South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
A01 Annuities - Assumption Agreement
A01.000 Annuities - Assumption Agreement
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms applicable
None 75-00 100 Prior Approval
A02G Group Annuities - Deferred Non-Variable
A02G.001 Fixed Premium None None None 75-22 200 No form filings required for group annuities
A02G.002 Flexible Premium
None None None 75-22 200 No form filings required for group annuities
A02G.003 Single Premium None None None 75-22 200 No form filings required for group annuities
A02G.004 Modified Single Premium
None None None 75-22 200 No form filings required for group annuities
A02G.005 Limited Flexible Premium
None None None 75-22 200 No form filings required for group annuities
A02I Individual Annuities- Deferred Non-Variable
A02I.001 Fixed Premium Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable, Contract Summary, Actuarial Memorandum
None 75-12 100/300 Exempt
A02I.002 Flexible Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable, Contract Summary, Actuarial memorandum
None 75-12 100/300 Exempt
A02I.003 Single Premium Form Cover letter, Certificate of Readability,
None 75-12 100/300 Exempt
Page 1 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable, Actuarial certification
A02I.004 Modified Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable, Actuarial certification
None 75-12 100/300 Exempt
A02I.005 Limited Flexible Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable, Contract Summary, Actuarial memorandum
None 75-12 100/300 Exempt
A02.1G Group Annuities - Deferred Non-Variable
A02.1G.001 Fixed Premium
None None None 75-22 200 No form filings required for group annuities
A02.1G.002 Flexible Premium
None None None 75-22 200 No form filings required for group annuities
A02.1G.003 Single Premium
None None None 75-22 200 No form filings required for group annuities
A02.1G.004 Modified Single Premium
None None None 75-22 200 No form filings required for group annuities
A02.1G.005 Limited Flexible Premium
None None None 75-22 200 No form filings required for group annuities
A02.1G Group Annuities - Deferred Variable
A02.1G.001 Fixed Premium
None None None 75-40 200 No form filings required for group annuities
Page 2 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
A02.1G.002 Flexible Premium
None None None 75-40 200 No form filings required for group annuities
A02.1G.003 Single Premium
None None None 75-40 200 No form filings required for group annuities
A02.1G.004 Modified Single Premium
None None None 75-40 200 No form filings required for group annuities
A02.1G.005 Limited Flexible Premium
None None None 75-40 200 No form filings required for group annuities
A02.1I Individual Annuities- Deferred Non-Variable
A02.1I.001 Fixed Premium Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
None 75-12 100/300 Exempt
A02.1I.002 Flexible Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
None 75-12 100/300 Exempt
A02.1I.003 Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
None 75-12 100/300 Exempt
A02.1I.004 Modified Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
None 75-12 100/300 Exempt
Page 3 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
A02.1I.005 Limited Flexible Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
None 75-12 100/300 Exempt
A02.1I Individual Annuities- Deferred Variable
A02.1I.001 Fixed Premium Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
None 75-30 100/300/400 Exempt
A02.1I.002 Flexible Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
None 75-30 100/300/400 Exempt
A02.1I.003 Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
None 75-30 100/300/400 Exempt
A02.1I.004 Modified Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
None 75-30 100/300/400 Exempt
A02.1I.005 Limited Flexible Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
None 75-30 100/300/400 Exempt
Page 4 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
A03G Group Annuities-Deferred Variable
A03G.001 Fixed Premium None None None 75-40 200 No form filings required for group annuities
A03G.002 Flexible Premium
None None None 75-40 200 No form filings required for group annuities
A03G.003 Single Premium None None None 75-40 200 No form filings required for group annuities
A03G.004 Modified Single Premium
None None None 75-40 200 No form filings required for group annuities
A03G.005 Limited Flexible Premium
None None None 75-40 200 No form filings required for group annuities
A03I Individual Annuities - Deferred Variable
None None
A03I.001 Fixed Premium Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
None 75-30 100/300/400 Exempt
A03I.002 Flexible Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
None 75-30 100/300/400 Exempt
A03I.003 Single Premium Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
None 75-30 100/300/400 Exempt
Page 5 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
A03I.004 Modified Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
None 75-30 100/300/400 Exempt
A03I.005 Limited Flexible Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
None 75-30 100/300/400 Exempt
A05G Group Annuities - Immediate Non-Variable
A05.000 Annuities - Immediate Non-variable
No form filings required for group annuities
75-21 200 No form filings required for group annuities
A05I Individual Annuities- Immediate Non-Variable
A05I.000 Annuities - Immediate Non-variable
None None None 75-11 100/300 Exempt
A06G Group Annuities - Immediate Variable
A06G.000 Annuities - Immediate Variable
None None None 75-40 200 No form filings required for group annuities
A06I Individual Annuities - Immediate Variable
A06I.000 Annuities – Immediate Variable
Form 75-30 100/300/400 Exempt
A06.1G Group Annuities - Immediate Non-Variable
A06.1G.000 Annuities - Immediate Non-Variable
None None None 75-21 200 No form filings required for group annuities
A06.1G Group Annuities - Immediate Variable
A06.1G.000 Annuities - Immediate Variable
None None None 75-40 200 No form filings required for group annuities
A06.1I Individual Annuities- Immediate Non-Variable
A06.1I.000 Annuities - Immediate Non-Variable
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable, Actuarial certification
None 75-11 100/300 Exempt
Page 6 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
A06.1I Individual Annuities- Immediate Variable
A06.1I.000 Annuities - Immediate Variable
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable, Actuarial certification
None 75-30 100/300/400 Exempt
A07G Group Annuities - Special
A07G.001 Equity Indexed None None None 75-20 200 No form filings required for group annuities
A07G.002 Modified Guaranteed
None None None 75-20 200 No form filings required for group annuities
A07I Individual Annuities - Special
A07I.001 Equity Indexed Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 75-10 100/300/400 Exempt
A07I.002 Modified Guaranteed
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 75-10 100/300/400 Exempt
A08G Group Annuities - Unallocated
A08G.001 Funding Agreement
None None None 75-20 200 No form filings required for group annuities
A08G.002 GIC None None None 75-20 200 No form filings required for group annuities
A08G.003 Deposit Administration
None None None 75-20 200 No form filings required for group annuities
Page 7 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
A10 Annuities - Other A10.000 Annuities - Other Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 75-00 100/300/400 Exempt
CR01 Credit - Assumption Agreement
CR01.000 Credit - Assumption Agreement
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
None 01-00 100 Prior Approval
CR01 Credit - Assumption Agreement
CR01.000 Credit - Assumption Agreement
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
None 55-00 100 Prior Approval
CR02G Group Credit - Credit Disability
CR02G.001 Monthly Premium - Open-End
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-30 100/200/400/600 Prior Approval
CR02G.002 Monthly Premium - Closed-End
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-30 100/200/400/600 Prior Approval
CR02G.003 Single Premium
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms
Actuarial memorandum and rates
55-30 100/200/400/600 Prior Approval
Page 8 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
Applicable
CR02G.004 Full Term Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-30 100/200/400/600 Prior Approval
CR02G.005 Critical Period Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-30 100/200/400/600 Prior Approval
CR02G.006 Truncated Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-30 100/200/400/600 Prior Approval
CR02G.007 Other Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-30 100/200/400/600 Prior Approval
CR02I Individual Credit - Credit Disability
CR02I.001 Monthly Premium – Open-End
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-30 100/200/300/600 Prior Approval
Page 9 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
CR02I.002 Monthly Premium - Closed-End
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-30 100/200/300/600 Prior Approval
CR02I.003 Single Premium
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-30 100/200/300/600 Prior Approval
CR02I.004 Full Term Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-30 100/200/300/600 Prior Approval
CR02I.005 Critical Period Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-30 100/200/300/600 Prior Approval
CR02I.006 Truncated Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-30 100/200/300/600 Prior Approval
CR02I.007 Other Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-30 100/200/300/600 Prior Approval
Page 10 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
CR03G Group Credit - FMLA
Actuarial memorandum and rates
CR03G.001 Monthly Premium - Open-End
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-30 100/200/400/600 Prior Approval
CR03G.002 Monthly Premium - Closed-End
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-30 100/200/400/600 Prior Approval
CR03G.003 Single Premium
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-30 100/200/400/600 Prior Approval
CR03I Individual Credit -FMLA
CR03I.001 Monthly Premium - Open-End
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-30 100/200/300/600 Prior Approval
Page 11 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
CR03I.002 Monthly Premium - Closed-End
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-30 100/200/300/600 Prior Approval
CR03I.003 Single Premium
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-30 100/200/300/600 Prior Approval
CR04G Group Credit - Life CR04G.001 Monthly
Premium - Open-End Form/Rate Cover letter, Certificate
of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
01-50 100/200/300 Prior Approval
CR04G.002 Monthly Premium - Closed-End
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
01-50 100/200/300 Prior Approval
CR04G.003 Single Premium
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
01-50 100/200/300 Prior Approval
CR04G.004 Gross Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
01-50 100/200/300 Prior Approval
Page 12 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
CR04G.005 Net Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
01-50 100/200/300 Prior Approval
CR04G.006 Truncated Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
01-50 100/200/300 Prior Approval
CR04I Individual Credit - Life
CR04I.001 Monthly Premium - Open-End
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
01-50 100/200/400 Prior Approval
CR04I.002 Monthly Premium - Closed-End
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
01-50 100/200/400 Prior Approval
