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SERFF State USER MANUAL APPENDIX

1. Pla ny Corres pondence d Contact Standard Component ID Plan Name Metal Level Availability State Status Disposition Status Network Exchange Workflow Status Adequacy 12345WY1230001 Newco Individual Plan Gold Gold On Exchange Currently Under Review y IV 12345WY1230002 Newco Individual Plan Platinum Platinum Off Exchange Please Select z O a 12345WY1230003 Newco Individual Plan Silver Silver On Exchange Please Select C Icon Legend Certified Certification Denied B Unique Plan Design Y Network Adequacy Reviewed Save Note The Certified or Certification Denied icons won t appear until the Certification has been submitted Also the Disposition Status will automatically update once the Disposition has been submitted for the binder 5 Updating Status on a Supporting Documentation Item SERFF allows the Reviewer to set an optional status on each item on the Supporting Documentation tab amp Note The Schedule Item Status can be updated from the Instance Preferences under the Settings tab All status option updates must be made by users with the Configuration Manager role under the Settings tab SERFF State Manual Appendix Page 25 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Supporting Company Correspondence Documentation and Contact ssocia s Templates Expand All _Collapse All Schedule Item Status
2. Settings Filing Rules EFT Report Binder Overview A binder is a collection of one to many Plans sharing a common year state company and market type All SERFF Plan Management binders may be viewed under the Plan Management tab Users with the State Plan Manager role will be able to view all binders within that instance My Binders A listing of all binders regardless of status that have been submitted to a given state Plan Management General Instructions Plan Management General Instructions contain overall binder information advising companies how they should submit SERFF binders to a particular state It is important to be as specific and thorough as possible in the Plan Management General Instructions to ensure industry users submit the most complete and accurate binder EFT Report The EFT report includes all Plan Management binder and SERFF filing transactions Please note The summary report does not indicate the type of SERFF transaction SERFF State Manual Appendix Page 8 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Plan Management General Instructions View Plan Management General Instructions 1 Click the Plan Management tab Plan Management General Instructions 2 Click on the Instructions is displayed for states participating in SERFF Plan Management link A list of all Plan Management General Filings Plan Management Messages
3. A State QHP Application Attestations Please Select wi 03 19 2013 Please Select Description Digitally sign and attach your attestation Y AttestationForm pdf Waiting Assignment Comment Attachments 2 Sample Attestation s Submitted Date Submitted 03 14 2013 By TC SERFF Support Updat Click the button to put the binder in Edit mode 1 2 Navigate to the Supporting Documentation tab 3 Click the drop down list next to a Schedule Item 4 Select the status appropriate for the item 5 Save the binder Reviewer Notes A Reviewer Note is internal communication and is not submitted to industry Only those state users who have access to the filing will be able to view the Reviewer Note For more information regarding Reviewer Notes please refer to Lesson 5 of the SERFF User Manual Note to Filer A Note to Filer is sent from a state user to the filer For more information regarding Notes to Filer please refer to Lesson 5 of the User Manual Objection Letters Creating an Objection Letter A reviewer may send an Objection Letter containing one to many issues informing the issuer of items that need Create Objection Letter to be amended and resubmitted Click the button from within the Correspondence tab SERFF State Manual Appendix Page 26 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Objection Letter for STO1 MN14 125000022 Save Apply
