Health Insurance - Rate and Form Filing Information for Implementation of the Patient Protection and Affordable Care Act Provisions

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House Bill 1900 and Senate Bill 922, passed by the Virginia General Assembly and recently signed by Governor McDonnell, establish a number of new requirements applicable to health insurance coverage issued in Virginia. Among other things, these bills conform Virginia law to the 2014 provisions addressed in the Patient Protection and Affordable Care Act (PPACA), also referred to as the Affordable Care Act (ACA); require the review and approval of premium rates applicable to many health insurance products; and require the Bureau of Insurance, with the assistance of the Virginia Department of Health, to perform plan management functions for the federal health benefits exchange in Virginia.

The Bureau created this webpage to assist insurers as they prepare their product filings to comply with these new requirements. This webpage includes guidance information addressing: (1) Essential health benefits; (2) premium rate review requirements; and (3) form and rate checklists. It also includes Frequently Asked Questions and information about meetings and workshops to assist carriers with questions or comments.

To receive alerts each time the webpage is updated, enter your e-mail address at the envelope icon in the upper right corner of this page. We strongly encourage all carriers and interested parties to consult this webpage often and regularly to promote complete and accurate submissions, facilitating their timely review.

Guidance Information:

1. Essential Health Benefits (EHBs)
   • EHB Guidance Document (Revised 04/23/2013)
   • EHB Market Rules
   • Stand-alone Dental Plan Market Rules
   • EHB Benchmark Plan Documents
     • Anthem KeyCare 30
     • Medicaid SMILES
     • FEP Blue Vision
     • Prescription Categories and Classes
2. Premium Rate Review Requirements
   • Rating Areas (Revised 4/16/2013)
   • Rules Governing Filing of Rates for Individual & Group Accident & Sickness Insurance (eff. 7/01/2013)
     • Unified rate review template
     • Template for data supporting rate revisions Form 130A (eff. 7/2013)
     • Trend analysis details Form 130B (eff. 7/2013)
3. Form and Rate Checklists
   • Important Information for all Carriers Concerning Completion of Checklists
     • EHB Checklist (Updated 4/23/2013)
     • Individual Major Medical, PPO, Hospital-Medical-Surgical Checklist (Updated 4/16/2013)
     • Health Services Plans (Individual and Small Group) Checklist (Updated 4/16/2013)
     • HMO (Individual and Small Group) Checklist (Updated 4/16/2013)
     • Small Group Major Medical Insurance and PPO Checklist (Updated 4/16/2013)
     • Rate Review Checklist
4. Frequently Asked Questions (Revised 04/30/2013)

5. Filing Deadline Extension (Revised 5/15/2013)

   The BOI is aware that, due to problems carriers have experienced receiving validated templates in a timely manner, CMS has extended the QHP application deadline for the Federally Facilitated Marketplace (FFM). Virginia will similarly extend the filing deadline. All carriers who have begun the QHP application process and submitted the Binder to Virginia by 8:00 PM Eastern Time on Friday, May 3, 2013, will be considered to have met Virginia’s QHP submission deadline provided they have submitted as much of their QHP application(s), and any submissions of plans for use inside and outside of the FFM, as possible by this time. Carriers will be given an opportunity to finalize their submissions on Monday, May 6th or as soon thereafter as the template validation problems have been corrected.
   
   Due to the delayed release of the revised plan and benefits template for stand-alone dental plans and, in turn, the delayed capability for stand-alone dental plans to submit an application for an exchange-certified plan through SERFF, Virginia has moved the submission window for such plans. The new submission window to submit exchange-certified stand-alone dental plans on or off the exchange is May 31 – June 5, 2013.