Iously-approved forms for a similar product and a summary of the differences between the approved similar form and the new form. 3. The differences between in-network and out-of-network. 4. The contact information of two people that can answer questions about this filing. The following are submitted in this filing for review: 1. New policy and certificate, if applicable. 2. Amendment to an approved form. 3. Endorsements and/or riders being attached to a policy or contract that was approved by OI.
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How to fill out the OR 440-4978 online
The OR 440-4978 form is critical for submission related to exchange certified pediatric dental insurance in Oregon. This guide provides a comprehensive walkthrough to help users complete the form accurately and efficiently.
Follow the steps to successfully complete and submit the OR 440-4978 form online.
- Press the ‘Get Form’ button to acquire the OR 440-4978 form and open it in your preferred online editor.
- Begin the form by entering the insurer's name at the top of the form. This information must be accurate and legible.
- Input the date of the filing in the designated field. Ensure that the date reflects the actual submission date.
- Select the appropriate Type of Insurance (TOI) code from the provided options, ensuring it aligns with your filing specifics.
- Complete the Marketing section by indicating whether this is an Individual Health - Dental, Small Group, Group Health - Dental Stand Alone, or Embedded within medical forms.
- Fill in the SERFF number related to your filing if applicable. This is crucial for tracking purposes.
- Specify whether the form is for coverage 'Inside exchange only,' 'Outside exchange only,' or 'Both inside and outside exchange.'
- For policies also covering adults, check that you submit the additional Form 440-3172A along with this form, if necessary.
- Complete all required fields within the General Requirements and General Form Requirements sections, ensuring compliance with all indicated provisions.
- Review your entries to prevent any omitted information or incomplete sections, as this will lead to disapproval of your filing.
- Finalize the form by saving your changes. You may choose to download a copy, print it, or share it as required.
Complete your OR 440-4978 filing online today to ensure compliance with Oregon's pediatric dental insurance regulations.
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