4. Submit Cancel Please choose the parameters for your report Begin Date inclusive End Date inclusive E Report type Detail report e Summary report Report format webpage CSV file Select the Begin Date and End Date Please note that dates must be formatted as mm dd yyyy Select either Detail Report or Summary Report Example below shows a Detail report selection Select either Web page or CSV file Example below shows a Web page selection Submit 6 Click the button SERFF State Manual Appendix Page 40 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved SERFF EFT Reports EFT Detail Report for dates 03 20 2013 to 03 20 2013 03 20 2013 Binders Transaction Company Company Submitter Name Plan SERFF Tracking Date Name Code Year Number 03 20 2013 Hallmark 19530 ZSERFFstaff 2014 HLMK NJ14 125002654 National zIndustrySupportL Insurance Company 03 20 2013 Hallmark 19530 ZSERFFstaff 2014 HLMK NJ14 125002654 National zIndustrySupportL Insurance Company subtotal for 03 20 2013 2 transaction s total amount 200 00 totals for 03 20 2013 2 transaction s total amount 200 00 Binder Plan Name Name Inside Market Plans Inside Market Plans Standard Component ID 23NJ1239092 23NJ1239093 Amount Transaction Number 100 00 1764312 100 00 1764313 E Please note the EFT report will display both binder EFT submissions and Rate For
5. e Plan Transferred to Exchange e Removed Schedule ltem from Binder e Review Status Updated for Binder For more information regarding SERFF Message Settings please refer to page 146 of the SERFF User Manual SERFF State Manual Appendix Page 6 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Messages The Message Center contains notifications about activity on SERFF filings and binders Users receive messages for all events on filings or binders to which they are a reviewer or have access via SERFF roles Messages are identified by a distinct subject line Once the message is opened additional information is displayed and the user may link directly to the filing or binder referenced The Message Center may be accessed via the Messages tab located between the Plan Management and Seitings tabs Filings Plan Management Settings Filing Rules Reports SERFF State Manual Appendix Page 7 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Plan Management View Users with a Plan Management role have access to Plan Management which is located directly to the right of the Filings tab Navigating to this tab will allow the user to work within the Plan Management view of SERFF Depending on the roles assigned Plan Management users will have the option to view My Binders Plan Management General Instructions or run an EFT Report
6. Cancel Binder Name Individual 2014 Plan Year 2014 Market Type Individual Authors Lacey Seemann SERFF Tracking Num STO1 MNi4 125000022 State Minnesota State Tracking Num Reviewers Binder Type Medical Company Health Company Company Tracking Num Date Submitted Objection Letter Status Awaiting Company Response Comments Objection for whole Binder _Attach Files Save Apply Cancel The Objection Letter Date will automatically populate today s date but may be changed if desired 2 Enter a Respond By Date if applicable for a date in the future This date is used to notify the issuer of the latest date the state will accept a response to the Objection Letter Select the Objection Letter Status from the dropdown Enter any objections pertaining to thebinder in the Comments field Upload any attachments if applicable Save 6 Click the button Submit 7 Once you have confirmed the Objection Letter is correct click the button Save E After clicking the user may Submit Edit Delete or Close the Objection Letter 8 The Date Submitted under the Filing Correspondence tab indicates the date the Objection was sent to the issuer SERFF State Manual Appendix Page 27 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Status Submitted By Submitted On Responded By Response Created On Resp Fending Industry Response zz5ER
7. El O Program Attestations for SPE FFE Issuers Do Not Transfer To Exchange El 4 Under each Supporting Documentation item if the system should not include this item in the transfer of the plan select the item as Do Not Transfer To Exchange a 5 Click to finalize your changes These settings can be changed but will not impact plan transfer requests already processed SERFF State Manual Appendix Page 37 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved PDF Pipeline PDF Pipeline provides users with the ability to generate an on demand single PDF file of their entire binder The results are displayed instantly and the user can save the PDF locally to their network or review online E Generating a PDF Pipeline 1 Open the binder PDF Pipeline 2 Click the button Minnesota View Binder Log Binder Name Sample Dental Binder SERFF Tracking Num ST08 MN14 125000023 SERFF Status Submitted Plan Year 2014 State Tracking Num Date Submitted 06 11 2013 Market Type Individual Company Tracking Num Company Status Binder Type Dental Only Authors Laura Jackson Reviewers pe Associate a See eee Ss eee Schedule Items Documentation and Contact Standard Component ID Plan Name Metal Level Availability State Status Disposition Status 11223MN1223333 Icon Legend Certified Certification Denied La Unique Plan Design A dialog box will appear Gene
