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IDOI > Company Compliance > Accident & Health  > Product Filing Information/Instructions  > INDIVIDUAL NON-QUALIFIED HEALTH PLANS (NONQHPs) FILING INSTRUCTIONS for MAJOR MEDICAL and HMO INDIVIDUAL NON-QUALIFIED HEALTH PLANS (NONQHPs) FILING INSTRUCTIONS for MAJOR MEDICAL and HMO

(NOT PARTICIPATING/OFF the HEALTH INSURANCE EXCHANGE)

(INCLUDING NON-EMPLOYER ASSOCIATIONS and/or TRUSTS)

All filings must be submitted via SERFF and include the following information for form and/or rate filings:

Form Filing Instructions

  1. Complete the appropriate checklist for the filing submitted.
    1. 10(A) Individual Checklist
    2. 12(A) Individual HMO Checklist
    3. 20(C) Out of State Association/Trust Products Checklist
  2. Include applicable filing requirements.
    1. 4.1(B) NonQHP Individual New Rate/Form
      1. Requirement applies to new rates and/or forms filed.
        (Provide data for sections II, III and IV if the form filing affects rates or benefit structure.)
    2. Provide the SERFF Tracking Number(s) for prior and/or current rate filings related to the form filing within the last 18 months. Include data under the General Information tab in the Filing Description field.
  3. Add the form number to the lower left-hand corner of the first page of the policy and to relevant documents, such as riders and amendments.
    1. Documents must be in final print form.
    2. Form numbers cannot be variable.

Rate Filing Instructions

  1. Complete the appropriate checklist for the filing submitted.
    (Some sections may not be relevant to rate filings.)
    1. 10(A) Individual Checklist
    2. 12(A) Individual HMO Checklist
    3. 20(C) Out of State Association/Trust Products Checklist
  2. Include applicable filing requirements.
    1. 4.1(B) NonQHP Individual New Rate/Form
      1. Requirement applies to new rates and/or forms filed.
    2. 7.0(B) NonQHP Individual Rate Adjustment
      1. Requirement applies to rate adjustments for existing rates as an increase, decrease or rate neutral.
  3. Include related policy form numbers.
  4. Complete Rate Summary Worksheet or Unified Rate Review Template (URRT)- Worksheet 1 and 2.
  5. Complete the following required data templates via SERFF: Prescription Drug Template, Rates Template and Unified Rate Review Template (URRT) as listed above. (The URRT is required for rate increase above 0%.) Templates are available at http://www.serff.com/plan_management_data_templates.htm.
    1. To provide adequate actuarial value information, submit one of the following data sets in your preferred format: (1) Sufficient data for every plan and cost sharing variations to determine the actuarial value or (2) A copy of the actuarial value calculator output page for each plan and cost sharing variation.
  6. Complete Major Medical Experience Workbook.
    1. Applicable to rate adjustments for existing rates.
    2. Include as an attachment under the Supporting Documentation tab in SERFF with the file name “Experience Workbook.”
  7. Complete filing Attestations.

    *If a carrier plans to offer coverage for child only and/or catastrophic plans, reference the Individual QHPs/EHBs Filing Instructions for On an Exchange and/or Individual EHB Filing Instructions for Off an Exchange and complete requirements as applicable.

    *Product filings fees for rates and policy forms must be submitted via Electronic Funds Transfer (EFT) at the time of filing submission. View General Instructions in SERFF for additional details.