Skip to main content

Network Adequacy

Updated 03/12/2020

Frequently Asked Questions

  • DIFS grants partial service area approval to issuers who demonstrate network adequacy in a portion of a service area. Issuers should refer to DIFS annual Form and Rate Filing Bulletin for specific details concerning partial service area approval.

  • Yes, this is true.

  • CMS has deferred to states performing plan management functions the authority to conduct review of network adequacy. Please review the Michigan Network Adequacy Guidance posted annually on the DIFS website and in SERFF under the Plan Management Tab.

  • No, accreditation does not relieve the issuer from network adequacy filings. The following are required templates pertaining to network adequacy:

    On Marketplace: (1) Network ID Template (Federal); (2) Service Area Template (Federal); (3) Michigan Network Data Template (Michigan); and (4) Essential Community Providers (ECP).

    Off Marketplace: (1) Network ID Template (Federal); (2) Service Area Template (Federal); and (3) Michigan Network Data Template (Michigan). The ECP template is not required for Off Marketplace.

  • Yes, every provider must be listed. The template allows data to be downloaded. For specific questions on the template contact Sara Beland at 517-284-8710.

  • Attestations will be in PDF format that will be submitted in SERFF as part of the issuer's binder(s) submission. Attestation(s) will be submitted under the Supporting Documentation tab in the binder filing. There are no specific requirements relative to the authorized signatures required; however, the issuer's signatory should have the appropriate authority as established by the issuer's policies.

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