SERFF Tracking #: ZURC State Tracking #: Company Tracking #: CW OL 35534
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1 Product Name: Primary Health Care Liability Policy Endorsements Filing at a Glance Company: Product Name: State: TOI: Sub-TOI: Filing Type: Zurich American Insurance Company Primary Health Care Liability Policy Endorsements Wisconsin 17.0 Other Liability-Occ/Claims Made Professional Errors & Omissions Liability Form Date Submitted: 01/29/2013 SERFF Tr Num: SERFF Status: State Tr Num: State Status: ZURC Closed-Filed Co Tr Num: CW OL Effective Date Requested (New): Effective Date Requested (Renewal): Author(s): Reviewer(s): 03/01/ /01/2013 Jennifer Atilano Disposition Date: 02/04/2013 Disposition Status: Effective Date (New): Effective Date (Renewal): Shasta Hoffhein (primary) Filed
2 Product Name: Primary Health Care Liability Policy Endorsements General Information Project Name: Primary Health Care Liability Policy Endorsements Project Number: CW OL Reference Organization: Reference Title: Filing Status Changed: 02/04/2013 Status of Filing in Domicile: Not Filed Domicile Status Comments: Reference Number: Advisory Org. Circular: State Status Changed: Deemer Date: 02/27/2013 Created By: Jennifer Atilano Corresponding Filing Tracking Number: Filing Description: Submitted By: Jennifer Atilano We submit for review and approval, one new endorsement, U-HCU-908-A CW, Locum Tenens Health Care Providers. U- HCU-908-A CW is intended to be used with the Health Care Professional Liability Coverage Part previously approved under Serff Tracking Number ZURC Please see the Explanatory Memorandum for further details. Company and Contact Filing Contact Information Jennifer Atilano, Filing Analyst 1400 American Lane Schaumburg, IL Filing Company Information Zurich American Insurance Company 1400 American Lane Schaumburg, IL (847) ext. [Phone] [Phone] CoCode: Group Code: 212 Group Name: FEIN Number: State of Domicile: New York Company Type: State ID Number: Filing Fees Fee Required? Retaliatory? Fee Explanation: No No
3 Product Name: Primary Health Care Liability Policy Endorsements Correspondence Summary Dispositions Status Created By Created On Date Submitted Filed Shasta Hoffhein 02/04/ /04/2013
4 Product Name: Primary Health Care Liability Policy Endorsements Disposition Disposition Date: 02/04/2013 Effective Date (New): Effective Date (Renewal): Status: Filed Comment: Used with form filings that are subject to file & use under s (1)(c) and (1m) Wis. Stat. Effective July 1st, 2008, changes in insurance law exempted certain policy forms from receiving prior approval before use. This filing may be used 30 days after receipt by OCI. USE DATE:02/27/2013 Rate data does NOT apply to filing. Schedule Schedule Item Schedule Item Status Public Access Supporting Document Certification of Compliance and Readability Filed Yes Supporting Document Appraisal or Arbitration Provision Filed Yes Supporting Document Explanatory Memorandum Filed Yes Form Locum Tenens Health Care Providers Filed Yes
5 Product Name: Primary Health Care Liability Policy Endorsements Form Schedule Item Schedule Item Form Form Edition Form Form Action Specific Readability No. Status Name Number Date Type Action Data Score Attachments 1 Filed 02/04/2013 Locum Tenens Health Care Providers U-HCU- 908-A CW END New Form U-HCU- 908-A CW Locum Tenens - Health Care Providers.pdf Form Type Legend: ABE Application/Binder/Enrollment ADV Advertising BND Bond CER Certificate CNR Canc/NonRen Notice DEC Declarations/Schedule DSC Disclosure/Notice END Endorsement/Amendment/Conditions ERS Election/Rejection/Supplemental Applications OTH Other