CR04I.003 Single Premium
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
01-50 100/200/400 Prior Approval
CR04I.004 Gross Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
01-50 100/200/400 Prior Approval
Page 13 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
CR04I.005 Net Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
01-50 100/200/400 Prior Approval
CR04I.006 Truncated Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
01-50 100/200/400 Prior Approval
CR07 Credit - Other CR07.000 Credit - Other Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
01-00 100/200/300/400 Prior Approval
CR07 Credit - Other CR07.000 Credit - Other Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-00 100/200/300/4 00 Prior Approval
H01 Health - Assumption Agreement
H01.000 Health - Assumption Agreement
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
None 55-00 100 Prior Approval
H02G Group Health - Accident Only
H02G.000 Health - Accident Only
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-21 100/200/400 Exempt
Page 14 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
H02G Group Health - Accident Only
H02G.000 Health - Accident Only
Form/Rate -if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-21 100/200/400 Prior Approval
H02G Group Health - Accident Only
H02G.000 Health - Accident Only
Rate None N/A 55-21 100/200/400 No rate filing required for group health
H02I Individual Health - Accident Only
H02I.000 Health - Accident Only
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-11 100/200/300 Exempt
H02I Individual Health - Accident Only
H02I.000 Health - Accident Only
Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-11 100/200/300 Prior Approval
H03G Group Health - Accidental Death & Dismemberment
H03G.000 Health - Accidental Death & Dismemberment
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-21 100/200/400 Exempt
H03G Group Health - Accidental Death & Dismemberment
H03G.000 Health - Accidental Death & Dismemberment
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-21 100/200/400 Prior Approval
H03G Group Health - Accidental Death & Dismemberment
H03G.000 Health - Accidental Death & Dismemberment
Rate None N/A 55-21 100/200/400 No rate filing required for group health
Page 15 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
H03I Individual Health - Accidental Death & Dismemberment
H03I.000 Health - Accidental Death & Dismemberment
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-11 100/200/300 Exempt
H03I Individual Health - Accidental Death & Dismemberment
H03I.000 Health - Accidental Death & Dismemberment
Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-11 100/200/300 Prior Approval
H04 Health - Blanket Accident/Sickness
H04.000 Health - Blanket Accident/Sickness
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-12 100/200/300 Exempt
H04 Health - Blanket Accident/Sickness
H04.000 Health - Blanket Accident/Sickness
Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-12 100/200/300 Prior Approval
H04.001 Student Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-12 100/200/300 Exempt
H04.001 Student Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-12 100/200/300 Prior Approval
Page 16 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
H05 Health - Champus/Tricare Supplement
H05.000 Health - Champus/Tricare Supplement
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-41 100/200/300 Prior Approval
H06 Health - Conversion H06.000 Health - Conversion
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-10 100/200/300 Prior Approval
H07G Group Health - Specified Disease - Limited Benefit
H07G.001 Critical Illness Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-29 100/200/400 Exempt
H07G.001 Critical Illness Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-29 100/200/400 Prior Approval
H07G.001 Critical Illness Rate None N/A 55-29 100/200/400 No rate filing required for group health
H07G.002 Dread Disease Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-29 100/200/400 Exempt
Page 17 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
H07G.002 Dread Disease Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-29 100/200/400 Prior Approval
H07G.002 Dread Disease Rate None N/A 55-29 100/200/400 No rate filing required for group health
H07G.002A Dread Disease - Cancer Only
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-29 100/200/400 Exempt
H07G.002A Dread Disease - Cancer Only
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-29 100/200/400 Prior Approval
H07G.002A Dread Disease - Cancer Only
Rate None N/A 55-29 100/200/400 No rate filing required for group health
H07G.003 HIV Indemnity Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-29 100/200/400 Exempt
H07G.003 HIV Indemnity Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-29 100/200/400 Prior Approval
Page 18 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
H07G.003 HIV Indemnity Rate None N/A 55-29 100/200/400 No rate filing required for group health
H07I Individual Health - Specified Disease - Limited Benefit
H07I.001 Critical Illness Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-19 100/200/300 Exempt
H07I.001 Critical Illness Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-19 100/200/300 Prior Approval
H07I.002 Dread Disease Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-19 100/200/300 Exempt
H07I.002 Dread Disease Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-19 100/200/300 Prior Approval
H07I.002A Dread Disease - Cancer Only
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-19 100/200/300 Exempt
Page 19 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
H07I.002A Dread Disease - Cancer Only
Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-19 100/200/300 Prior Approval
H07I.003 HIV Indemnity Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-19 100/200/300 Exempt
H07I.003 HIV Indemnity Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-19 100/200/300 Prior Approval
H08G Group Health - Intensive Care -Limited Benefit
H08G.000 Health - Intensive Care - Limited Benefit
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-20 100/200/400 Exempt
H08G Group Health - Intensive Care -Limited Benefit
H08G.000 Health - Intensive Care - Limited Benefit
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-20 100/200/400 Prior Approval
H08G Group Health - Intensive Care -Limited Benefit
H08G.000 Health - Intensive Care - Limited Benefit
Rate None N/A 55-20 100/200/400 No rate filing required for group health
H08I Individual Health - Intensive Care -Limited Benefit
H08I.000 Health - Intensive Care - Limited Benefit
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms
N/A 55-10 100/200/300 Exempt
Page 20 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
Applicable
H08I Individual Health - Intensive Care -Limited Benefit
H08I.000 Health - Intensive Care - Limited Benefit
Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-10 100/200/300 Prior Approval
H09G Group Health - Organ & Tissue Transplant - Limited Benefit
H09G.000 Health - Organ & Tissue Transplant -Limited Benefit
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-20 100/200/400 Exempt
H09G Group Health - Organ & Tissue Transplant - Limited Benefit
H09G.000 Health - Organ & Tissue Transplant -Limited Benefit
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-20 100/200/400 Prior Approval
H09G Group Health - Organ & Tissue Transplant - Limited Benefit
H09G.000 Health - Organ & Tissue Transplant -Limited Benefit
Rate None N/A 55-20 100/200/400 No rate filing required for group health
H09I Individual Health - Organ & Tissue Transplant - Limited Benefit
H09I.000 Health - Organ & Tissue Transplant -Limited Benefit
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-16 100/200/300 Exempt
Page 21 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
H09I Individual Health - Organ & Tissue Transplant - Limited Benefit
H09I.000 Health - Organ & Tissue Transplant -Limited Benefit
Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-16 100/200/300 Prior Approval
H10G Group Health - Dental H10G.000 Health - Dental Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-23 100/200/400 Exempt
H10G Group Health - Dental H10G.000 Health - Dental Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-23 100/200/400 Prior Approval
H10G Group Health - Dental H10G.000 Health - Dental Rate None N/A 55-23 100/200/400 No rate filing required for group health
H10I Individual Health - Dental
H10I.000 Health - Dental Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-13 100/200/300 Exempt
H10I Individual Health - Dental
H10I.000 Health - Dental Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-13 100/200/300 Prior Approval
H11G Group Health - Disability Income
Page 22 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
H11G.001 Business Overhead Expense
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-24 100/200/400 Exempt
H11G.001 Business Overhead Expense
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-23 100/200/400 Prior Approval
H11G.001 Business Overhead Expense
Rate None N/A 55-20 100/200/400 No rate filing required for group health
H11G.002 Short Term Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-24 100/200/400 Exempt
H11G.002 Short Term Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-23 100/200/400 Prior Approval
H11G.002 Short Term Rate None N/A 55-20 100/200/400 No rate filing required for group health
H11G.003 Long Term Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-24 100/200/400 Exempt
Page 23 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
H11G.003 Long Term Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-23 100/200/400 Prior Approval
H11G.003 Long Term Rate None N/A 55-20 100/200/400 No rate filing required for group health
H11G.004 Other Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-24 100/200/400 Exempt
H11G.004 Other Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-23 100/200/400 Prior Approval
H11G.004 Other Rate None N/A 55-20 100/200/400 No rate filing required for group health
H11G.005 Combined Short Term and Long Term
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-24 100/200/400 Exempt
H11G.005 Combined Short Term and Long Term
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-23 100/200/400 Prior Approval
H11G.005 Combined Short Term and Long
Rate None N/A 55-20 100/200/400 No rate filing required for group health
Page 24 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
Term
H11I Individual Health - Disability Income
H11I.001 Business Overhead Expense -Unrelated to marketing with employer or association groups
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-14 100/200/300 Exempt
H11I.001 Business Overhead Expense -Unrelated to marketing with employer or association groups
Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-14 100/200/300 Prior Approval
H11I.002 Short Term - Unrelated to marketing with employer or association groups
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-14 100/200/300 Exempt
H11I.002 Short Term - Unrelated to marketing with employer or association groups
Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-14 100/200/300 Prior Approval
H11I.003 Long Term - Unrelated to marketing with employer or association groups
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-14 100/200/300 Exempt
Page 25 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
H11I.003 Long Term - Unrelated to marketing with employer or association groups
Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-14 100/200/300 Prior Approval
H11I.004 Other Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-14 100/200/300 Exempt
