Filing requirements​

Binders must be submitted via SERFF

Templates Tab needs to include:

Plan templates can be found at: www.serff.com/hix.htm

CMS Review tools can be found at: https://login.serff.com/StateQHPReview2015.html

  1. Administrative Data Template (in Exchange)
  2. Plan and Benefits Template (in & out of Exchange)
  3. Prescription Drug Template (in & out of Exchange)​
  4. Network Template (in & out of Exchange)
  5. Service Area Template (in & out of Exchange)
  6. Essential Community Providers Template (in Exchange)
  7. Rate Data Template (in & out of Exchange)
  8. Rating Business Rules Template (in & out of Exchange)

Supporting Documentation Tab needs to include:

  1. Binder Cover letter
  2. Certificate of Compliance: Word,   PDF
  3. Product Standards: Word,   PDF
  4. Plan Relativities and Supporting Exhibits: Word,  PDF
  5. Summary of Benefits and Coverage (SBC)
  6. Essential Community Provider Supplemental Response Form
  7. Partial Service Area Justification
  8. Unique Plan Design Supporting Documentation and Justification
  9. EHB Substituted Benefit Justification
  10. Formulary - inadequate Category/Class Count Justification
  11. Limited Cost Sharing Plan Variation  (required if the issuer wants to receive advance payments)
  12. Part I - Unified Rate Review Template
  13. Part III - Actuarial Memorandum
  14. Program Attestations for SBE Issuers

Note: Link source provided when possible.

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Current filing forms

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Helpful hints
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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.

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