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Combined Insurance Company of America


Friday, November 8, 2013
Reference: 
ACEH-129262999

This is a new filing. These new forms will not replace any existing forms. Please note the following: 

  • The Group Policy that will be used with this filing is the previously approved Group Policy Form No. P13999-DC which was approved by your Department on 12/12/2012 under SERFF Tracking No. CMBD-128786748. The Group Policy Form No. P13999-DC is a policy provides individual or family coverage. The Group Certificate Form No.C16670-DC provides limited benefits for specified critical illnesses. 
  • The forms are being filed for use both for in-state and out-of state use: 
  • If issued to a true employer, association or a trust group, the group policy that will be issued will be the group policy that is approved for use where the employer, association or trust is located. 
  • Variable items within the forms are denoted in brackets. All bracketed items are explained in the variability memorandum which is attached under the Supporting Documentation tab. 
  • All required transmittals, certifications, and checklist are attached, if applicable. 

These forms are intended for issue to eligible groups through a trust or directly to the group. The types of groups to be covered include specifically, but are not limited to, employer/employee groups; labor unions and similar employee organizations; bona fide associations; and credit unions.

Status:  Assigned

Percent Change: 0.000%

HIRFAssigned

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