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

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Chapters 670, 679, and 751, Acts of Assembly, 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 general guidance information. Please see the NAIC Product Checklists page to download applicable product-specific form review checklists, the Essential Health Benefits checklist, the Mental Health and Substance Use Disorder Benefits Parity checklist, and the Rate Review checklist. General Filing Instructions and Plan Management General Instructions may be found in SERFF. A timeline of BOI Plan Management and general review activities in Virginia for health insurance plans are posted at: https://www.scc.virginia.gov/boi/co/health/index.aspx

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)
   • 2014-2016 EHB Benchmark
     • EHB Guidance Document (Revised 04/23/2013)
     • EHB Benchmark Plan Documents
       • Anthem KeyCare 30
       • Medicaid SMILES
       • FEP Blue Vision
       • Prescription Categories and Classes
   • 2017 EHB Benchmark Summary and Plan Documents
     
     
2. Premium Rate Review Requirements
   • Rating Areas (Revised 6/06/2013)
   • Composite Premiums in the Small Group Market – Information (Revised 03/10/2015)
     • Approved Virginia Alternate Methodology
       
       
3. Filing Deadlines
   
   • Deadline for Filing Plans for the Individual and Small Group Federal Exchange and Any Health Insurance Plan Whose Offering/Enrollment Period Mirrors that of Exchange Plans and for Filing Exchange-certified Stand-alone Dental Plans
   • Virginia Deadline for Service Area Reduction Requests (Revised 06/07/2018)
     
     

Workshops and Meetings:

• Prior Meetings:
  • Workshop Meeting - March 28, 2013
    • Meeting Information
    • Agenda
    • Presentation Slides
      
      
  • Notice of Premium Rate Review Meeting - April 22, 2013
    • Meeting Information (Revised 4/16/2013)
      
      
  • Teleconference - April 15, 2014
    
    
  • 2015 Premium Rate Presentations - July 23, 2014
    • Order Directing Presentations - Case Number: INS-2014-00120
      
      
  • Teleconference - March 03, 2015
    
    
  • 2016 Premium Rate Presentations - July 22, 2015
    • Order Directing Presentations - Case Number: INS-2015-00065
    • 2016 Presentation Packet
      
      
  • 2017 Premium Rate Presentations - July 20, 2016
    • Order Directing Presentations – Case Number: INS-2016-00069
    • 2017 Presentations
      
      
  • 2018 Premium Rate Presentations - July 25, 2017
    • Order Directing Presentations – Case Number: INS-2017-00050
    • 2018 Presentations
    • Transcript - Case Number INS-2017-00050
      
      
  • Skype Meeting to introduce the new Virginia Rate Filing Template - Thursday, April 19, 2018
    • The new Virginia Rate Filing Template has been posted at https://www.scc.virginia.gov/boi/co/health/lh_check.aspx

If you have any questions regarding any information on this page or in any of the attachments, please contact us at ACAFilingInfo@scc.virginia.gov