8. 8 Similar to creating Objection Letters and Disposition once you have confirmed the Certification is Submit correct click the button 9 The Date Submitted under the Correspondence tab indicates the date the Certification was submitted Certifications Status Created By Created On Submitted By Date Submitted Submitted Laura Jackson 06 11 2013 Laura Jackson 06 11 2013 12 30 PM SERFF State Manual Appendix Page 31 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Tracking Number Search The Tracking Number Search box displays in the upper right portion of the SERFF Workspace This search will use the value entered to search the SERFF Tracking Number State Tracking Number Company Tracking Number Binder Tracking Number State Binder Tracking Number and Company Binder Tracking Number amp Running a Tracking Number Search 1 Enter the tracking number search field Search 2 Click the button and select the appropriate search selection from the displayed drop down menu Tracking Number BALE W 14 125002712 Search SERFF Tracking Number State Tracking Number Company Tracking Number Binder Tracking Number State Binder Tracking Number Company Binder Tracking Number E A wildcard may be used to take the place of the part of the number that isn t Known In the Tracking Number search the wildcard is For example if SERF FL14 12501 is entered it
9. Settings Filing Rules Reports My Binders Plan Management General Instructions EFT Report Plan Management General Instructions Att State Name Instance Name y Alabama AlabamaLife Alaska AlaskaLH Y Arizona ArizonaLH California CaliforniaLAH Colorado Colorado Connecticut ConnecticutLH 2 Idaho Idaho Illinois IllinoisLAH Indiana Indiana Iowa Iowa Kansas KansasAH Kentucky KentuckyH Maine MaineLH Maryland MarylandH Michigan MichiganLAH yp Minnesota Minnesota Mississippi MississippiLH 2 Montana Montana New Hampshire New HampshireLH 2 New Jersey New JerseyH 3 To open the Plan Management General Instructions for a specific state instance click anywhere in the state row 4 The selected Plan Management General Instruction page is displayed SERFF State Manual Appendix Page 9 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved View the AlabamaLife Plan Management General Instructions Edit Return to List HIX Exchange Support Plan Management Accepts EFT O General Instructions Last Modified On 02 26 2013 STATE ESSENTIAL HEALTH BENEFITS AND MANDATES To view Alabama s EHBs and mandates please visit www website gov SUBMISSION WINDOW AND DEADLINES In order to have adequate time to review QHP submissions Alabama requires all SERFF Binders containing Exchange plans to be submitted by April 30 2013 Submissions after this date will be handled on a case by case ba
10. sent to the issuer Status Created By Created On Submitted By Date Submitted Submitted Laura Jackson 06 11 2013 Laura Jackson 06 11 2013 12 26 PM For more information regarding Dispositions please refer to Lesson 5 of the SERFF User Manual Certifications Once the Disposition is submitted users with the proper permissions will have the ability to certify one to many plans within the binder Certifications are used to identify plans that have been certified or denied certification to be on the Exchange As decisions may take place at varying times for plans included in a single binder multiple Certifications may be submitted Note If your state or jurisdiction is a State Partnership Exchange or Marketplace Plan Management Exchange you will be recommending Certification to the Federal Exchange The user will select certified or certification denied as a recommendation to the Federal Exchange Creating a Certification 1 Click the Correspondence tab 2 Click the entity button Certification for STO1 MN14 125000022 Save Apply Cancel Binder Name Individual 2014 Plan Year 2014 Market Type Individual Authors Lacey Seemann SERFF Tracking Num STO1 MN14 125000022 State Minnesota State Tracking Num Reviewers Binder Type Medical Company Health Company Company Tracking Num Date Submitted Comments Recommending these plans for certification a Plans Certify Pl