H11I.004 Other Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-14 100/200/300 Prior Approval
H11I.005 Business Overhead Expense - Related to marketing with employer or association groups
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-14 100/200/300 Exempt
H11I.005 Business Overhead Expense - Related to marketing with employer or association groups
Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-14 100/200/300 Prior Approval
H11I.006 Short Term - Related to marketing with employer or association groups
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-14 100/200/300 Exempt
Page 26 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
H11I.006 Short Term - Related to marketing with employer or association groups
Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-14 100/200/300 Prior Approval
H11I.007 Long Term - Related to marketing with employer or association groups
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-14 100/200/300 Exempt
H11I.007 Long Term - Related to marketing with employer or association groups
Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-14 100/200/300 Prior Approval
H11I.008 Combined Short Term and Long Term Unrelated to marketing with employer or association groups
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-14 100/200/300 Exempt
H11I.008 Combined Short Term and Long Term Unrelated to marketing with employer or association groups
Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-14 100/200/300 Prior Approval
H11I.009 Combined Short Term and Long Term Related to marketing with employer or association groups
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-14 100/200/300 Exempt
Page 27 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
H11I.009 Combined Short Term and Long Term Related to marketing with employer or association groups
Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-14 100/200/300 Prior Approval
H12 Health - Excess/Stop Loss
H12.001 Accident & Sickness
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-27 100/200/400 Exempt
H12.002 Managed Care Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-27 100/200/400 Exempt
H12.003 Provider Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-27 100/200/400 Exempt
H12.004 Self-Funded Health Plan
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-27 100/200/400 Exempt
H13G Group Health - Short Term Care
Page 28 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
H13G.001 Home Health Care
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-20 100/200/400 Exempt
H13G.001 Home Health Care
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-20 100/200/400 Prior Approval
No rate filing required H13G.001 Home Health
Care Rate None N/A 55-20 100/200/400 for group health
H13G.002 Nursing Home Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-20 100/200/400 Exempt
H13G.002 Nursing Home Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-20 100/200/400 Prior Approval
H13G.002 Nursing Home Rate None N/A 55-20 100/200/400 No rate filing required for group health
H13G.003 Adult Day Care Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 55-20 100/200/400 Exempt
Page 29 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
H13G.003 Adult Day Care Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-20 100/200/400 Prior Approval
H13G.003 Adult Day Care Rate None N/A 55-20 100/200/400 No rate filing required for group health
H13I Individual Health - Short Term Care
H13I.001 Home Health Care
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-16 100/200/300 Exempt
H13I.001 Home Health Care
Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-16 100/200/300 Prior Approval
H13I.002 Nursing Home Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-16 100/200/300 Exempt
H13I.002 Nursing Home Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-16 100/200/300 Prior Approval
Page 30 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
H13I.003 Adult Day Care Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-16 100/200/300 Exempt
H13I.003 Adult Day Care Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-16 100/200/300 Prior Approval
H14G Group Health - Hospital Indemnity
H14G.000 Health - Hospital Indemnity
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-20 100/200/400 Exempt
H14G Group Health - Hospital Indemnity
H14G.000 Health - Hospital Indemnity
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-20 100/200/400 Prior Approval
H14G Group Health - Hospital Indemnity
H14G.000 Health - Hospital Indemnity
Rate None N/A 55-20 100/200/400 No rate filing required for group health
H14I Individual Health - Hospital Indemnity
H14I.000 Health - Hospital Indemnity
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-15 100/200/300 Exempt
Page 31 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
H14I Individual Health - Hospital Indemnity
H14I.000 Health - Hospital Indemnity
Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-15 100/200/300 Prior Approval
H15G Group Health - Hospital/Surgical/Medical Expense
H15G.001 Any Size Group Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-20 100/200/400 Exempt
H15G.001 Any Size Group Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-20 100/200/400 Prior Approval
H15G.001 Any Size Group Rate None N/A 55-20 100/200/400 No rate filing required for group health
H15G.002 Large Group Only
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-20 100/200/400 Exempt
H15G.002 Large Group Only
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-20 100/200/400 Prior Approval
Page 32 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
H15G.002 Large Group Only
Rate None N/A 55-20 100/200/400 No rate filing required for group health
H15G.003 Small Group Only
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-20 100/200/400 Exempt
H15G.003 Small Group Only
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-20 100/200/400 Prior Approval
H15G.003 Small Group Only
Rate None N/A 55-20 100/200/400 No rate filing required for group health
H15I Individual Health -Hospital/Surgical/Medical Expense
H15I.001 Health - Hospital/Surgical/Medical Expense
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-18 100/200/300 Prior Approval
H16G Group Health - Major Medical
H16G.001A Any Size Group - PPO
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
H16G.001A Any Size Group - PPO
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
Page 33 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
H16G.001A Any Size Group - PPO
Rate None N/A 55-22 100/200/400 No rate filing required for group health
H16G.001B Any Size Group - POS
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
H16G.001B Any Size Group - POS
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
H16G.001B Any Size Group - POS
Rate None N/A 55-22 100/200/400 No rate filing required for group health
H16G.001C Any Size Group - Other
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
H16G.001C Any Size Group - Other
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
H16G.001C Any Size Group - Other
Rate None N/A 55-22 100/200/400 No rate filing required for group health
H16G.002A Large Group Only - PPO
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
Page 34 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
H16G.002A Large Group Only - PPO
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
H16G.002A Large Group Only - PPO
Rate None N/A 55-22 100/200/400 No rate filing required for group health
H16G.002B Large Group Only - POS
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
H16G.002B Large Group Only - POS
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
H16G.002B Large Group Only - POS
Rate None N/A 55-22 100/200/400 No rate filing required for group health
H16G.002C Large Group Only - Other
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
H16G.002C Large Group Only - Other
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
Page 35 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements,
SC Endorsements, Applications, Sub-Type of
Insurance Informational, if applicable) Form Rate
Line How Filing DOI Series Code Handled
H16G.002C Large Group Only - Other
Rate None N/A 55-22 100/200/400 No rate filing required for group health
H16G.003A Small Group Only - PPO
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
H16G.003A Small Group Only - PPO
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
H16G.003A Small Group Only - PPO
Rate None N/A 55-22 100/200/400 No rate filing required for group health
H16G.003B Small Group Only - PPO Basic
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
H16G.003B Small Group Only - PPO Basic
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
H16G.003B Small Group Only - PPO Basic
Rate None N/A 55-22 100/200/400 No rate filing required for group health
Page 36 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
H16G.003C Small Group Only - PPO Standard
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
H16G.003C Small Group Only - PPO Standard
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
H16G.003C Small Group Only - PPO Standard
Rate None N/A 55-22 100/200/400 No rate filing required for group health
H16G.003D Small Group Only - POS
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
H16G.003D Small Group Only - POS
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
H16G.003D Small Group Only - POS
Rate None N/A 55-22 100/200/400 No rate filing required for group health
H16G.003E Small Group Only - POS Basic
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
Page 37 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
H16G.003E Small Group Only - POS Basic
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
H16G.003E Small Group Only - POS Basic
Rate None N/A 55-22 100/200/400 No rate filing required for group health
H16G.003F Small Group Only - POS Standard
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
H16G.003F Small Group Only - POS Standard
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
H16G.003F Small Group Only - POS Standard
Rate None N/A 55-22 100/200/400 No rate filing required for group health
H16G.003G Small Group Only - Other
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
H16G.003G Small Group Only - Other
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
Page 38 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
H16G.003G Small Group Only - Other
Rate None N/A 55-22 100/200/400 No rate filing required for group health
H16G.004 Short Term Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Exempt
H16G.004 Short Term Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-22 100/200/400 Prior Approval
H16G.004 Short Term Rate None N/A 55-22 100/200/400 No rate filing required for group health
H16I Individual Health - Major Medical
H16I.005A Individual - Preferred Provider (PPO)
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-17 100/200/300 Prior Approval
H16I.005B Individual - Point-of-Service (POS)
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-17 100/200/300 Prior Approval
H16I.005C Individual - Other
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-17 100/200/300 Prior Approval
Page 39 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
H16I.004 Short Term Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-17 100/200/300 Prior Approval
H17G Group Health - Prescription Drug
H17G.000 Health - Prescription Drug
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-20 100/200/400 Exempt
H17G Group Health - Prescription Drug
H17G.000 Health - Prescription Drug
