Form must be typed.
Include the Company’s Mississippi Privilege License number as the State Tracking
For Type of Insurance
- Accident and Health
- Medicare Supplement
- Long Term
- Care HMO
For the Product Coding, use the appropriate numeric code listed in the column TOI
of the NAIC Uniform Life, Accident & Health Annuity and Credit Coding Matrix. If
filing is a paper submission, include two (2) copies of the Transmittal Document
and a self-addressed stamped envelope.
Mississippi Filing Fee Form.pdf is required. Completed Form and remittance enclosed
with paper filings. If a SERFF filing, include copy of Form with the electronic
filing, and a copy of the Form should be forwarded with remittance to the Mississippi
Insurance Department, Actuarial Division, P. O. Box 79, Jackson, MS 39205-0079.
When filing a rate increase for any type Accident and Health policies, note the
information and Rate Increase Information form which must be included. Refer to
MSRATE.pdf and RII 7/02.pdf. Certification is required.