toll free telephone number / prosthetic devices / out-of-area emergency services / large / Certain employers / care of terminal illness / applicable provider network / gynecological services / health care services / gynecologic cytology screening technologies / wellness services / healthcare / out-ofnetwork emergency services / early intervention services / co-insurance / insurance fraud / network emergency services / insurance coverage / out-of-network services / obstetrical services / federal insurance laws / ambulance services / hospice services / treatment of breast cancer / health insurance / assistive technology services / treatment for the diagnosis of autism spectrum disorder / sickness insurance / individual applications / radiologic imaging / treatment of that specific type of cancer / healthcare professional / ancillary services / insurance contracts / telemedicine services / postpartum services / health carrier / hospital-medical-surgical product / /
MedicalCondition
Colorectal Cancer / Autism Spectrum Disorder / personal injuries / Hospital Stay/Anesthesia Morbid Obesity / prostate cancer / illness / breast cancer / hemophilia / physical illness / congenital defects / cancer / lymphedema / diabetes / Sickness / orally administered cancer / intractable cancer pain / pain / Terminal Illness / congenital bleeding disorders / serious dysfunction / morbid obesity / /
MedicalTreatment
chemotherapy / physical therapy / breast surgery / occupational therapy / hysterectomy / pain management / gastric bypass surgery / Mastectomy / /
Organization
Department of Health Notice / Medicare / Financial Regulation Division / FDA / State Corporation Commission Bureau of Insurance / office of the Managed Care Ombudsman / Department of Health and Human Services / Department of Health / Service Area Complaints Bureau of Insurance / /
Person
John Doe / / /
Position
attorney / personal representative / COB / physician / General Counsel / Additional SERFF Filing Requirements General / officer / actuary / participating obstetrician-gynecologist / board-certified physician / Major / REVIEW REQUIREMENTS General / /
Form Filing Review Checklist LARGE GROUP MAJOR MEDICAL INSURANCE, PREFERRED PROVIDER ORGANIZATIONS, HOSPITAL-MEDICAL-SURGICAL Notice: This checklist and the Mental Health Parity and Addiction Equity Act checklist, must b