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Use this form if you are filing a form or rate for life or health insurance. Complete the following: A. List all form numbers submitted with this filing and give a brief description of the purpose coverage for each form.The Health Bureau accepts accident and health policy form and rate filings submitted electronically through SERFF. • Adoption of Review Standard Checklists for many kinds of rate and form filings. LISTING OF CURRENT FILING FORMS AS OF April 19, 2023. Please review the applicable Administrative Code for the full text of the regulation. (d) Transmittal checklist requirement. Make a concise statement of the product filing issue addressed. This checklist must be submitted with any form or rate filings for Group Long Term Care (LTC) policies. Check our Filings Section for instructions on how to make new forms filings.