the Commissioner of Insurance (OCI). It is a summary, not an OCI directive, and is intended to help ensure filings include the referenced required information.\"},{\"question\":\"Which documents must be attached for certain SERFF filing requirements, such as rates and actuarial information?\",\"answer\":\"For rates, the checklist requires attaching an Actuarial Memorandum that includes a schedule of rates and anticipated loss ratios on an earned incurred basis. It also notes SERFF incorporates the required transmittal documents and references SERFF help instructions.\"},{\"question\":\"What must Short Term Limited Duration (STLD) policies include regarding federal notice and duration?\",\"answer\":\"STLD policies must include the required federal STLD notice with policy and enrollment materials, with an effective date stated as 9/1/2024 in the checklist. The checklist also requires that STLD may be issued for no more than 3 months after consideration of renewals/extensions, with total duration not exceeding 4 months.\"}]","Form Filing Checklist - Short Term Major Medical Individual & Group | PDF",1789634314]