11. time all plans show this message even when the transfer was successful The SERFF team is working to correct this See below for more information e Show Errors This link will allow you to expand what errors are associated with the plan transfer Please note that at this time this link will always be present even if there are no errors associated with that plan Examples of responses from CMS After a response has been received from CMS there are several types of messages that may appear e HAPI Processed SERFF State Manual Appendix Page 36 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Plan Transfer History x Request Time User Reply Time Result Status 07 30 2013 02 03 PM 07 30 2013 03 06 PM Request was processed by HAPI Show Errors E If the plan was transferred after Saturday July 27 this indicates the plan was successfully transferred to the exchange no other action is needed amp Indicating an item should not be transferred to the exchange 1 Navigate to the binder Update 2 Select to place the binder into update mode 3 Navigate to the Supporting Documentation tab of the binder Plans Associate Fees Templates Supporting Correspondence Schedule Items Documentation O Compliance Plan and Organizational Chart Cover Sheet Do Not Transfer To Exchange ES Essential Community Provider Supplemental Response Form Do Not Transfer To Exchange
12. will produce all binders that begin with SERF FL14 12501 The wildcard may be used at the beginning of the number as well SERFF State Manual Appendix Page 32 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Transfer Plans Users with the State Plan Management Transfer Plan User role will have ability to transfer plans to the exchange once they have been certified E Transferring plans to the exchange Transter to Exchange 1 Once in the binder click the a wraas Templates Supporting Documentation Premier 1000 PD Advantage 3000 PD Classic 3250 PD AdvantagePlus 5500 PD Basic PD Company Name Life Insurance Company Binder Name CT ALIC QHP IVL Binder Plan Year 2014 Market Type Individual Binder Type Medical State Binder Description Plans Associate Schedule Items Standard Component ID Plan Name La 39159CT0080001 La 39159CT0080002 La 39159CT0080003 B 39159CT0080005 B 39159CT0080006 button Connecticut View Binder Log SERFF Tracking Num AETN CT14 125001609 SERFF Status Submitted State Tracking Num Date Submitted 05 29 2013 Company Tracking Num Reviewers Authors Company l Correspondence and Contact Metal Level Availability Gold Silver Bronze Bronze Catastrophic On Exchange On Exchange On Exchange On Exchange On Exchange State Status Disposition Status Network Exchange Workflow Status Adequacy Icon
13. 9159CT0080002 On Exchange Approved Ka Classic 3250 PD 39159CT0080003 On Exchange Received For Informational Purposes Only Approved m Reduced Approved AdvantagePlus 5500 PD 39159CT0080005 On Exchange Withdrawn __ Approved Basic PD 39159CT0080006 On Exchange Please Select Approved Ka Attachments Upload Attachment Save Apply Cancel Enter comments SERFF will automatically bring in the Plan Name Standard Component ID and Plan Availability for the plans included on the binder 5 Select a Plan Disposition Status for each plan The Plan Disposition Status is pulled from the State Instance Preferences and is displayed to industry users amp Note All status option updates must be made by users with the Configuration Manager role under the Settings tab 6 Select a Plan State Status for each Plan if applicable If a Plan State Status was previously selected for each plan SERFF will automatically populate these fields for the user 7 Upload any attachments if applicable Save 8 Click the button Save E After clicking the user may Submit Edit Delete or Close the Disposition Letter Submit 9 Once you have confirmed the Disposition is correct click the button SERFF State Manual Appendix Page 29 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved 10 The Date Submitted under the Filing Correspondence tab indicates the date the Disposition was
