§403.232. Requirements and procedures for obtaining certification. — Inbound Citations

(a) The emblem is a graphic symbol, approved by HHS, that indicates that CMS has certified a policy as meeting the requirements of the voluntary certification program, specified in § 403.232.

(b) If the requirements specified in § 403.232 are met, CMS will—

(1) Certify the policy; and

(2) Authorize the insuring organization to display the emblem on the policy, as provided for in § 403.231.

(a) For purposes of requesting CMS certification under § 403.232, the insuring organization must submit the following loss ratio data to CMS for review—

(1) A statement of why the policy is to be considered, for purposes of the loss ratio standards, an individual or a group policy.

(3) The general marketing method and the underwriting criteria used for the selection of applicants to whom coverage is offered.

(vii) Expected distribution, by age and sex, of persons who will purchase the policy in the coming year.

(A) The process used to select insureds from among those that apply for a policy; and

(i) The policy continues to meet the requirements specified in § 403.232(a); and

(i) The policy fails to meet the requirements specified in § 403.232(a); or

(1) Any changes in the material, specified in § 403.232(b), that was submitted for previous certification.

(i) The original material submitted to CMS for review, as specified in § 403.232(b) or § 403.239(a); and

(a) For purposes of certification requests submitted under § 403.232(b) and subsequent review as specified in § 403.239(a), statement of actuarial opinion means a signed declaration in which a qualified actuary states that the assumptions used in calculating the expected loss ratio are appropriate and reasonable, taking into account actual policy experience, if any, and reasonable expectations.