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-20 100/200/400 Prior Approval
H17G Group Health - Prescription Drug
H17G.000 Health - Prescription Drug
Rate None N/A 55-20 100/200/400 No rate filing required for group health
H17I Individual Health - Prescription Drug
H17I.000 Health - Prescription Drug
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-16 100/200/300 Prior Approval
H18G Group Health - Sickness
H18G.000 Health - Sickness
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-20 100/200/400 Exempt
Page 40 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
H18G Group Health - Sickness
H18G.000 Health - Sickness
Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-20 100/200/400 Prior Approval
H18G Group Health - Sickness
H18G.000 Health - Sickness
Rate None N/A 55-20 100/200/400 No rate filing required for group health
H18I Individual Health - Sickness
H18I.000 Health - Sickness
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-10 100/200/300 Prior Approval
H19I Individual Health - Travel
H19I.000 Health - Travel Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-10 100/200/300 Exempt
H19I Individual Health - Travel
H19I.000 Health - Travel Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-10 100/200/300 Prior Approval
H19G Group Health - Travel H19G.000 Health - Travel Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-20 100/200/400 Exempt
Page 41 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
H19G Group Health - Travel H19G.000 Health - Travel Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-20 100/200/400 Prior Approval
H19G Group Health - Travel H19G.000 Health - Travel Rate None N/A 55-20 100/200/400 No rate filing required for group health
H20G Group Health - Vision H20G.000 Health - Vision Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-28 100/200/400 Exempt
H20G Group Health - Vision H20G.000 Health - Vision Form/Rate - if mass marketed
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-28 100/200/400 Prior Approval
H20G Group Health - Vision H20G.000 Health - Vision Rate None N/A 55-28 100/200/400 No rate filing required for group health
H20I Individual Health - Vision
H20I.000 Health - Vision Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-16 100/200/300 Exempt
H20I Individual Health - Vision
H20I.000 Health - Vision Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-16 100/200/300 Prior Approval
Page 42 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
HOrg01 Health Organizations -Assumption Agreement
HOrg01.000 Health Organizations - Assumption Agreement
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-00 100 Prior Approval
HOrg02G Group Health Organizations -Health Maintenance (HMO)
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
HOrg02G.001 Conversion Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-25 100/200/400/5 00 Prior Approval
HOrg02G.001 Conversion Rate None N/A 55-25 100/200/400/5 00 No rate filing required for group health
HOrg02G.002A Any Size Group - PPO
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-25 100/200/400/5 00 Prior Approval
HOrg02G.002A Any Size Group - PPO
Rate None N/A 55-25 100/200/400/5 00 No rate filing required for group health
HOrg02G.002B Any Size Group - POS
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-25 100/200/400/5 00 Prior Approval
HOrg02G.002B Any Size Group - POS
Rate None N/A 55-25 100/200/400/5 00 No rate filing required for group health
Page 43 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
HOrg02G.003A Large Group Only - PPO
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-25 100/200/400/5 00 Prior Approval
HOrg02G.003A Large Group Only - PPO
Rate None N/A 55-25 100/200/400/5 00 No rate filing required for group health
HOrg02G.003B Large Group Only - POS
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-25 100/200/400/5 00 Prior Approval
HOrg02G.003B Large Group Only - POS
Rate None N/A 55-25 100/200/400/5 00 No rate filing required for group health
HOrg02G.004A Small Group Only - PPO Basic
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-25 100/200/400/5 00 Prior Approval
HOrg02G.004A Small Group Only - PPO Basic
Rate None N/A 55-25 100/200/400/5 00 No rate filing required for group health
HOrg02G.004B Small Group Only - PPO Standard
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-25 100/200/400/5 00 Prior Approval
HOrg02G.004B Small Group Only - PPO Standard
Rate None N/A 55-25 100/200/400/5 00 No rate filing required for group health
Page 44 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
HOrg02G.004C Small Group Only - POS Basic
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-25 100/200/400/5 00 Prior Approval
HOrg02G.004C Small Group Only - POS Basic
Rate None N/A 55-25 100/200/400/5 00 No rate filing required for group health
HOrg02G.004D Small Group Only - POS Standard
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-25 100/200/400/5 00 Prior Approval
HOrg02G.004D Small Group Only - POS Standard
Rate None N/A 55-25 100/200/400/5 00 No rate filing required for group health
HOrg02G.004E Small Group Only - Other
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-25 100/200/400/5 00 Prior Approval
HOrg02G.004E Small Group Only - Other
Rate None N/A 55-25 100/200/400/5 00 No rate filing required for group health
HOrg02I Individual Health Organizations - Health Maintenance (HMO)
HOrg02I.005A Individual - Preferred Provider (PPO)
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-10 100/200/300/5 00 Prior Approval
Page 45 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
HOrg02I.005B Individual - Point-of-Service (POS)
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-10 100/200/300/5 00 Prior Approval
HOrg02I.005C Individual - Other
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-10 100/200/300/500 Prior Approval
L01 Life - Assumption Agreement
L01.000 Life - Assumption Agreement
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-00 100/200/300/400/ 500
Prior Approval
L02G Group Life - Endowment
L02G.000 Life - Endowment
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-20 100/300 Exempt
L02G Group Life - Endowment
L02G.000 Life - Endowment
Rate None N/A 01-20 100/300 No rate filing required for life insurance
L02G.001 Single Life - Fixed/Indeterminate Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-20 100/300 Exempt
L02G.001 Single Life - Fixed/Indeterminate Premium
Rate None N/A 01-20 100/300 No rate filing required for life insurance
Page 46 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L02G.002 Single Life - Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-20 100/300 Exempt
L02G.002 Single Life - Single Premium
Rate None N/A 01-20 100/300 No rate filing required for life insurance
L02G.101 Joint (First to Die) -Fixed/Indeterminate Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-20 100/300 Exempt
L02G.101 Joint (First to Die) -Fixed/Indeterminate Premium
Rate None N/A 01-20 100/300 No rate filing required for life insurance
L02G.102 Joint (First to Die) - Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-20 100/300 Exempt
L02G.102 Joint (First to Die) - Single Premium
Rate None N/A 01-20 100/300 No rate filing required for life insurance
L02G.201 Joint (Last Survivor) -Fixed/Indeterminate Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-20 100/300 Exempt
L02G.201 Joint (Last Survivor) -Fixed/Indeterminate Premium
Rate None N/A 01-20 100/300 No rate filing required for life insurance
Page 47 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L02G.202 Joint (Last Survivor) - Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-20 100/300 Exempt
L02G.202 Joint (Last Survivor) - Single Premium
Rate None N/A 01-20 100/300 No rate filing required for life insurance
L02I Individual Life - Endowment
L02I.000 Life - Endowment
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-10 100/400 Exempt
L02I Individual Life - Endowment
L02I.000 Life - Endowment
Rate None N/A 01-10 100/400 No rate filing required for life insurance
L02I.001 Single Life - Fixed/Indeterminate Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-10 100/400 Exempt
L02I.001 Single Life - Fixed/Indeterminate Premium
Rate None N/A 01-10 100/400 No rate filing required for life insurance
L02I.002 Single Life - Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-10 100/400 Exempt
L02I.002 Single Life - Single Premium
Rate None 01-10 100/400 No rate filing required for life insurance
Page 48 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L02I.101 Joint (First to Die) -Fixed/Indeterminate Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
N/A 01-10 100/400 Exempt
L02I.101 Joint (First to Die) -Fixed/Indeterminate Premium
Rate None 01-10 100/400 No rate filing required for life insurance
L02I.102 Joint (First to Die) - Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-10 100/400 Exempt
L02I.102 Joint (First to Die) - Single Premium
Rate None 01-10 100/400 No rate filing required for life insurance
L02I.201 Joint (Last Survivor) -Fixed/Indeterminate Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-10 100/400 Exempt
L02I.201 Joint (Last Survivor) -Fixed/Indeterminate Premium
Rate None 01-10 100/400 No rate filing required for life insurance
L02I.202 Joint (Last Survivor) - Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-10 100/400 Exempt
L02I.202 Joint (Last Survivor) - Single Premium
Rate None 01-10 100/400 No rate filing required for life insurance
Page 49 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L03G Group Life - Special L03G.000 Group Life - Special
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-20 100/300 Exempt
L03G Group Life - Special L03G.000 Group Life - Special
Rate None 01-20 100/300 No rate filing required for life insurance
L03I Individual Life - Special
L03I.000 Individual Life - Special
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-10 100/400 Exempt
L03I Individual Life - Special
L03I.000 Individual Life - Special
Rate None 01-10 100/400 No rate filing required for life insurance
L04G Group Life - Term L04G.003 Single Life -
Single Premium Form Cover letter, Certificate
of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-21 100/400 Exempt
L04G.003 Single Life - Single Premium
Rate None 01-21 100/400 No rate filing required for life insurance
L04G.004 Joint (First to Die) - Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-21 100/400 Exempt
L04G.004 Joint (First to Die) - Single Premium
Rate None 01-21 100/400 No rate filing required for life insurance
Page 50 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L04G.005 Joint (Last Survivor) - Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-21 100/400 Exempt
L04G.005 Joint (Last Survivor) - Single Premium
Rate None 01-21 100/400 No rate filing required for life insurance
L04G.103 Renewable - Single Life -Fixed/Indeterminate Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-21 100/400 Exempt
L04G.103 Renewable - Single Life -Fixed/Indeterminate Premium
Rate None 01-21 100/400 No rate filing required for life insurance
L04G.104 Renewable - Joint (First to Die) -Fixed/Indeterminate Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-21 100/400 Exempt
L04G.104 Renewable - Joint (First to Die) -Fixed/Indeterminate Premium
Rate None 01-21 100/400 No rate filing required for life insurance
L04G.105 Renewable - Joint (Last Survivor) -Fixed/Indeterminate Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-21 100/400 Exempt
L04G.105 Renewable - Joint (Last Survivor) -Fixed/Indeterminate
Rate None 01-21 100/400 No rate filing required for life insurance
Page 51 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
Premium