14. FFStaff zzStatesuppontTC 03 19 2013 08 18 AM For more information regarding Objection Letters please refer to Lesson 5 of the SERFF User Manual Response Letters For more information about viewing Response Letters please refer to Lesson 5 of the SERFF User Manual Dispositions A Disposition is the final result of the review of the binder When a Disposition is created the status of the binder is changed to Closed While the Disposition is created and submitted at the binder level plans are approved and or disapproved at the plan level Creating a Disposition 1 Click the Filing Correspondence tab neeg Tun 2 Click the A button SERFF State Manual Appendix Page 28 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Disposition for AETN CT14 125001609 Save Apply Cancel Binder Name CT ALIC QHP IVL Binder Plan Year 2014 Market Type Individual Authors SERFF Tracking Num AETN CT14 125001609 State Connecticut State Tracking Num Reviewers Binder Type Medical Company Aetna Life Insurance Company Company Tracking Num Date Submitted Comments Disposition comment for binder Plan Name Standard Component Plan Availability Plan Disposition Status 4 Plan State Status Y ID Please Select Approved EA Premier 1000 PD 39159CT0080001 On Exchange A Approved El Advantage 3000 PD 3
15. Legend gt Transferred to Exchange O Certified Certification Denied Las Decertified B Unique Plan Design Network Adequacy Reviewed Assign Reviewers Update Transfer to Exchange 2 The system will display a list of all the plans on the binder By unchecking one or more options in the the filter the list of plans displayed can be narrowed SERFF State Manual Appendix Page 33 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Plans transferred to your State Health Exchange are not processed immediately Once your Exchange notifies SERFF of the results the plan statuses will be updated Filter On Exchange Of Exchange Standard Component ID 39159CT0080001 39159CT0080002 39159CT0080003 39159CT0080005 39159CT0080006 Blank Plan Availability Certification Status On Exchange On Exchange On Exchange On Exchange On Exchange Cancel Transfer a Please note that all information related to the selected plan s will be transferred to the exchange However the sytem will not transfer the Supporting Documentation items that have been marked as Do Not Transfer To Exchange under the Supporting Documentation tab For instructions on how to mark Supporting Documentation items see page 7 of this document Plans transferred to your State Health Exchange are not processed immediately Once your Exchange notifies SERFF of the results the plan
16. SERFF STATE USER MANUAL APPENDIX Providing flexibility promoting uniformity Table of Contents NOAA li 2 CONVENTIONS Used in TAS IMAN iria 2 SERFF Binder Tracking NUMDEL csscccccsssccccessececeesececcesececeesececseecceseesecesaunecessunccessesecesseneceesegeeeetas 3 Plan Management User Roles A AAA A 4 SEINE S a adi 5 Message Sets Na 5 MIOS tt dol 7 Plan Manacement VW a a a a a N 8 Pinder OVNI Wy arnesu 8 Plan Management General INStrUuctiONns c cccseccccsssececeeseccccensccceeesececceueceeeeusecessuseceseegeceeseeecessenesetsenes 9 MVB A q E A 12 Bidor a c a GN O rae E E A coments aateecame 14 View BINd er LOE nacrtani a 15 Plane TaD PP ri o o A E E N 17 Associate Schedule tems in A Na 18 Fac cielo e el ec eee 19 Templates oasis 20 supporting DOCUMENTATION cian sii ot is 21 Company ana CONtAClussctia cd 22 COrrespondente nia 23 A a e E 24 Boye Fed ty TIM E E E N E pa 24 Reviewer Notes uti aaa 26 Note to ler tes e cris es o O e e RE te TTT ene Pen eee oe 26 ODEON Letters sisas ri ai da 26 RESPONSE Lee rin a 28 DISPOSICION SAA 28 CONCORD 30 TRACKING INUIM DCF e arce dns 32 A RR 33 PD PP A 38 ETRE oso 40 SERFF State Manual Appendix Page 1 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Introduction The System for Electronic Rate and Form Filing SERFF is a smart Internet application designed to provide an efficient process for rat
17. To begin receiving a specific message highlight the message type and move it to the box on the right a Messages on the right will be received in the user s Message Center messages on the left will not be received It s recommended that users opt in to all binder messages SERFF State Manual Appendix Page 5 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Filing Activity Messages Filing Activity Messages Help Added Schedule tem for Binder Binder Amendment Letter Submited Amendment Letter Submitted Binder Certification Letter Submited Filing Confidentiality Changed Binder Disposition Letter Deleted Filing Reopened Binder Mote To Filer Deleted Filing Reviewer Assigned Binder Mote To Filer Submitted Filing Submitted Binder Mote To Reviewer Submitted Mote To Reviewer Submitted Binder Primary Reviewer Changed Binder Reopened Binder Response Letter Submitted Binder Reviewer Note Deleted Messages related to Plan Management are as follows e Binder Amendment Letter Submitted e Binder Certification Letter Submitted e Binder Disposition Letter Deleted e Binder Note to Filer Deleted e Binder Note to Filer Submitted e Binder Note to Review Submitted e Binder Note to Review Changed e Binder Reopened e Binder Response Letter Submitted e Binder Reviewer Note Deleted e Binder Reviewer Note Saved e Binder Submitted e Plan Exchange Workflow Status Updated e Plan State Status Updated
