The following form filing guidance and resources have been updated for Plan Year 2020, and are intended to provide health plan issuers with information regarding form content requirements and the relevant statutes, rules, and bulletins. This guidance is not exhaustive and intended as a reference tool. Health plan issuers are responsible to review and comply with all applicable state and federal law.
ACA Form Filing Guidance Document:
The Ohio Department of Insurance has developed ACA Compliant Form Filing Guidance to provide comprehensive instructions for the development of Affordable Care Act compliant form filings in the individual, non-employer group, and small group markets. The manual identifies important terms and provides filing instructions and information about document development. Failure to follow the instructions in this manual may result in delay or disapproval of a filing.
The following documents must be completed (as applicable) and attached on the Supporting Documents tab of the filing in SERFF:
- ACA Form Filing Checklists
- The form checklists listed below are applicable to Individual, Non-Employer Group and Small Employer Group Non-Grandfathered ACA compliant products, effective January 1, 2020. The checklists are intended as guides for the preparation of ACA form filings to identify and summarize relevant statutes, rules, and bulletins but are not an exhaustive or complete statement of all applicable requirements and provisions. Please refer to the Ohio Revised Code, Ohio Administrative Code and other applicable law for complete information.
- ACA form filing checklists are included as form filing Requirements in SERFF. A completed checklist applicable to the type of product filing must be submitted under the SERFF Supporting Documentation Tab:
Ohio Essential Health Benefit (EHB) Locator Worksheet
- EHB Locator Worksheet confirms and identifies the form number and page location of Essential Health Benefits. The filer also identifies when the coverage exceeds the Benchmark Plan (including limitations/exclusions), or when actuarial equivalent coverage is substituted. Any exceptions to the Ohio Benchmark Plan coverage must be noted and explained. The EHB Locator worksheet is not required for Pediatric Stand-Alone Dental Plans.
ACA Off Exchange Only Rx EHB Worksheet
- A completed Off Exchange Rx EHB Worksheet is required for each distinct formulary that will be used for plans that are required to comply with ACA Essential Health Benefit (EHB) drug coverage and will only be offered Off Exchange. Do not complete this worksheet for any plan that will be offered On Exchange.
ACA Compliant Form Filing Resources
- Ohio Essential Health Benefits
- Ohio Benchmark Plans