Filing Requirements FAQ

  • Updated 05/03/17

FAQ
Will issuers be offered training on how to use the System for Electronic Rate/Form Filing (SERFF) for form and rate submissions?

SERFF is providing training. Please visit www.serff.com/serff_health_insurance_plan_management.htm for more information. Those on the SERFF email list will be notified of the scheduled trainings.

Will DIFS be customizing SERFF to meet the state's needs?

SERFF has added Michigan specifications as requested by DIFS; limited changes were made by Michigan. See Bulletin 2014-06-INS and Bulletin 2014-08-INS for QHP and Stand-Alone Dental (respectively) filing guidance.

Will plans be required to submit all non-grandfathered products that are applicable to Small Group and Individual products, regardless of whether they are on/off exchange?

Yes, as required under Bulletin 2011-14-INS.

Will the Department of Health and Human Services (HHS) be reviewing and approving plans and rates offered off the exchange? How does this apply to grandfathered plans?

No, HHS will not be reviewing and approving plans and rates offered off the exchange whether they are grandfathered or non-grandfathered plans.

When we apply to have our plans certified as QHP's, is that considered an application for participation on the exchange or is that a different step?

Yes, certification of a QHP constitutes certification for participation on the Marketplace. As a Partnership state, Michigan will submit recommendations to HHS regarding QHP certification and recertification; HHS will receive, approve (as appropriate), implement, and oversee a state's certification and recertification recommendations. However, all health plans sold, whether on the Marketplace or off the Marketplace, must be qualified health plans; it is the certification of these plans that make them eligible for the Marketplace. DIFS does not certify off Marketplace products but does review the plans for EHB compliance.

What will DIFS expect to be included in the filing of the compliance plan, organizational chart, and other initial plan data collection materials?

A complete set of instructions for the 2015 plan year QHP application will be available soon. It will be located on the CMSzONE website for States and Issuers. It will cover general QHP application instructions, including issuer module, benefits and service area module, rating module and justifications.

Can you clarify, as a Federally Facilitated Marketplace (FFM) partnership model, what, if anything, do issuers have to submit through the HIOS process - as opposed to the SERFF process?

Issuers must access the Health Insurance Oversight System (HIOS) to obtain a HIOS user ID. With the exception of the Unified Rate Review Table (URRT), issuers will submit everything to DIFS through SERFF for review and approval, DIFS will transmit the approved binders containing required information and data to HHS. The (URRT must be submitted to DIFS and HIOS separately. The HIOS submission deadline is the same as the DIFS deadline (6/9/14 on Marketplace; 9/15/14 for off Marketplace).

Are there specific filing requirements for Medicaid-only HMOs that want to expand into the commercial market, using the Marketplace?

There are HMOs in Michigan that offer only the Medicaid/MiChild products. If one of these HMOs decides to expand their product offering into the commercial-side of the market, there is no carry-over from the Medicaid side of the market. All form, rate, network adequacy filings that would be required of an HMO in the commercial market must be made. In addition, the SERFF binder filings and the templates would be required.

What provider network, network adequacy, and service area templates are required to be filed in the binder to provide commercial products on the Marketplace?

For HMOs in Michigan that offer only Medicaid products and wish to expand into the commercial-side of the market, there are templates that must be completed on the SERFF binder filings, specifically for network adequacy and service area. These are: (1) Michigan Data Template; (2) Essential Community Providers (ECP) Template; and (3) Service Area Template. These items need to be completed to get approval.

Please confirm if DIFS will require issuers to submit the two-year enrollment projections as required when health plans expand into new service areas for Medicaid/MIChild. If so, will filing be required as part of the HIX SERFF templates or separately?

The DIFS Michigan Network Data Template [Request Summary] requires an issuer to provide three years of enrollment projections for each county the issuer's QHPs will be offered on the Marketplace. The template is to be completed and included in the company's Binder(s) submission through SERFF. The following is a link to the DIFS web page containing the Michigan Network Data Template and instructions. http://www.michigan.gov/difs/0,5269,7-303-13047_13049---,00.html

Please confirm that there are no other requirements for Medicaid-only HMOs other than those identified above for participation on the HIX.

DIFS considers it a service area expansion when a Medicaid-only HMO elects to expand its line of business to include offering commercial individual or small group coverage on the Marketplace. As is required for service area expansions, the HMO must submit two years of financial projections, in addition to its three year membership projections. Financial projections should include a balance sheet, income statement, cash flow, and Risk Based Capital (RBC) level. If a HMO with a commercial line of business files an individual and/or group Binder which includes new counties for which DIFS has not granted service area approval, it must submit two years of financial projections in addition to its three year membership projections for those new counties. Financial projections should include a balance sheet, income statement, cash flow, and RBC level. In either scenario, the financial projections are to be submitted in the supporting documentation tab.

Please confirm that no additional components must be filed with DIFS related to licensing, other than those listed above, to satisfy the notice filing requirement in MCLA ยง 500.3557.

MCL 500.3557(e) requires a HMO to file notice with the Director of any significant changes in operations. A HMO with a commercial line of business offering QHPs on the Marketplace would not be considered a significant change in operations. A Medicaid-only HMO expanding to commercial business by offering individual and/or small group on the Marketplace would be considered a significant change in business. DIFS considers the Medicaid-only HMO's filing of certificates of coverage, rates and binders in SERFF as acceptable notification of the HMO's change in operations and compliance with section 3557(e).

What filings are required for Medicaid-only plans that want to enter the individual and small group commercial market?

HMOs that currently offer Medicaid plans and are expanding product offerings to the commercial market have the same requirements as all HMOs in the commercial market. The filing requirements are located in Bulletin 2014-06-INS and in Chapter 35 in the Insurance Code.

Does the new QHP process affect the filing process for grandfathered plans?

The filing process for grandfathered plans is not affected by the QHP filing process. Grandfathered plans are not eligible to be on the Marketplace.

What process should carriers use to withdraw non-grandfathered individual and small group plans that are non-ACA compliant?

An issuer that terminates a particular product, for any reason, must give 90 days' notice to plan sponsors or individual policy holders (as applicable). The plan sponsor or individual must be given the option to purchase, on a guaranteed issue basis, all other coverage the issuer offers in the market. The carrier must discontinue the product uniformly, without regard to claims experience or health status of participants, dependents of beneficiaries under a particular health plan. See 45 CFR § 146.152(c).

Are there restrictions on who may sign the attestation?

A complete set of instructions for the 2015 plan year QHP application will be available soon. It will be located on the CMSzONE website for States and Issuers. It will cover general QHP application instructions, including issuer module, benefits and service area module, rating module and justifications.

Must attestations be submitted through SERFF?

Yes, attestations must be submitted through SERFF and must be uploaded under the Supporting Documentation tab of the Binder filing.

Will the submission of the attestation need to be done by a SERFF user or can they sign and upload an attestation and attest by proxy through the submitter?

QHP issuers must complete the attestation on their own behalf. If a third party filer is managing the filing for the issuer, the third party authorized to make the filing may upload the attestation but it is the issuer that must attest to compliance.

  • The answers provided are not meant to be a substitute for legal advice.