L04G.203 Specified Age or Duration - Single Premium - Single Life
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-21 100/400 Exempt
L04G.203 Specified Age or Duration - Single Premium - Single Life
Rate None 01-21 100/400 No rate filing required for life insurance
L04G.204 Specified Age or Duration - Single Premium - Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-21 100/400 Exempt
L04G.204 Specified Age or Duration - Single Premium - Joint (First to Die)
Rate None 01-21 100/400 No rate filing required for life insurance
L04G.205 Specified Age or Duration - Single Premium - Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-21 100/400 Exempt
L04G.205 Specified Age or Duration - Single Premium - Joint (Last Survivor)
Rate None 01-21 100/400 No rate filing required for life insurance
L04G.213 Specified Age or Duration -Fixed/Indeterminate Premium - Single Life
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-21 100/400 Exempt
Page 52 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L04G.213 Specified Age or Duration -Fixed/Indeterminate Premium - Single Life
Rate None 01-21 100/400 No rate filing required for life insurance
L04G.214 Specified Age or Duration -Fixed/Indeterminate Premium - Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-21 100/400 Exempt
L04G.214 Specified Age or Duration -Fixed/Indeterminate Premium - Joint (First to Die)
Rate None 01-21 100/400 No rate filing required for life insurance
L04G.215 Specified Age or Duration -Fixed/Indeterminate Premium - Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-21 100/400 Exempt
L04G.215 Specified Age or Duration -Fixed/Indeterminate Premium - Joint (Last Survivor)
Rate None 01-21 100/400 No rate filing required for life insurance
L04G.303 Decreasing - Single Life - Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-21 100/400 Exempt
L04G.303 Decreasing - Single Life - Single Premium
Rate None 01-21 100/400 No rate filing required for life insurance
Page 53 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L04G.304 Decreasing - Joint (First to Die) -Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-21 100/400 Exempt
L04G.304 Decreasing - Joint (First to Die) -Single Premium
Rate None 01-21 100/400 No rate filing required for life insurance
L04G.305 Decreasing - Joint (Last Survivor) -Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-21 100/400 Exempt
L04G.305 Decreasing - Joint (Last Survivor) -Single Premium
Rate None 01-21 100/400 No rate filing required for life insurance
L04G.313 Decreasing - Single Life -Fixed/Indeterminate Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-21 100/400 Exempt
L04G.313 Decreasing - Single Life -Fixed/Indeterminate Premium
Rate None 01-21 100/400 No rate filing required for life insurance
L04G.314 Decreasing - Joint (First to Die) -Fixed/Indeterminate Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-21 100/400 Exempt
L04G.314 Decreasing - Joint (First to Die) -Fixed/Indeterminate Premium
Rate None 01-21 100/400 No rate filing required for life insurance
Page 54 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L04G.315 Decreasing - Joint (Last Survivor) -Fixed/Indeterminate Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-21 100/400 Exempt
L04G.315 Decreasing - Joint (Last Survivor) -Fixed/Indeterminate Premium
Rate None 01-21 100/400 No rate filing required for life insurance
L04G.403 Deposit Term - Single Life
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-21 100/400 Exempt
L04G.403 Deposit Term - Single Life
Rate None 01-21 100/400 No rate filing required for life insurance
L04G.404 Deposit Term - Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-21 100/400 Exempt
L04G.404 Deposit Term - Joint (First to Die)
Rate None 01-21 100/400 No rate filing required for life insurance
L04G.405 Deposit Term - Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-21 100/400 Exempt
L04G.405 Deposit Term - Joint (Last Survivor)
Rate None 01-21 100/400 No rate filing required for life insurance
Page 55 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L04G.500 Other Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-20 100/400 Exempt
L04G.500 Other Form None Rate 100/400 No rate filing required for life insurance
L04I Individual Life - Term L04I.003 Single Life -
Single Premium Form Cover letter, Certificate
of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-11 100/400 Exempt
L04I.003 Single Life - Single Premium
Rate None 01-11 100/400 No rate filing required for life insurance
L04I.004 Joint (First to Die) - Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-11 100/400 Exempt
L04I.004 Joint (First to Die) - Single Premium
Rate None 01-11 100/400 No rate filing required for life insurance
L04I.005 Joint (Last Survivor) - Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-11 100/400 Exempt
L04I.005 Joint (Last Survivor) - Single Premium
Rate None 01-11 100/400 No rate filing required for life insurance
Page 56 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L04I.103 Renewable - Single Life -Fixed/Indeterminate Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-11 100/400 Exempt
L04I.103 Renewable - Single Life -Fixed/Indeterminate Premium
Rate None 01-11 100/400 No rate filing required for life insurance
L04I.104 Renewable - Joint (First to Die) - Fixed Premium/Indeterminate Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-11 100/400 Exempt
L04I.104 Renewable - Joint (First to Die) - Fixed Premium/Indeterminate Premium
Rate None 01-11 100/400 No rate filing required for life insurance
L04I.105 Renewable - Joint (Last Survivor) -Fixed Premium/Indeterminate Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-11 100/400 Exempt
L04I.105 Renewable - Joint (Last Survivor) -Fixed Premium/Indeterminate Premium
Rate None 01-11 100/400 No rate filing required for life insurance
L04I.203 Specified Age or Duration - Single Premium - Single Life
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-11 100/400 Exempt
L04I.203 Specified Age or Duration - Single
Rate None 01-11 100/400 No rate filing required for life insurance
Page 57 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
Premium - Single Life
L04I.204 Specified Age or Duration - Single Premium - Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-11 100/400 Exempt
L04I.204 Specified Age or Duration - Single Premium - Joint (First to Die)
Rate None 01-11 100/400 No rate filing required for life insurance
L04I.205 Specified Age or Duration - Single Premium - Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-11 100/400 Exempt
L04I.205 Specified Age or Duration - Single Premium - Joint (Last Survivor)
Rate None 01-11 100/400 No rate filing required for life insurance
L04I.213 Specified Age or Duration -Fixed/Indeterminate Premium - Single Life
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-11 100/400 Exempt
L04I.213 Specified Age or Duration -Fixed/Indeterminate Premium - Single Life
Rate None 01-11 100/400 No rate filing required for life insurance
L04I.214 Specified Age or Duration -Fixed/Indeterminate Premium - Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-11 100/400 Exempt
Page 58 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L04I.214 Specified Age or Duration -Fixed/Indeterminate Premium - Joint (First to Die)
Rate None 01-11 100/400 No rate filing required for life insurance
L04I.215 Specified Age or Duration -Fixed/Indeterminate Premium - Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-11 100/400 Exempt
L04I.215 Specified Age or Duration -Fixed/Indeterminate Premium - Joint (Last Survivor)
Rate None 01-11 100/400 No rate filing required for life insurance
L04I.303 Decreasing -Single Life - Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-11 100/400 Exempt
L04I.303 Decreasing -Single Life - Single Premium
Rate None 01-11 100/400 No rate filing required for life insurance
L04I.304 Decreasing - Joint (First to Die) -Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-11 100/400 Exempt
L04I.304 Decreasing - Joint (First to Die) -Single Premium
Rate None 01-11 100/400 No rate filing required for life insurance
L04I.305 Decreasing - Joint (Last Survivor) -Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms
01-11 100/400 Exempt
Page 59 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
Applicable
L04I.305 Decreasing - Joint (Last Survivor) -Single Premium
Rate None 01-11 100/400 No rate filing required for life insurance
L04I.313 Decreasing - Single Life -Fixed/Indeterminate Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-11 100/400 Exempt
L04I.313 Decreasing - Single Life -Fixed/Indeterminate Premium
Rate None 01-11 100/400 No rate filing required for life insurance
L04I.314 Decreasing - Joint (First to Die) -Fixed/Indeterminate Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-11 100/400 Exempt
L04I.314 Decreasing - Joint (First to Die) -Fixed/Indeterminate Premium
Rate None 01-11 100/400 No rate filing required for life insurance
L04I.315 Decreasing - Joint (Last Survivor) -Fixed/Indeterminate Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-11 100/400 Exempt
L04I.315 Decreasing - Joint (Last Survivor) -Fixed/Indeterminate Premium
Rate None 01-11 100/400 No rate filing required for life insurance
Page 60 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L04I.403 Deposit Term - Single Life
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-11 100/400 Exempt
L04I.403 Deposit Term - Single Life
Rate None 01-11 100/400 No rate filing required for life insurance
L04I.404 Deposit Term - Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-11 100/400 Exempt
L04I.404 Deposit Term - Joint (First to Die)
Rate None 01-11 100/400 No rate filing required for life insurance
L04I.405 Deposit Term - Joint (Last to Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-11 100/400 Exempt
L04I.405 Deposit Term - Joint (Last to Survivor)
Rate None 01-11 100/400 No rate filing required for life insurance
L04I.500 Other Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-10 100/400 Exempt
L04I.500 Other Rate None 01-10 100/400 No rate filing required for life insurance
L06G Group Life - Variable
Page 61 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L06G.001 Single Life - Fixed Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-40 100/300/500 Exempt
L06G.001 Single Life - Fixed Premium
Rate None 01-40 100/300/500 No rate filing required for life insurance
L06G.002 Single Life - Flexible Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-40 100/300/500 Exempt
L06G.002 Single Life - Flexible Premium
Rate None 01-40 100/300/500 No rate filing required for life insurance
L06G.003 Single Life - Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-40 100/300/500 Exempt
L06G.003 Single Life - Single Premium
Rate None 01-40 100/300/500 No rate filing required for life insurance
L06G.004 Single Life - Modified Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-40 100/300/500 Exempt
L06G.004 Single Life - Modified Single Premium
Rate None 01-40 100/300/500 No rate filing required for life insurance
L06G.101 Joint (First to Die) - Fixed Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms
01-40 100/300/500 Exempt
Page 62 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
Applicable
L06G.101 Joint (First to Die) - Fixed Premium
Rate None 01-40 100/300/500 No rate filing required for life insurance
L06G.102 Joint (First to Die) - Flexible Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-40 100/300/500 Exempt
L06G.102 Joint (First to Die) - Flexible Premium
Rate None 01-40 100/300/500 No rate filing required for life insurance
L06G.103 Joint (First to Die) - Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-40 100/300/500 Exempt
