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Dental binders

Filing requirements

Templates:

All templates required whether on or off the Exchange. Current plan templates and supporting documentation can be found at: Qualified Health Plan Application Instructions, Templates and Materials (QHP)

  1. Plan and Benefits Template
  2. Service Area Template
  3. ECP/Network Adequacy Template
  4. Transparency in Coverage Template (on-exchange only)
  5. Network ID Template
  6. Rate Data Template
  7. Business Rules Template

Submission Requirements:

  1. Binder Cover letter
  2. Certificate of Compliance: Word | PDF
  3. Essential Community Provider Supplemental Response Form
  4. Product Standards: Word | PDF
  5. Program Attestations for SBE Issuers
  6. Partial County Service Area Justification
  7. Stand-Alone Dental Plans-Description of EHB Allocation
  8. SADP Actuarial Value Supporting Documentation and Justification
  9. Plan ID Crosswalk Template

Note: Link source provided when possible.

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