Description of Review

Contact Person: Illinois Division of 320 West Washington Insurance Street Cindy Colonius Review Requirements Springfield, IL 62767- Checklist 0001 217-782-4572 [email protected] Line(s) of Line(s) of Business Insurance Accidental Death Individual and Group Benefits – Individual and Group Policy Riders Products (Riders) Illinois Insurance Code Illinois Compiled Link Statutes Online Illinois Administrative Code Administrative Link Regulations Online Product Coding Matrix Product Coding Matrix LOCATION OF REVIEW REQUIREMENTS REFERENCE DESCRIPTION OF REVIEW STANDARD IN FILING STANDARDS REQUIREMENTS NOTE: These brief summaries do not include all requirements of all laws, regulations, bulletins, or requirements, so review actual law, regulation, bulletin, or requirement for details to ensure that forms are fully compliant before filing with the Department of Insurance. FORM FILING REFERENCE DESCRIPTION OF REVIEW STANDARDS LOCATION OF REQUIREMENTS REQUIREMENTS STANDARD IN FILING Review Requirements Go to Review Each filing must include a completed Review Checklist Requirements Requirements Checklist that must contain a Checklists on DOI web completed “Location of Standard in Filing” column for site. See next column each required element of the filing. Please indicate the proper page # and form # for each entry. Cover Letter and Letter of 50 IL Adm. Code In addition to referencing any previously approved Submission 1405.20 (e) form number(s) as required by 50 IL Adm. Code 50 IL Adm. Code 1405.20(e), those references must also include the 2001.30 (a) (3) filing number and SERFF tracking number (if 50 IL Adm. Code applicable and available) for the referenced forms. 916.40 (b) Letters of submission must generally describe the intent and use of the form being filed and, if applicable, how it will be used with any previously approved form(s). ADMINISTRATIVE CODE REFERENCE DESCRIPTION OF REVIEW STANDARDS PROVISIONS REQUIREMENTS Company Name 50 IL Adm. Code The name of the company shall appear on the form. 1405.20 c) 1) Appropriate Descriptive Title 50 IL Adm. Code There must be an appropriate, unambiguous title 1405.20 c) 5) describing the form.

1 215 ILCS 4/143(1) Accidental Cause 50 IL Adm. Code Supplemental benefits may be added to a life policy, 1405.40 p) 1) even though Accidental Death, Dismemberment and Loss of Eyesight Benefits are limited to accidental cause. Accidental Means 50 IL Adm. Code Accidental means test requires that both the cause 1405.40 p) 2) and result of the accident be an accident. Direct Result Language 50 IL Adm. Code Only direct result language is permitted. The phrase Requirement 1405.40 p) 2) or "independent of all other causes" is prohibited.

Prohibited Language 50 IL Adm. Code Provisions for loss due to accident or accidental injury 1405.40 p) 2) shall not contain language limiting, reducing, or 50 IL Adm. Code excluding liability for a loss resulting from purely 1405.40 p) 3) accidental circumstances such as “involuntary”, or “unintentional”. Words such as "external", "violent" or "visible wound" are prohibited.

Contributory Language 50 IL Adm. Code Contributory language such as “indirectly”, “wholly or Prohibited 1405.40 p) 2) in part”, or “contributed to by” is prohibited. GENERAL INFORMATION REFERENCE DESCRIPTION OF REVIEW STANDARDS REQUIREMENTS Additional Benefits 50 IL Adm. Code Accidental Death Benefits are considered additional 1405.40 p) 1) benefits. These benefits must be paid in addition to the basic policy death benefit. Schedule Page 50 IL Adm. Code The schedule page or data page must indicate the Requirement 1405.40 p) 1) amount of the basic death benefit in one column and the amount of the accidental death benefit in a separate column to make it clear that the accidental death benefit will be paid in addition to the basic death benefit. Prohibited Exclusion – 50 IL Adm. Code Forms containing provisions excluding hazardous Hazardous Sports 1405.20(a)(3)(B) sports (i.e. scuba diving, hang-gliding, motorcycle racing, race car or stock car racing, etc. are prohibited.

Prohibited Exclusion for 50 IL Adm. Code Exclusions such as “that results from or arises out of Past or Present 1405.40 p) 3) any past or present employment or occupation for Employment 215 ILCS 5/143(1) compensation or profit” are prohibited.

Prohibited Exclusion - 50 IL Adm. Code Exclusions for loss resulting from a purely Ingestion of 1405.40(p) accidental circumstance such as involuntary, or poison/inhalation of 215 ILCS 5/143(1) unintentional ingestion of poison or infectious poisonous gases or 215 ILCS 5/401 organism, or inhalation of poisonous gases or fumes. fumes are prohibited.

DEPARTMENT REFERENCE DESCRIPTION OF REVIEW STANDARDS POSITIONS REQUIREMENTS Benefit Restrictions 215 ILCS 5/143(1) Surgical reattachment, coma, critical burn, exposure, loss of use or paralysis, loss of speech and/or hearing

2 are not considered Accidental Death and Dismemberment benefits. Exclusion Limitations 215 ILCS 5/143(1) Benefits may not be excluded for loss that results from the actions of someone other than the insured’s. Prohibited Exclusion - Illegal 215 ILCS 5/143(1) Exclusions that use language regarding illegal acts or Acts/Illegal Activity 215 ILCS 5/401 illegal activity are not permitted.

Limitation on Exclusion for 50 IL Adm. Code Use of drugs may only be excluded for the insured's Drug Use 1405.40 (p) intentional use of illegal drugs or intentional misuse of 215 ILCS 5/143(1) prescription or over the counter drugs (not taken as 215 ILCS 5/401 directed).

Limitation for Exclusion for 50 IL Adm. Code Intoxication may only be excluded if the loss is the Intoxication 1405.40(p) direct result of the insured's intoxication above the 215 ILCS 5/143(1) legal limit. 215 ILCS 5/401