Accident & Health Rate Filing and Plan Management Binder Information and Instructions

Rate (and Form/Rate) Filings

All Rate Filings for Accident & Health must be submitted via SERFF and include:

1. related policy form numbers
2. an Actuarial Memorandum (outlines below)
3. an Experience Workbook

Additionally, all fields in SERFF are expected to be completed. Guidance on the most important fields can be found in Required Rate Fields in SERFF, which can also be found on the Supporting Documentation tab in SERFF.

For full details of Filing requirements, see the Indiana General Instructions in SERFF.

Plan Management Binder Submissions

All ACA compliant Major Medical and Dental plans must be submitted annually in a Binder through Plan Management in SERFF. If there are changes to rates or forms, then a Rate or Form/Rate filing would also need to be submitted in SERFF. Note that all Plan Management templates and other documents that are submitted in HIOS must be identical to the same templates and documents in SERFF. Thus, updated templates and documents must be submitted to both HIOS and SERFF concurrently.

For full details of Plan Management requirements, see the Indiana Plan Management General Instructions. This can also be found in SERFF.

Filing Fees

Product filing fees for rates and policy forms must be submitted via Electronic Funds Transfer (EFT) at the time of filing submission. There are no filing fees for Binder Submissions. View General Instructions on the Filing Rules tab in SERFF for additional details.

Actuarial Memorandum Outlines

• Dental
  • Used for all rate related Dental fillings.
• Major Medical
  • Used for all rate related Major Medical filings except for Short Term Major Medical, which uses the Basic Actuarial Memorandum Outline.
• Long Term Care
  • Used for all rate related LTC filings.
• Medicare Supplement
  • Used for all rate related Medicare Supplement filings.
• Basic
  • Used for all rate related Accident and Health filings that don't use the Dental, Major Medical, Long Term Care, or Medicare Supplement Actuarial Memorandum Outlines.

Experience Workbooks

Required for all filings.

• Experience Workbook (updated 9/13/2018)
  • Used for all rate related non-LTC filings.
  • Experience Workbook Instructions (updated 9/19/2018)
  • Experience Workbook Glossary (updated 9/19/2018)
• Long Term Care
  • Used for all rate related LTC filings.

IDOI and Plan Management Templates

• IDOI Data Templates
  • IDOI EHB Verification
  • IDOI Rate and Crosswalk
• Plan Management Templates
  • These can be found in SERFF via the links on the Templates tab of the Binders, or on CMS.gov Qualified Health Plans page. 
• IDOI Clinical Appropriateness Review
  • Guidance
  • Clinical Appropriateness Review (Master drug list and subgroup review tool updated 7/11/2018)

Rate Changes for Transitional Major Medical and Student Plans

Transitional Major Medical includes Non-Grandfathered plans issued between March 23, 2010 and December 21, 2013. Any change in rates needs to be submitted using a Rate Review Justification (RRJ) sheet. Please read the instructions in the link below. These filings will be done using a rate only type in SERFF. They will need an actuarial memorandum, experience workbook and the RRJ. For rate increases greater than 15%, a concurrent filing in HIOS is needed. 

Both the instructions and the RRJ Template itself can be found either by doing a search for "RRJ" at CMS.gov, or (as of 4/9/2015) as the first two links showing at http://www.cms.gov/site-search/search-results.html?q=RRJ. 

Questions related to submitting Accident/Health Rate Filings should be directed to:

Karl Knable
317-232-2416
kknable@idoi.in.gov