6 Endorsement # Locum Tenens Health Care Providers Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer Add l Prem. Return Prem. Named Insured and Mailing Address: Producer: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: Health Care Professional Liability - Claims Made Coverage Part Section II WHO IS AN INSURED, Paragraph B. is amended to include the following: Any temporary health care provider (locum tenens): Substituted for a physician, podiatrist, dentist, nurse midwife or certified registered nurse anesthetist who is: a. Employed by the Named Insured; and b. Included as an Additonal Insured under this Coverage Part, but only for their duties in such physician's podiatrist's, dentist's, nurse midwife's or certified registered nurse anesthetist's absence and on behalf of the Named Insured. Such substitution shall not exceed thirty (30) consecutive days. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. Includes copyrighted material of Insurance Services Office, Inc., with its permission. U-HCU-908-A CW (12/12) Page 1 of 1
7 Product Name: Primary Health Care Liability Policy Endorsements Supporting Document Schedules Item Status: Status Date: Satisfied - Item: Certification of Compliance and Readability Filed 02/04/2013 Comments: Attachment(s): Wisconsin Cert Signed.pdf Item Status: Status Date: Bypassed - Item: Appraisal or Arbitration Provision Filed 02/04/2013 Bypass Reason: n/a Item Status: Status Date: Satisfied - Item: Explanatory Memorandum Filed 02/04/2013 Comments: Attachment(s): Explanatory Memorandum U-HCU-908-A CW Locum Tenans - Health Care Providers.pdf
8 CERTIFICATE OF COMPLIANCE AND READABILITY I, Peter J. Eckardt (name), an officer of Zurich American Insurance Company (company name), hereby certify that I have authority to bind and obligate the company by filing this (these) form(s). I further certify that, to the best of my information, knowledge and belief: 1. The accompanying form(s) as identified by the attached listing comply(ies) with all applicable provisions of the Wisconsin Statutes and with all applicable administrative rules of the Commissioner of Insurance. 2. The form(s) does (do) not contain any inconsistent, ambiguous, or misleading clauses. 3. The form(s) does (do) not contain specification or conditions that unreasonably or deceptively limit the risk purported to be assumed in the general coverage of the policy form(s). 4. The only variations from a form currently on file with the commissioner of insurance and the only unconventional policy provisions are clearly marked or otherwise indicated pages n/a of the attached form(s) or in an attachment. 5. The attached form(s) is(are) in final format exactly as will be offered for issuance or delivery in Wisconsin, except for hypothetical data and other appropriate variable material. 6. If this form is a consumer insurance policy, the text of the form(s) meet(s) the minimum reading ease score or, if authorized by the commissioner, the score is lower than the minimum required by s. Ins 6.07(4)(a)1., Wis. Adm. Code. Product used to determine the Flesch score: n/a. LH 631 (Ed. 1/12) Wolters Kluwer Financial Services Uniform Forms TM
9 I understand that the commissioner of insurance will rely on this certification regarding the forms filed, and should it be determined that the policy form(s) does(do) not comply with the applicable laws, regulations, filing requirements and product standards or that this certification is materially false or incorrect, appropriate corrective and disciplinary action, including retroactive disapproval, as authorized by law, may be taken by the commissioner against the company and the officer completing this certification. (Signature) Vice President (Title) 1/28/2013 (Date) Individual responsible for this filing: Name: Jennifer Atilano Title: Regulatory Services Analyst Address: 1400 American Lane, Schaumburg, IL Phone Number: 847/ Date: 01/28/13 LH 631 (Ed. 1/12) Wolters Kluwer Financial Services Uniform Forms TM
10 Locum Tenens Health Care Providers U-HCU-908-A CW Explanatory Memorandum This filing is to submit one new endorsement, U-HCU-908-A CW, Locum Tenens Health Care Providers. U-HCU-908-A CW provides coverage for locum tenens health care providers as detailed in the endorsement replacing physicians employed and covered under the policy. U- HCU-908-A-CW is an optional endorsement at the request of the insured. The insured learns about the endorsement at the request of the insured's agent or broker. There is no rate impact associated with this endorsement. U-HCU-908-A CW is intended to be used with the Health Care Professional Liability Coverage Part.
