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Plan binders

Filing requirements

Binders must be submitted via SERFF

Templates Tab needs to include:

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. Prescription Drug Template
  3. Service Area Template
  4. Transparency in Coverage Template (on-exchange only)
  5. Network ID Template
  6. ECP/Network Adequacy Template
  7. Rate Data Template
  8. Rating Business Rules Template

Supporting Documentation Tab needs to include:

  1. Binder Cover letter
  2. Certificate of Compliance: Word | PDF
  3. Product Standards: Word | PDF
  4. Summary of Benefits and Coverage (SBC)
  5. Essential Community Provider Supplemental Response Form
  6. Partial Service Area Justification
  7. Unique Plan Design Supporting Documentation and Justification
  8. EHB Substituted Benefit Justification
  9. Combined prescription drug supporting documentation and justification
  10. Limited Cost Sharing Plan Variation (required if the issuer wants to receive advance payments)
  11. Part I - Unified Rate Review Template
  12. Part III - Actuarial Memorandum
  13. Program Attestations for SBE Issuers
  14. Plan ID Crosswalk Template
  15. Discrimination - Treatment Protocol Supporting Documentation and Justification
  16. Initial Binder Review Questions 

Note: Link source provided when possible.

FAQ for 2023