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 (CCIIO)

  1. Plan and Benefits Template
  2. Prescription Drug Template
  3. Service Area Template
  4. ECP/Network Adequacy Template
  5. Rate Data Template
  6. 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. Formulary - inadequate Category/Class Count 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. QIS Implementation and Progress Report form
  16. Discrimination - Treatment Protocol Supporting Documentation and Justification

Note: Link source provided when possible.

FAQ for 2017


Current filing forms

Helpful hints
Associations, Trusts and Discretionary Groups

Effective July 1, 2007, Oregon law changed the division's regulation of Associations, Trusts, and MEWAs. Refer to detailed filing requirements on the links below.