TOI: 11.2 Med Mal-Claims Made Only Sub-TOI: 11.2003 Chiropractic
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More informationTOI: LTC03I Individual Long Term Care SERFF Status: Closed-Filed State Tr Num: 50253. Authors: Julie Maclin, Joan Disposition Date: 11/14/2011
Filing at a Glance Company: Transamerica Life Insurance Company SERFF Tr Num: AEGJ-127820390 State: Arkansas TOI: LTC03I Individual Long Term Care SERFF Status: Closed-Filed State Tr Num: 50253 Sub-TOI:
More informationSERFF Status: Closed State Tr Num: EFT $25 Made/Occurrence
Project Name/Number: GL Forms In Response To Terrorism Risk Insurance Program Reauthorization Act Of 2007/08-091-001-GL-AR Filing at a Glance Company: QBE Insurance Corporation Product Name: GL Forms In
More informationFor Informational Purposes Sub-TOI: L08.000 Life - Other Co Tr Num: WANDA HILL State Status: Filed-Closed
Project Name/Number: / Filing at a Glance Company: United of Omaha Life Insurance Company 2009 Drop Ticket Informational SERFF Tr Num: MUTM-126496393 State: Arkansas Letter TOI: L08 Life - Other SERFF
More informationTOI: 35.0 Interline Filings Sub-TOI: 35.0002 Commercial Interline Filings
SERFF Tracking Number: SEPX-126145911 State: Wisconsin Filing Company: Sentry Insurance a Mutual Company State Tracking Number: Company Tracking Number: ML WI0949601F01 TOI: 35.0 Interline Filings Sub-TOI:
More informationWEST VIRGINIA OFFICE OF THE INSURANCE COMMISSIONER Workers Compensation Insurance Review Standards Checklist
Workers Compensation REVIEW REQUIREMENTS REFERENCE COMMENTS FORMS Applications REFERENCE COMMENTS Fee, filing 33-6-34 The Filing Fee is $50.00 per Form filing and applies on a per company basis. Submission,
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SERFF Tracking Number: AMGN-126032695 State: Arkansas Filing Company: AIG Life Insurance Company State Tracking Number: 41647 Company Tracking Number: LIFE U/W QUESTIONNAIRES TOI: L08 Life - Other Sub-TOI:
More informationSERFF Tracking #: AESP-128603015 State Tracking #: Company Tracking #: ICC 12 OL 3004 0812
Product Name: TransACE Long Term Care Rider Consumer Flyer Filing at a Glance Company: Product Name: State: TOI: Sub-TOI: Filing Type: Transamerica Life Insurance Company TransACE Long Term Care Rider
More informationTOI: 17.2 Other Liability-Occ Only Sub-TOI: 17.2001 Commercial General Liability
/ Filing at a Glance Company: Great American Spirit Insurance Company SERFF Tr Num: GRTA-125596599 State: Wisconsin TOI: 17.2 Other Liability-Occ Only SERFF Status: Closed State Tr Num: Sub-TOI: 17.2001
More informationFiling at a Glance. General Information. Company and Contact
SERFF Tracking Number: MRKB-125255859 State: Arkansas First Filing Company: Markel American Insurance Company,... State Tracking Number: AR-PC-07-025803 Company Tracking Number: 0706FF068 TOI: 17.0 Other
More informationFiling at a Glance. General Information
MS05G Group - Standard Sub- Filing at a Glance Company: UnitedHealthcare Insurance Company SERFF Tr Num: UHLC-126138844 State: ArkansasLH MS05G Group - SERFF Status: Closed State Tr Num: 42298 Standard
More informationSERFF Tracking #: USAA-130216478 State Tracking #: Company Tracking #: PA1520097
State: Pennsylvania First Filing Company: Garrison Property and Casualty Insurance Company,... Filing at a Glance Companies: State: TOI: Sub-TOI: Filing Type: Garrison Property and Casualty Insurance Company
More informationSERFF Status: Closed-Filed- State Tr Num: 43499 9/14/09 A156314 AR PRU
Project Name/Number: / Filing at a Glance Company: Pruco Life Insurance Company Group Filing 9/14/09 A156314 AR PRU TOI: A03I Individual Annuities - Deferred Variable Sub-TOI: A03I.002 Flexible Premium
More informationFiling at a Glance. Metropolitan Life Insurance Company GCERT2000 Series - Business Overhead Expense
SERFF Tracking #: META-128701397 State Tracking #: Company Tracking #: T12-135 - State: Arkansas Filing Company: Metropolitan Life Insurance Company TOI/Sub-TOI: H11G Group Health - Disability Income/H11G.001
More informationThis advertising material is new and does not replace any advertisements filed by Genworth Life Insurance Company.
SERFF Tracking Number: GEFA-125987509 State: Wisconsin Filing Company: Genworth Life Insurance Company State Tracking Number: Company Tracking Number: TOI: LTC03I Individual Long Term Care Sub-TOI: LTC03I.001
More informationWe respectfully submit the above Rider for your review and approval. It is new and does not replace any like forms previously filed with your state.