L06G.103 Joint (First to Die) - Single Premium
Rate None 01-40 100/300/500 No rate filing required for life insurance
L06G.104 Joint (First to Die) - Modified Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-40 100/300/500 Exempt
L06G.104 Joint (First to Die) - Modified Single Premium
Rate None 01-40 100/300/500 No rate filing required for life insurance
L06G.201 Joint (Last Survivor) - Fixed Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms
01-40 100/300/500 Exempt
Page 63 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
Applicable
L06G.201 Joint (Last Survivor) - Fixed Premium
Rate None 01-40 100/300/500 No rate filing required for life insurance
L06G.202 Joint (Last Survivor) - Flexible Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-40 100/300/500 Exempt
L06G.202 Joint (Last Survivor) - Flexible Premium
Rate None 01-40 100/300/500 No rate filing required for life insurance
L06G.203 Joint (Last Survivor) - Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-40 100/300/500 Exempt
L06G.203 Joint (Last Survivor) - Single Premium
Rate None 01-40 100/300/500 No rate filing required for life insurance
L06G.204 Joint (Last Survivor) - Modified Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-40 100/300/500 Exempt
L06G.204 Joint (Last Survivor) - Modified Single Premium
Rate None N/A 01-40 100/300/500 No rate filing required for life insurance
L06I Individual Life - Variable
Page 64 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
Sub-Type of Insurance L06I.001 Single Life - Fixed Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-30 100/400/500 Exempt
L06I.001 Single Life - Fixed Premium
Rate None N/A 01-30 100/400/500 No rate filing required for life insurance
L06I.002 Single Life - Flexible Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-30 100/400/500 Exempt
L06I.003 Single Life - Single Premium
Rate None N/A 01-30 100/400/500 No rate filing required for life insurance
L06I.003 Single Life - Single Premium
Form Cover letter, Certificate 01-30 100/400/500 Exempt
L06I.003 Single Life - Single Premium
Rate None N/A 01-30 100/400/500 No rate filing required for life insurance
L06I.004 Single Life - Modified Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-30 100/400/500 Exempt
L06I.004 Single Life - Modified Single Premium
Rate None N/A 01-30 100/400/500 No rate filing required for life insurance
L06I.101 Joint (First to Die) - Fixed Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-30 100/400/500 Exempt
L06I.101 Joint (First to Die) - Fixed Premium
Rate None N/A 01-30 100/400/500 No rate filing required for life insurance
Page 65 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L06I.102 Joint (First to Die) - Flexible Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-30 100/400/500 Exempt
L06I.102 Joint (First to Die) - Flexible Premium
Rate None N/A 01-30 100/400/500 No rate filing required for life insurance
L06I.103 Joint (First to Die) - Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-30 100/400/500 Exempt
L06I.103 Joint (First to Die) - Single Premium
Rate None N/A 01-30 100/400/500 No rate filing required for life insurance
L06I.104 Joint (First to Die) - Modified Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-30 100/400/500 Exempt
L06I.104 Joint (First to Die) - Modified Single Premium
Rate None N/A 01-30 100/400/500 No rate filing required for life insurance
L06I.201 Joint (Last Survivor) - Fixed Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-30 100/400/500 Exempt
L06I.201 Joint (Last Survivor) - Fixed Premium
Rate None N/A 01-30 100/400/500 No rate filing required for life insurance
Page 66 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
Sub-Type of Insurance L06I.202 Joint (Last Survivor) - Flexible Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-30 100/400/500 Exempt
L06I.202 Joint (Last Survivor) - Flexible Premium
Rate None N/A 01-30 100/400/500 No rate filing required for life insurance
L06I.203 Joint (Last Survivor) - Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-30 100/400/500 Exempt
L06I.203 Joint (Last Survivor) - Single Premium
Rate None N/A 01-30 100/400/500 No rate filing required for life insurance
L06I.204 Joint (Last Survivor) - Modified Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-30 100/400/500 Exempt
L06I.204 Joint (Last Survivor) - Modified Single Premium
Rate None N/A 01-30 100/400/500 No rate filing required for life insurance
L07G Group Life - Whole L07G.101
Fixed/Indeterminate Premium - Single Life
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.101 Fixed/Indeterminate Premium - Single Life
Rate None N/A 01-23 100/300 No rate filing required for life insurance
Page 67 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L07G.102 - Fixed/Indeterminate Premium - Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.102 - Fixed/Indeterminate Premium - Joint (First to Die)
Rate None N/A 01-23 100/300 No rate filing required for life insurance
L07G.103 - Fixed/Indeterminate Premium -Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.103 - Fixed/Indeterminate Premium -Joint (Last Survivor)
Rate None N/A 01-23 100/300 No rate filing required for life insurance
L07G.104 Fixed/Indeterminate Premium - Single Life - Funeral Expense
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.104 Fixed/Indeterminate Premium - Single Life - Funeral Expense
Rate None N/A 01-23 100/300 No rate filing required for life insurance
L07G.111 Single Premium - Single Life
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.111 Single Premium - Single Life
Rate None N/A 01-23 100/300 No rate filing required for life insurance
Page 68 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L07G.112 Single Premium - Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.112 Single Premium - Joint (First to Die)
Rate None N/A 01-23 100/300 No rate filing required for life insurance
L07G.113 Single Premium -Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.113 Single Premium -Joint (Last Survivor)
Rate None N/A 01-23 100/300 No rate filing required for life insurance
L07G.114 Single Premium - Single Life - Funeral Expense
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.114 Single Premium - Single Life - Funeral Expense
Rate None N/A 01-23 100/300 No rate filing required for life insurance
L07G.121 Graded Premium - Single Life
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.121 Graded Premium - Single Life
Rate None N/A 01-23 100/300 No rate filing required for life insurance
Page 69 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Sub-Type of Insurance Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L07G.122 Graded Premium - Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.122 Graded Premium - Joint (First to Die)
Rate None N/A 01-23 100/300 No rate filing required for life insurance
L07G.123 Graded Premium -Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.123 Graded Premium -Joint (Last Survivor)
Rate None N/A 01-23 100/300 No rate filing required for life insurance
L07G.201 Early Duration Reduced Benefit -Level Premium - Any Policy Design
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.201 Early Duration Reduced Benefit -Level Premium - Any Policy Design
Rate None N/A 01-23 100/300 No rate filing required for life insurance
L07G.202 Early Duration Reduced Benefit -Level Premium - Any Policy Design - Funeral Expense
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.202 Early Duration Reduced Benefit -Level Premium - Any Policy Design - Funeral Expense
Rate None N/A 01-23 100/300 No rate filing required for life insurance
Page 70 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
Sub-Type of Insurance
L07G.211 Early Duration Reduced Benefit -Single Premium - Any Policy Design
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.211 Early Duration Reduced Benefit -Single Premium - Any Policy Design
Rate None N/A 01-23 100/300 No rate filing required for life insurance
L07G.212 Early Duration Reduced Benefit -Single Premium - Any Policy Design - Funeral Expense
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.212 Early Duration Reduced Benefit -Single Premium - Any Policy Design - Funeral Expense
Rate None N/A 01-23 100/300 No rate filing required for life insurance
L07G.301 Current Assumption - Fixed Premium -Single Life
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.301 Current Assumption - Fixed Premium -Single Life
Rate None N/A 01-23 100/300 No rate filing required for life insurance
L07G.302 Current Assumption - Fixed Premium -Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.302 Current Assumption - Fixed Premium -Joint (First to Die)
Rate None N/A 01-23 100/300 No rate filing required for life insurance
Page 71 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L07G.303 Current Assumption - Fixed Premium -Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.303 Current Assumption - Fixed Premium -Joint (Last Survivor)
Rate None N/A 01-23 100/300 No rate filing required for life insurance
L07G.311 Current Assumption - Single Premium - Single Life
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.311 Current Assumption - Single Premium - Single Life
Rate None N/A 01-23 100/300 No rate filing required for life insurance
L07G.312 Current Assumption - Single Premium - Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.312 Current Assumption - Single Premium - Joint (First to Die)
Rate None N/A 01-23 100/300 No rate filing required for life insurance
L07G.313 Current Assumption - Single Premium -Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.313 Current Assumption - Single Premium -Joint (Last Survivor)
Rate None N/A 01-23 100/300 No rate filing required for life insurance
Page 72 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L07G.321 Current Assumption - Indeterminate Premium - Single Life
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.321 Current Assumption - Indeterminate Premium - Single Life
Rate None N/A 01-23 100/300 No rate filing required for life insurance
L07G.322 Current Assumption - Indeterminate Premium - Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.322 Current Assumption - Indeterminate Premium - Joint (First to Die)
Rate None N/A 01-23 100/300 No rate filing required for life insurance
L07G.323 Current Assumption - Indeterminate Premium -Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.323 Current Assumption - Indeterminate Premium -Joint (Last Survivor)
Rate None N/A 01-23 100/300 No rate filing required for life insurance
L07G.401 Adjustable - Current Assumption -Indeterminate Premium - Single Life
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
Page 73 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L07G.401 Adjustable - Current Assumption -Indeterminate Premium - Single Life
Rate None N/A 01-23 100/300 No rate filing required for life insurance
L07G.402 Adjustable - Current Assumption -Indeterminate Premium - Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.402 Adjustable - Current Assumption -Indeterminate Premium - Joint (First to Die)
Rate None N/A 01-23 100/300 No rate filing required for life insurance
L07G.403 Adjustable - Current Assumption -Indeterminate Premium -Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.403 Adjustable - Current Assumption -Indeterminate Premium -Joint (Last Survivor)
Rate None N/A 01-23 100/300 No rate filing required for life insurance
L07G.501 External Index- Level Premium -Single Life
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.501 External Index- Level Premium -Single Life
Rate None N/A 01-23 100/300 No rate filing required for life insurance
