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ACA Form Filing Checklists

​The following supporting documents are required for non-grandfathered ACA Compliant Individual, Non-Employer Group, and Small Group form submissions.

Form Filing Submission Checklists:

The form checklist confirms the location of selected state and federal requirements within the forms. It is not exhaustive, and review of all applicable law is required. This consolidated checklist replaces the multiple, subject-specific checklists previously required. There are three versions:

When the checklist is required:

The applicable form checklist must be submitted with all new policy/certificate of coverage form filings. The form checklist does not need to be filed for a rider, amendment or endorsement to an ODI previously approved form filing.


The State of Ohio is an Equal Opportunity Employer

Ohio Department of Insurance
50 W. Town Street, Third Floor - Suite 300
Columbus, Ohio  43215
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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