18. an Name Standard Availability Plan Disposition Status Plan State Status Y Action Date Component ID Please Select v On Exchange Plan A 98765MN0000100 On Exchange 2 Approved Closed Approved With Review y Please Select Certified Certification Denied Not Determined a ts U d Attachment Cancel SERFF State Manual Appendix Page 30 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved 3 Select a status from the Certify dropdown for each plan This identifies each plan as being Certified Certification Denied Not Determined Or Decertified 4 Ifa Plan State Status was selected on the Disposition the Plan State Status field is automatically populated Enter comments Upload any attachments if applicable Save 7 Click the button Certification for STO1 MN14 125000022 Binder Name Individual 2014 Plan Year 2014 Market Type Individual Authors Lacey Seemann SERFF Tracking Num STO1L MN14 125000032 State Minnesota State Tracking Num Reviewers Binder Type Medical Company Health Company Company Tracking Num Date Submitted Comments Recommending these plans for certification Plans Certify Plan Standard Availability Plan Plan Action Date Name Component ID Disposition State Status Status 9 Certified On 98765MN0000100 On 2 Approved Closed 06 11 2013 12 29 PM Exchange Exchange Approved Plan A With Review Attachments
19. as necessary button Filings Messages Settings Filing Rules Reports HHS Reporting Edit the AlabamaLife Plan Management General Instructions save apoty conca HIX Exchange Support Plan Management Type of Exchange State Based Accepts EFT General Instructions Last Modified On 02 26 2013 To view Alabama s EHBs and mandates please visit ww w website gov SUBMISSION WINDOW AND DEADLINES In order to have adequate time to review QHP submissions Alabama requires all SERFF Binders containing Exchange plans to be submitted by April 30 2013 Submissions after this date will be handled on a case by case basis time permitting Alabama will complete all reviews and make certification decisions bu June 15 2013 6 If there are attachments attach them under the Attachments section using the button SERFF State Manual Appendix Page 11 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Attachments Attachments EA Addendum pdf Remove Date Uploaded 12 20 2012 12 11 PM Save 7 Click the button My Binders E Opening a Binder 1 Navigate to any of the binders listed in the My Binders view and click anywhere on the binder row My Binders Pa Company Name E Market Type Binder Name Status Date Submitted Geisinger Health Plan Small Group PBN 03122013 O Assigned 03 13 2013 Geisinger Health Plan S
20. ated with the binder e SERFF Tracking Num This number is unique and assigned by SERFF It will differ from SERFF filing tracking numbers by containing four extra numbers and letters in the middle of the tracking number e SERFF Status This value is assigned by the SERFF application and automatically updates as activity occurs on a binder This field has two main purposes 1 give state and industry a common measure as to where the binder is in the process and 2 give the SERFF application a mechanism to control activities that can take place on a binder o Draft Binder has been assigned a tracking number but has not been completed and submitted to the state o Submitted to State The binder has passed all applicable validations and Author has submitted the binder to the state State can now access the filing o Assigned State has assigned the binder to one or more reviewers SERFF State Manual Appendix Page 14 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved o Pending Industry Response There are one or more open Objection Letters on the binder that need a response from the issuer o Pending State Action One or more Objection Letters have been responded to by the issuer Binder is still open o Closed The state has created a Disposition indicating the final action of the binder and its collection of plans o Reopened The state has reopened the binder Binder Name The issuer
