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Rate Filing Guidance


Information has been updated below for the 2018 Plan Year!

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.


Important Notices!

Updated as of August 10, 2017 

Large Group Rate Filing Deadline
The deadline for 2018 PY large group rate filings has been extended to September 12, 2017.



Ohio Rate Filing Requirements


2018 EHB Compliant Major Medical and Stand Alone Dental Plans

CMS released the final instructions for issuers to complete Unified Rate Review Reporting for Single Risk Pool Plans. These instructions apply to the 2018 PY and are available on the CCIIO QHP website at: https://www.qhpcertification.cms.gov/s/Unified%20Rate%20Review


SERFF has been updated as of 4/24/2017, with 2018 PY

Supporting Documentation requirements:

  1. Ohio ACA Rate Filing Guidance and Checklist (see link in bottom section of this page)
    This checklist is 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.

    NOTE:  This checklist is a new requirement for SADP rate filings for the 2018 PY (see additional information in "Special Notes" section below for SADP rate filings).  For major medical rate filings, the only change from the 2017 checklist version is to update the PY dates.  It is acceptable for major medical issuers to submit 2018 PY rate filings using either the 2017 PY or the 2018 PY checklist version.

  2. 2018 Part 1 Unified Rate Review Template (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.

  3. 2018 Part III Actuarial Memorandum and Certifications
    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.
Final 2018 PY Unified Rate Review instructions and the URRT have been posted by CMS on the CCIIO QHP website at: https://www.qhpcertification.cms.gov/s/Unified%20Rate%20Review
Special Notes Re: 2018 PY Stand Alone Dental Plan (SADP) Rate Filing Requirements
  1. A rate filing with supporting actuarial documents is required for 2018 plan year recertification of all SADPs unless both of the following conditions are met:

    a) There is no change in rates from the approved 2017 PY rates; and

    b) Trend was not used in developing the approved 2017 PY rates. Trend was not used in developing the approved 2017 PY rates.

    Certification by a credentialed Actuary that both conditions are met must be filed in SERFF in lieu of the 2018 PY rates.

  2. Completion of the Ohio ACA Rate Filing Guidance and Checklist is a new requirement that was just posted in SERFF for 2018 PY SADP rate filings.  SADP filers that started drafting their 2018 PY filings in SERFF prior to this change may submit the filing using the 2017 PY list of requirements, but should also review the new checklist from the link below to determine if any additional information needs to be provided based on the new checklist information.
    SADP filers completing the new checklist for their 2018 PY filing should use the column for major medical filings in "Rate Filing Checklist" (pgs. 4-8) to enter information for applicable checklist items and should enter "N/A" for checklist items that are not applicable to SADPs.
  3. The 2018 PY "SADP Actuarial Value Supporting Documentation and Justification" form and the "SADP - Description of EHB Allocation" form will not be required as Supporting Documentation for 2018 PY SADP Rate or Form filings. However, the 2018 PY versions of these forms must be completed and submitted in response to the applicable Supporting Document requirements in the corresponding SADP 2018 PY certification Binder filing submission.



Updated as of April 7, 2017 

Ohio Rate Filing Deadlines

2018 EHB Compliant Health Plans and 2017/2018 Student Health Plans
The rate filing deadlines for (1) student health plans, (2) both on-exchange and off-exchange major medical plans and (3) both on-exchange and off-exchange certified Stand Alone Dental Plans (SADPs) are provided below:
ODI will continue to monitor the policy changes being discussed in Washington and how those may impact health insurance in Ohio.  However, the revised timelines we are outlining below are likely final for submissions related to plan year 2018. 
Rate Filing Market Type
Ohio Filing Deadline
Student Health Plans
  - for the 2017/2018 School Year
March 27, 2017
Certified SADPs
April 30, 2017 NEW!
Individual & Small Group Major Medical Plans
June 5, 2017 NEW!


ACA Rate Filing Resources​


The State of Ohio is an Equal Opportunity Employer

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