Filing at a Glance Company: Fidelity Security Life Insurance Company Refractive Surgery {and Loss of SERFF Tr Num: FDLT-125073215 State: Wisconsin Sight} Benefit Rider TOI: H20G Group Health - Vision SERFF
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/ Filing at a Glance Company: Western-Southern Life Assurance Company Single Premium Whole Life SERFF Tr Num: WSST-125087774 State: Wisconsin 2006/Legacy Master/Schedule Page Informational/WSLAC/CH TOI:
More informationSERFF Tracking #: FHLA-129477086 State Tracking #: Company Tracking #: DCL6RATES
SERFF Tracking #: FHLA-129477086 State Tracking #: Company Tracking #: DCL6RATES State: District of Columbia Filing Company: Family Heritage Life Insurance Company of America TOI/Sub-TOI: Product Name:
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SERFF Tracking Number: MLLM-126729865 State: Arkansas Filing Company: Kemper Investors Life Insurance Company State Tracking Number: 46401 Company Tracking Number: 0146PAL02-08 TOI: L09I Individual Life
More informationSERFF Tracking #: CNNA-130482819 State Tracking #: Company Tracking #: CQ-CSFA-16-4001-DC
Product Surety Filing at a Glance Companies: Product State: TOI: Sub-TOI: Filing Type: The Cincinnati Casualty Company The Cincinnati Insurance Company Surety District of Columbia 24.0 Surety 24.0000 Surety
More informationStatus of Filing in Domicile:
Filing at a Glance Company: Marquette National Life Insurance Company SERFF Tr Num: UNAM-126105722 State: ArkansasLH TOI: MS06 Medicare Supplement - Other SERFF Status: Closed State Tr Num: 42074 Sub-TOI:
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/ Filing at a Glance Company: John Hancock Life Insurance Company (U.S.A.) SERFF Tr Num: MNLE-126559929 State: Wisconsin TOI: LTC06 Long Term Care - Other SERFF Status: Closed-Filed State Tr Num: Sub-TOI:
More informationDebbie Kingsley, Alycia Sumbera, Melissa Sample, Kathleen Collins, Erik Blasko, Verlyn Colbert
Product Name: Age-In Prospecting DM Mailer - LOYAL Filing at a Glance Company: Product Name: State: Loyal American Life Insurance Company Age-In Prospecting DM Mailer - LOYAL District of Columbia TOI:
More informationA05I.000 Annuities - Immediate Non-variable Variable Access Account Payout Life Annuities
Filing at a Glance Company: Access Account Payout Life SERFF Tr Num: TCRE-125874453 State: ArkansasLH Annuities SERFF Status: Closed State Tr Num: 40688 A05I.000 Annuities - Immediate Nonvariable Co Tr
More informationSERFF Tracking #: BFLI-128726934 State Tracking #: Company Tracking #: AR B 21092 TV3
Product Name: Medicare Supplement Television Commercials Filing at a Glance Company: Product Name: State: Bankers Fidelity Life Insurance Company Medicare Supplement Television Commercials Arkansas TOI:
More informationCompany: 5 Star Life Insurance Company Product Name: Individual Life - Term SERFF Tr Num: FIVE-126096912 State: Arkansas
TOI: L04I Sub-TOI: L04I.500 Other Filing at a Glance Company: 5 Star Life Insurance Company SERFF Tr Num: FIVE-126096912 State: Arkansas TOI: L04I SERFF Status: Closed-Approved- State Tr Num: 42009 Closed
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SERFF Tracking Number: GARD-126259680 State: Wisconsin Filing Company: Company Tracking Number: The Guardian Life Insurance Company of America State Tracking Number: TOI: H11I Individual Health - Disability
More informationSERFF Tracking #: MEAM-128778084 State Tracking #: Company Tracking #: DC FC ACTUARIAL ADDENDUM_DISCOUNTS
SERFF Tracking #: MEAM-128778084 State Tracking #: Company Tracking #: DC FC ACTUARIAL ADDENDUM_DISCOUNTS State: District of Columbia Filing Company: MedAmerica Insurance Company TOI/Sub-TOI: LTC06 Long
More informationProject Number: SVF PX Date Approved in Domicile: 02/09/2010
Project Name/Number: / Filing at a Glance Company: Transamerica Financial Life Insurance Company SERFF Tr Num: AEGN-127173488 State: Arkansas TOI: A03G Group Annuities - Deferred Variable SERFF Status:
More informationSERFF Tracking #: DDPA-129574186 State Tracking #: Company Tracking #: DIC, O15HCR GRP PPO DC, RATES
SERFF Tracking #: DDPA-129574186 State Tracking #: Company Tracking #: DIC, O15HCR GRP PPO DC, RATES State: District of Columbia Filing Company: Dentegra Insurance Company TOI/Sub-TOI: Product Name: H10G
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Project Name/Number: / Filing at a Glance Company: John Hancock Life Insurance Company (U.S.A.) SERFF Tr Num: MNLE-126553946 State: Arkansas TOI: LTC06 Long Term Care - Other SERFF Status: Closed-Filed
More informationSERFF Tracking #: MASS-129194940 State Tracking #: Company Tracking #: 2013 RADIUS STUDENT DISCOUNT
SERFF Tracking #: MASS-129194940 State Tracking #: Company Tracking #: 2013 RADIUS STUDENT DISCOUNT State: District of Columbia Filing Company: Massachusetts Mutual Life Insurance Company TOI/Sub-TOI:
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