Health benefit plans – individual major medical

​​​​Filing requirements

Insurers offering health benefit plans in the individual and small group major medical market are required to follow annual filing timelines, and provide additional information to the Division of Financial Regulation and Centers for Medicare and Medicaid Services (CMS), one of the federal agencies responsible for Affordable Care Act health reform implementation. Because individual health plan information is eventually uploaded to electronic platforms for annual enrollment shopping, the division only accepts filings through SERFF.

For 2026 plans, please also see: Additional filing requirements for 2026 Health Plans

1. NAIC Transmittal Form and Product Coding matrices for completing transmittal forms
2. Instructions for the Cover Letter (or Filing Description)
3. Health plan templates ​(Use Ctrl+page up or Ctrl+page down to navigate tabs and exhibits)​
   Note: Insurers are required to use the most recent version of the templates.
4. Major medical, health benefit plan review timeline
5. Product standards:
   • Individual form filings: Word | PDF
   • Small group form filings: Word | PDF
   • Rate filings: PDF
   • Binder Filings: Word | PDF
   • In addition to being posted at https://www.qhpcertification.cms.gov/s/Application%20Instructions
   • Filers must download and use the latest version of the Excel templates when submitting QHP applications in SERFF or HIOS. Please ensure the success of your QHP submission, whether filing it via SERFF or HIOS, by completing the most current version of the template.
6. Readability Certification
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7. Standard Review Questions