21. cess to all binders on the instance State Plan Management Transfer Plan This role allows the user the ability to User transfer a plan or plans to a state exchange or the Federal system Note With the Read only role the user won t be able to view items included on the Associate Schedule ltems tab Note The Certify Plan User role is an action that an SBM SPM or MPM would take Typically FFMs will not use this functionality SERFF State Manual Appendix Page 4 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Settings Message Settings The State Plan Management User role in SERFF will generate several messages related to binders The user will not automatically be opted in to all of the new message types To begin receiving these messages users should navigate to their Message Settings and select the Plan Management message types they would like to recelve 7 Updating Message Settings 1 Click on the Settings tab Settings Filings Plan Management Messages Filing Rules HHS Reporting User Preferences Instance Preferences iick Text Companies Contacts Contact a Contact Information Email Address serfhelpMnaic org Ex name domain com Address 1100 Walnut cy State Missouri Phone 816 783 8990 Ext Ex 123 555 4567 Save Cancel 2 Choose Eon the left hand side of the screen 3
22. d Denied Certification Icon Legend i Transmitted to Exchange Certified Certification Denied Lal Unique Plan De Network Adequacy Reviewed Enter a State Tracking Number optional Enter a State Binder Description optional Under the Plans tab select a State Status optional for each plan included in the binder State statuses are pulled from the state s Instance Preferences and may be set at any time Additionally they are displayed to industry users A Configuration Manager may create additional state statuses that are applicable to plan review to assist with workflow management SERFF State Manual Appendix Page 24 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved 5 Under the Plans tab select the Network Adequacy Indicator if applicable for each plan The Network Adequacy Indicator is a field that allows the state reviewer to indicate that the issuer s plan meets their network adequacy standards 6 Under the Plans tab select an Exchange Workflow Status if applicable for each plan The Exchange Workflow Status is a configurable status intended for use by a State based Exchange Department of Insurance and their Exchange counterpart This status may also be useful for states in other Exchange models to indicate the status of review activities that may be completed by the Department of Insurance or another entity outside of the Department of Insurance
23. defined name of the plans being submitted State Tracking Num The state tracking number if applicable Date Submitted The date the binder was submitted Plan Year The year the plans are effective within the Exchange Marketplace or the outside market Company Tracking Number The company tracking number if applicable Market Type Individual or Small Group Reviewers Reviewers assigned to the binder Binder Type Medical or Dental Only Authors Authors of the binder State Binder Description This field is intended for the state to use however they deem necessary They can enter state specific comments track data etc This field is not seen by the industry View Binder Log Users have the ability to view activity history on a binder with the View Binder Log feature The activities displayed are limited to Binder Events The View Binder Log feature is particularly helpful if more than one person has worked on a submission or if there was a problem with the submission 5 How to Access the Binder Log To access View Binder Log click on the a hyperlink in the upper right hand corner under the state name SERFF State Manual Appendix Page 15 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Minnesota View Binder Log Company Name Health Company SERFF Tracking Num ST01 MN14 125000022 SERFF Status Submitted Binder Name Individual 2014 State Tracking Num Date Sub
