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.