California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1 - Document Submission and Approval Procedures; Fees › Section 2216 - Document Submission Form

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Submissions of all documents described in
				  subdivisions (1) through (12) of Section
				  2202(a) shall
				  include a Document Submission Form, in the form set forth in subdivision (b) of
				  this Section
				  2216. Submitters shall complete
				  the Document Submission Form according to the instructions on the Document
				  Submission Form.
The Commissioner may note disapprovals or nonacceptances
					 for filing on a copy of the Document Submission Form returned to the submitter
					 or by letter. Upon Approval or Acknowledgement for Filing, the Commissioner
					 shall return one copy of the Document Submission Form to the submitter. The
					 Commissioner shall indicate the Commissioner's action on each document
					 submitted in the appropriate column adjacent to the form number of the document
					 in accordance with Section
					 2217.
(b) California Department of Insurance
				  Document Submission Form.
California Insurer Number (Not NAIC
							 Number):
FOR DEPARTMENT USE ONLY
CDI file
							 number:
Insurer Name:
[] PAB
							 [] AO [] HPAB [] HAO
Reviewer:
Submitter email and US mail
							 addresses:
Comments:
Initial Submission Date:
Department Action Date:
Document Form Number
Document
							 Type (e.g., Policy, Rider, etc.)
Subdivision(s) of Cal. Code Regs.,
							 tit. 10 §
														2202(a)
Department Action
Fee
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
FILER INSTRUCTIONS:
Make
							 entries on the form to the left of the
TOTAL:
triple vertical line. For each document
							 being submitted, enter the document
number and a plain language description
							 of the document type. Use additional Document Submission Forms as
							 necessary.
Page __________ of _____
(c)
				  Documents described in different subdivisions of Section
				  2202(a) of this
				  Article shall not be submitted with the same Document Submission Form unless
				  they are part of the same contract. Forms intended for use in both group and
				  individual products shall be submitted only as individual forms, except where
				  the individual form is not subject to filing; forms intended for use in both
				  life and disability products shall be submitted only as disability forms. A
				  form containing supplemental life benefits as defined in section
				  2202(a)(7),
				  above, shall be submitted according to the document class of the contract of
				  which the supplemental life benefits are a part. For example, if a variable
				  life insurance policy form contains supplemental life provisions, the policy
				  form shall be filed as a variable life insurance policy form. In contrast, if a
				  rider to a variable life insurance policy contains only supplemental life
				  disability provisions and is filed alone, without the variable life insurance
				  policy, the rider shall be filed as a supplemental life disability
				  form.
(d) Document Submission Forms
				  accompanying rate filings shall display the form numbers of the documents to
				  which the rates apply in the "Document Form Number" column and "Rates" in the
				  "Doc Type" column.
(e) The
				  Commissioner reserves the right to require Document Submission Forms with
				  submissions of any other documents which must be submitted for action. Such
				  requirement may be imposed by prior notice to affected submitters by Bulletin,
				  Notice or letter.
1.
					 Renumbering of former section
					 2216 to section
					 2216(e) and
					 renumbering of former section
					 2215 to section
					 2216(a)-(d),
					 including amendment of section heading and section and repealer and new NOTE
					 filed 2-11-97; operative 3-13-97 (Register 97, No. 7).
2. Amendment
					 of section heading, section and NOTE filed 2-4-2016; operative 4-1-2016
					 (Register 2016, No. 6).
3. Change without regulatory effect amending
					 subsection (a) filed 7-14-2021 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2021, No. 29). Filing deadline specified in Government
					 Code section
					 11349.3(a)
					 extended 60 calendar days pursuant to Executive Order
					 N-40-20.
Note: Authority cited: Sections
						742.43,
						779.21,
						10168.92,
						10192.3,
						10234,
						10292,
						10327,
						10506,
						10506.3,
						10704,
						12921.6 and
						12973.9,
						Insurance Code. Reference: Sections
						742.42,
						779.8,
						795.5,
						1320,
						10112.5,
						10113.95(c),
						10123.36,
						10123.135,
						10123.137(d),
						10133.5,
						10163.35,
						10168.93,
						10181.3,
						10192.13(a)(7),
						10192.14(b)(1),
						10192.15,
						10192.19,
						10192.22,
						10198.61,
						10205,
						10225,
						10231.2,
						10231.6,
						10232,
						10234.9,
						10234.93,
						10234.97,
						10236.11,
						10236.13,
						10270,
						10270.1,
						10270.2,
						10270.3,
						10270.5,
						10270.507,
						10270.57,
						10270.9,
						10270.93,
						10271,
						10271.1,
						10290,
						10292,
						10295.2,
						10436,
						10506,
						10705,
						10717,
						10753.05,
						10753.17,
						11066,
						11069,
						11658,
						12921.6 and
						12973.9,
						Insurance Code.