Statutes, codes, and regulations
California Code Of Regulations
Title 10 - InvestmentChapter 5 - Insurance CommissionerSubchapter 2 - Policy Forms and Other Documents
Article 1 - Document Submission and Approval Procedures; Fees
Section 2216 - Document Submission Form

Cal. Code Regs. tit. 10 § 2216

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Current through Register 2024 Notice Reg. No. 50, December 13, 2024
Section 2216 - Document Submission Form
(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 NumberDocument Type (e.g., Policy, Rider, etc.)Subdivision(s) of Cal. Code Regs., tit. 10 § 2202(a)Department ActionFee
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FILER INSTRUCTIONS: Make entries on the form to the left of theTOTAL:
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.

Cal. Code Regs. Tit. 10, § 2216

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.

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.