Form must be typed.
Include the Company’s Mississippi Privilege License number as the State Tracking ID.

For Type of Insurance
  • Life
  • 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.