Page 74 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L07G.502 External Index - Level Premium -Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.502 External Index - Level Premium -Joint (First to Die)
Rate None N/A 01-23 100/300 No rate filing required for life insurance
L07G.503 External Index - Level Premium -Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.503 External Index - Level Premium -Joint (Last Survivor)
Rate None N/A 01-23 100/300 No rate filing required for life insurance
L07G.511 External Index - Single Premium -Single Life
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.511 External Index - Single Premium -Single Life
Rate None N/A 01-23 100/300 No rate filing required for life insurance
L07G.512 External Index - Single Premium -Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.512 External Index - Single Premium -Joint (First to Die)
Rate None N/A 01-23 100/300 No rate filing required for life insurance
Page 75 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L07G.513 External Index - Single Premium -Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-23 100/300 Exempt
L07G.513 External Index - Single Premium -Joint (Last Survivor)
Rate None N/A 01-23 100/300
L07I Individual Life - Whole L07I.101
Fixed/Indeterminate Premium - Single Life
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.101 Fixed/Indeterminate Premium - Single Life
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.102 Fixed/Indeterminate Premium - Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.102 Fixed/Indeterminate Premium - Joint (First to Die)
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.103 Fixed/Indeterminate Premium - Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.103 Fixed/Indeterminate Premium - Joint (Last Survivor)
Rate None N/A 01-13 100/400 No rate filing required for life insurance
Page 76 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L07I.104 Fixed/Indeterminate Premium - Single Life - Funeral Expense
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.104 Fixed/Indeterminate Premium - Single Life - Funeral Expense
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.111 Single Premium - Single Life
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.111 Single Premium - Single Life
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.112 Single Premium - Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.112 Single Premium - Joint (First to Die)
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.113 Single Premium -Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.113 Single Premium -Joint (Last Survivor)
Rate None N/A 01-13 100/400 No rate filing required for life insurance
Page 77 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L07I.114 Single Premium - Single Life - Funeral Expense
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.114 Single Premium - Single Life - Funeral Expense
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.121 Graded Premium - Single Life
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.121 Graded Premium - Single Life
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.122 Graded Premium - Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.122 Graded Premium - Joint (First to Die)
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.123 Graded Premium -Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.123 Graded Premium -Joint (Last Survivor)
Rate None N/A 01-13 100/400 No rate filing required for life insurance
Page 78 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L07I.124 Graded Premium - Jumping Juvenile (Term to Age X, Whole Life Thereafter)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.124 Graded Premium - Jumping Juvenile (Term to Age X, Whole Life Thereafter)
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.201 Early Duration Reduced Benefit - Level Premium - Any Policy Design
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.201 Early Duration Reduced Benefit - Level Premium - Any Policy Design
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.202 Early Duration Reduced Benefit - Level Premium - Any Policy Design - Funeral Expense
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.202 Early Duration Reduced Benefit - Level Premium - Any Policy Design - Funeral Expense
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.211 Early Duration Reduced Benefit -Single Premium - Any Policy Design
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.211 Early Duration Reduced Benefit -Single
Rate None N/A 01-13 100/400 No rate filing required for life insurance
Page 79 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
Premium - Any Policy Design
L07I.212 Early Duration Reduced Benefit -Single Premium - Any Policy Design - Funeral Expense
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.212 Early Duration Reduced Benefit -Single Premium - Any Policy Design - Funeral Expense
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.301 Current Assumption - Fixed Premium -Single Life
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.301 Current Assumption - Fixed Premium -Single Life
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.302 Current Assumption - Fixed Premium -Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.302 Current Assumption - Fixed Premium -Joint (First to Die)
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.303 Current Assumption - Fixed Premium -Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.303 Current Assumption - Fixed Premium -Joint (Last
Rate None N/A 01-13 100/400 No rate filing required for life insurance
Page 80 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
Survivor)
L07I.311 Current Assumption - Single Premium Single Life
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.311 Current Assumption - Single Premium Single Life
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.312 Current Assumption - Single Premium Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.312 Current Assumption - Single Premium Joint (First to Die)
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.313 Current Assumption - Single Premium Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.313 Current Assumption - Single Premium Joint (Last Survivor)
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.321 Current Assumption - Indeterminate Premium - Single Life
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.321 Current Assumption -
Rate None N/A 01-13 100/400 No rate filing required for life insurance
Page 81 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
Indeterminate Premium - Single Life
L07I.322 Current Assumption - Indeterminate Premium - Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.322 Current Assumption - Indeterminate Premium - Joint (First to Die)
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.323 Current Assumption - Indeterminate Premium -Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.323 Current Assumption - Indeterminate Premium -Joint (Last Survivor)
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.401 Adjustable - Current Assumption -Indeterminate Premium - Single Life
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.401 Adjustable - Current Assumption -Indeterminate Premium - Single Life
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.402 Adjustable - Current Assumption -Indeterminate Premium - Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
Page 82 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L07I.402 Adjustable - Current Assumption -Indeterminate Premium - Joint (First to Die)
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.403 Adjustable - Current Assumption -Indeterminate Premium -Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.403 Adjustable - Current Assumption -Indeterminate Premium -Joint (Last Survivor)
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.501 External Index - Level Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.501 External Index - Level Premium
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.502 External Index - Level Premium - Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.502 External Index - Level Premium - Joint (First to Die)
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.503 External Index - Level Premium - Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.503 External Index - Level Premium - Joint
Rate None N/A 01-13 100/400 No rate filing required for life insurance
Page 83 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
(Last Survivor)
L07I.511 External Index - Single Premium
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.511 External Index - Single Premium
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.512 External Index - Single Premium - Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.512 External Index - Single Premium - Joint (First to Die)
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L07I.513 External Index - Single Premium - Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-13 100/400 Exempt
L07I.513 External Index - Single Premium - Joint (Last Survivor)
Rate None N/A 01-13 100/400 No rate filing required for life insurance
L08 Life - Other L08.000 Life - Other Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-00 100/200/300/400/ 500
Exempt
L08.000 Life - Other Rate None N/A 01-00 100/200/300/ 4 00/500
No rate filing required for life insurance
L09G Group Life - Flexible Premium Adjustable Life
Page 84 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L09G.001 Single Life Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-20 100/300 Exempt
L09G.001 Single Life Rate None N/A 01-20 100/300 No rate filing required for life insurance
L09G.002 Joint (Last Survivor)
Form Cover letter, Certificate 01-20 100/300 Exempt
L09G.002 Joint (Last Survivor)
Rate None N/A 01-20 100/300 No rate filing required for life insurance
L09G.003 Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-20 100/300 Exempt
L09G.003 Joint (First to Die)
Rate None N/A 01-20 100/300 No rate filing required for life insurance
L09G.101 External Indexed - Single Life
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-20 100/300 Exempt
L09G.101 External Indexed - Single Life
Rate None N/A 01-20 100/300 No rate filing required for life insurance
L09G.102 External Indexed - Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-20 100/300 Exempt
L09G.102 External Indexed - Joint (First to Die)
Rate None N/A 01-20 100/300 No rate filing required for life insurance
Page 85 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L09G.103 External Indexed - Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-20 100/300 Exempt
L09G.103 External Indexed - Joint (Last Survivor)
Rate None N/A 01-20 100/300 No rate filing required for life insurance
L09I Individual Life - Flexible Premium Adjustable Life
L09I.001 Single Life Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-10 100/400 Exempt
L09I.001 Single Life Rate None N/A 01-10 100/400 No rate filing required for life insurance
L09I.002 Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-10 100/400 Exempt
L09I.002 Joint (Last Survivor)
Rate None N/A 01-10 100/400 No rate filing required for life insurance
L09I.003 Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-10 100/400 Exempt
L09I.003 Joint (First to Die)
Rate None N/A 01-10 100/400 No rate filing required for life insurance
Page 86 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
L09I.101 External Indexed - Single Life
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-10 100/400 Exempt
L09I.101 External Indexed - Single Life
