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ACA Compliant Rate Filing Guidance

​The following guidance provides rate filing requirements for major medical and certified SADP plans. This guidance is not exhaustive. Health plan issuers are responsible to review and comply with all applicable state and federal law.

Tentative Rate Filing Deadlines:

  • March 27, 2019 - Student Health Plans for the 2019/2020 school year
  • May 20, 2019 - All SADPs that are on-exchange and/or off-exchange certified
  • July 1, 2019 - On-exchange Individual and Small Group major medical plans
  • July 24, 2019 - Off-exchange ONLY Individual and Small Group major medical plans
  • September 9, 2019 - Large Group major medical plans

 

Ohio Rate Filing Requirements

  • Ohio ACA Rate Filing Guidance and Checklist
    T
    his checklist should be used in submitting all ACA compliant On-Exchange and Off-Exchange major medical products and On-Exchange and Off-Exchange Certified Stand Alone Dental Plan (SADP) products.

  • 2020 Part 1 Unified Rate Review Template v5.0 (URRT) - Not applicable to SADPs
    The URRT is required for all single risk pool plans in the individual and small group medical markets, including single risk pool plans that experience rate increases, rate decreases, or no rate changes, as well as new single risk pool plans. Important! Please attach both an Excel (.xls) and a .pdf version of the completed URRT.
  • 2020 Part III Actuarial Memorandum and Certifications - Not applicable to SADPs
    Required for single risk pool plans in the individual and small group medical markets, Part III is an Actuarial Memorandum that includes the actuarial reasoning and assumptions, justifications, and methodologies that support the entries in the Unified Rate Review Template (URRT). Important! Only an unredacted version of the Part III Actuarial Memorandum and Certifications is required for the Ohio rate filing submission in SERFF.

Draft 2020 PY Unified Rate Review instructions and the URRT v5.0 were posted to HIOS on 3/11/2019 with the following CMS Note:
 
"Note: The revised Unified Rate Review Template and instructions are currently under review by the Office of Management and Budget (OMB). The template is therefore subject to change. An issuer who uses the template published in HIOS' URR module on March 11, 2019 for purposes of submitting quarterly filings for 2019 or annual filings for 2020 will be deemed to be in compliance with the requirement to file its rate justification data on a form prescribed by the Secretary even if that form differs from what is ultimately approved."

 

Special Notes Re: 2020 PY Stand Alone Dental Plan (SADP) Rate Filing Requirements

  • A rate filing with supporting actuarial documents is required for 2020 plan year recertification of all SADPs unless both of the following conditions are met:
    • There is no change in rates from the approved 2019 PY rates; and
    • Trend was not used in developing the approved 2019 PY rates.
       
  • Certification by a credentialed Actuary that both conditions are met must be filed in SERFF in lieu of the 2020 PY rates.

 

Guidance and Information

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Ohio Department of Insurance
50 W. Town Street, Third Floor - Suite 300
Columbus, Ohio  43215
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Mike DeWine, Governor | Jillian Froment, Director
General Info: 614-644-2658 | Consumer Hotline: 800-686-1526
Fraud Hotline: 800-686-1527 | Medicare Hotline: 800-686-1578