Rate None N/A 01-10 100/400 No rate filing required for life insurance
L09I.102 External Indexed - Joint (First to Die)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-10 100/400 Exempt
L09I.102 External Indexed - Joint (First to Die)
Rate None N/A 01-10 100/400 No rate filing required for life insurance
L09I.103 External Indexed - Joint (Last Survivor)
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-10 100/400 Exempt
L09I.103 External Indexed - Joint (Last Survivor)
Rate None N/A 01-10 100/400 No rate filing required for life insurance
LTC01 Long Term Care - Assumption Agreement
LTC01.000 Long Term Care - Assumption Agreement
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-00 100 Prior Approval
LTC02G Group Long Term Care - Home Health Care Only
Page 87 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
LTC02G.001 Qualified Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-60 100/200/400 Prior Approval
LTC02G.001 Qualified Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-60 100/200/400 Exempt
LTC02G.002 Non Qualified Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-60 100/200/400 Exempt
LTC02G.002 Non Qualified Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-60 100/200/400 Exempt
LTC02I Individual Long Term Care -Home Health Care Only
LTC02I.001 Qualified Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-60 100/200/300 Prior Approval
Page 88 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
LTC02I.002 Non Qualified Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-60 100/200/300 Prior Approval
LTC03G Group Long Term Care
LTC03G.001 Qualified Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-60 100/200/400 Prior Approval
LTC03G.001 Qualified Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-60 100/200/400 Exempt
LTC03G.002 Non Qualified Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-60 100/200/400 Exempt
LTC03I Individual Long Term Care
LTC03I.001 Qualified Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-60 100/200/300 Prior Approval
Page 89 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
LTC03I.002 Non Qualified Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-60 100/200/300 Prior Approval
LTC04G Group Long Term Care - Nursing Home
LTC04G.001 Qualified Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-60 100/200/400 Prior Approval
LTC04G.001 Qualified Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-60 100/200/400 Exempt
LTC04G.002 Non Qualified Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-60 100/200/400 Exempt
LTC04I Individual Long Term Care - Nursing Home
LTC04I.001 Qualified Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-60 100/200/300 Prior Approval
Page 90 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
LTC04I.002 Non Qualified Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-60 100/200/300 Prior Approval
LTC05G Group Long Term Care -Nursing Home & Home Health Care
LTC05G.001 Qualified Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-60 100/200/400 Prior Approval
LTC05G.001 Qualified Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-60 100/200/400 Exempt
LTC05G.002 Non Qualified Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-60 100/200/400 Exempt
LTC05I Individual Long Term Care - Nursing Home & Home Health Care
LTC05I.001 Qualified Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-60 100/200/300 Prior Approval
Page 91 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
LTC05I.002 Non Qualified Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-60 100/200/300 Prior Approval
MS01 Medicare Supplement -Assumption Agreement
MS01.000 Medicare Supplement - Assupmtion Agreement
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-44 100 Prior Approval
MS02G Group Medicare Supplement -Pre-Standardized
MS02G.000 Medicare Supplement - Pre-Standardized
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/400 Prior Approval
MS02I Individual Medicare Supplement -Pre-Standardized
MS02I.000 Medicare Supplement - Pre-Standardized
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/300 Prior Approval
MS03G Group Medicare Supplement -Medicare + Choice
MS03G.000 Medicare Supplement - Medicare + Choice
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/400 Prior Approval
MS03I Individual Medicare Supplement -Medicare + Choice
MS03I.000 Medicare Supplement - Medicare + Choice
Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/300 Prior Approval
Page 92 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
MS04G Group Medicare Supplement - Medicare Select
MS04G.001 Plan A Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/400 Prior Approval
MS04G.002 Plan B Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/400 Prior Approval
MS04G.003 Plan C Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/400 Prior Approval
MS04G.004 Plan D Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/400 Prior Approval
MS04G.005 Plan E Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/400 Prior Approval
Page 93 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
MS04G.006 Plan F (Basic) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/400 Prior Approval
MS04G.007 Plan F (High) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/400 Prior Approval
MS04G.008 Plan G Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/400 Prior Approval
MS04G.009 Plan H Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/400 Prior Approval
MS04G.010 Plan I Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/400 Prior Approval
Page 94 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
MS04G.011 Plan J (Basic) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/400 Prior Approval
MS04G.012 Plan J (High) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/400 Prior Approval
MS04G.013 Plan K Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/400 Prior Approval
MS04G.014 Plan L Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/400 Prior Approval
MS04I Individual Medicare Supplement -Medicare Select
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Page 95 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form
SC Line Code DOI Series
How Filing Handled Rate
MS04I.001 Plan A Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/300 Prior Approval
MS04I.002 Plan B Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/300 Prior Approval
MS04I.003 Plan C Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/300 Prior Approval
MS04I.004 Plan D Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/300 Prior Approval
MS04I.005 Plan E Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/300 Prior Approval
Page 96 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form
SC Line Code DOI Series
How Filing Handled Rate
MS04I.006 Plan F (Basic) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/300 Prior Approval
MS04I.007 Plan F (High) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/300 Prior Approval
MS04I.008 Plan G Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/300 Prior Approval
MS04I.009 Plan H Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/300 Prior Approval
MS04I.010 Plan I Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/300 Prior Approval
MS04I.011 Plan J (Basic) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/300 Prior Approval
Page 97 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form
SC Line Code DOI Series
How Filing Handled Rate
MS04I.012 Plan J (High) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/300 Prior Approval
MS04I.013 Plan K Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/400 Prior Approval
MS04I.014 Plan L Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-43 100/200/400 Prior Approval
MS05G Group Medicare Supplement -Standard Plans
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
MS05G.001 Plan A Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/400 Prior Approval
MS05G.002 Plan B Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/400 Prior Approval
Page 98 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
MS05G.003 Plan C Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/400 Prior Approval
MS05G.004 Plan D Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/400 Prior Approval
MS05G.005 Plan E Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/400 Prior Approval
MS05G.006 Plan F (Basic) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/400 Prior Approval
MS05G.007 Plan F (High) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/400 Prior Approval
MS05G.008 Plan G Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/400 Prior Approval
Page 99 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
MS05G.009 Plan H Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/400 Prior Approval
MS05G.010 Plan I Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/400 Prior Approval
MS05G.011 Plan J (Basic) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/400 Prior Approval
MS05G.012 Plan J (High) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/400 Prior Approval
MS05G.013 Plan K Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/400 Prior Approval
MS05G.014 Plan L Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/400 Prior Approval
Page 100 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
MS05I Individual Medicare Supplement -Standard Plans
Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
MS05I.001 Plan A Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/300 Prior Approval
MS05I.002 Plan B Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/300 Prior Approval
MS05I.003 Plan C Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/300 Prior Approval
MS05I.004 Plan D Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/300 Prior Approval
MS05I.005 Plan E Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/300 Prior Approval
Page 101 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form Rate
SC Line Code DOI Series
How Filing Handled
MS05I.006 Plan F (Basic) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/300 Prior Approval
MS05I.007 Plan F (High) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/300 Prior Approval
MS05I.008 Plan G Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/300 Prior Approval
MS05I.009 Plan H Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/300 Prior Approval
MS05I.010 Plan I Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/300 Prior Approval
MS05I.011 Plan J (Basic) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/300 Prior Approval
Page 102 of 103
South Carolina Department of Insurance Life, Accident and Health Matrix
Type of Insurance Sub-Type of Insurance
Filing Types Accepted (Please include Combos, Advertisements, Endorsements, Applications, Informational, if applicable) Form
SC Line Code DOI Series
How Filing Handled Rate
MS05I.012 Plan J (High) Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/300 Prior Approval
MS05L013 Plan K Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/300 Prior Approval
MS05L014 Plan L Form/Rate Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
Actuarial memorandum and rates
55-44 100/200/300 Prior Approval
ML01 Multi-Line - Assumption Agreement
ML01.000 Multi-Line - Assumption Agreement
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
55-00 100 Prior Approval
ML02 Multi-Line - Other ML02.000 Multi-Line - Other
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-55-10
100/200/300 Prior Approval
ML02 Multi-Line - Other ML02.000 Multi-Line - Other
Form Cover letter, Certificate of Readability, Certification of Compliance, LAH Third Party Authorization - if applicable, Forms Applicable
01-55-20
100/200/400 Exempt
Page 103 of 103