24. e and form filing With the release of v6 0 SERFF Plan Management functionality was introduced for Qualified Health Plan QHP and Qualified Dental Only Plan QDP submissions Using SERFF issuers can create and submit QHPs to states that have implemented SERFF for Plan Management for review approval and certification Conventions Used In This Manual The following special features are included in this appendix to assist readers Bold fonts are used to emphasize an idea or a representation The green pointer hand is used represent a task the user may perform 5 The red pointer hand is used to represent a note of special interest SERFF State Manual Appendix Page 2 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved SERFF Binder Tracking Number The SERFF binder represents a collection of templates and plan data filed on behalf of one company sent to one state To ensure uniqueness and provide searching capabilities each SERFF binder has a unique SERFF Tracking Number The SERFF Tracking Number is comprised of three parts Instance Identifier State and Binder Year Unique Numeric Identifier Characters ABCD WY14 000004382 1 Instance Identifier A unique four character ID assigned to an instance by the SERFF Help Desk Both states and industry are assigned Instance Identifiers 2 State and Binder Year Identifier The specific state to which the binder is submitted as we
25. em SERFF State Manual Appendix Page 23 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Assigning a Binder Assigning a binder will be completed through the same process as with rate and form filings For more information on assigning a reviewer to a binder please refer to page 93 of the SERFF User Manual Updating a Binder In addition to creating Correspondence which is covered in the next lesson there are a number of updates the state can make to a binder to manage workflow during the review process E Updating a Binder 1 Click the button The binder is put into update edit mode Minnesota View Binder Log Company Name Health Company SERFF Tracking Num STO1L MN14 125000022 SERFF Status Submitted Binder Name Individual 2014 State Tracking Num Date Submitted 06 05 2013 Plan Year 20i4 Company Tracking Num Market Type Individual Reviewers Binder Type Medical Authors Lacey Seemann State Binder Description iz only viewable by the state State Binder Description Plans Associate Fees Templates l Supporting Company Correspondence Schedule Items Documentation and Contact Standard Plan Metal Availability State Status Disposition Network Exchange Workflow Status Component ID Name Level Status Adequacy 98765MN0000100 On Gold On A Pleaze Select a dias bl Plan A Awaiting Certification Awaiting Transmission to the Exchange Certifie
26. g and an icon will appear next to the plan s on the binder Click on the transferred to exchange icon 2 to check the status of the transfer SERFF State Manual Appendix Page 35 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Plan Transfer History x Request Time User Reply Time Result Status 07 23 2013 12 28 PM lajacksonstate 07 23 2013 12 28 PM New request The Plan Transfer History includes the following fields e Request time The date and time of the initial transfer plan request e User The user that submitted the transfer plan request e Reply time The date and time the Result Status was updated e Result Status E New request This is the status that displays immediately after clicking transfer The plan is now in the queue and awaiting processing Plans will likely be in this state a very short time Request is processing This status means that SERFF is compiling the data and attachments for the plan and initiating the transfer to the exchange Plans will likely be in this state a very short time Request is complete This status means that the request has been sent to the exchange for processing but the exchange has not yet provided results Plans may be in this state for up to an hour During peak times plans may be in this state several hours E Request has a validation error from the exchange This indicates a response has been received from the exchange At this
27. ge Icon Legend D Transmitted to Exchange Certified Certification Denied E Unique Plan Design y Network Adequacy Reviewed SERFF State Manual Appendix Page 13 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Binder at a Glance Binder at a Glance contains key information about the binder and is always displayed at the top of the page regardless of which tab is being viewed Minnesota Company Name Health Company SERFF Tracking Num STO1 MN14 125000022 SERFF Status Submitted Binder Name Individual 2014 State Tracking Num Date Submitted 06 05 2013 Plan Year 2014 Company Tracking Num Market Type Individual Reviewers Binder Type Medical Authors Lacey Seemann State Binder Description Associa Schedul Templates Supporting Documentation Company te e Items and Contact Standard Plan Name Metal Availability State Disposition Network Exchange Component ID Level Status Status Adequacy Workflow Status 98765MN0000100 On Exchange Gold On Plan A Exchange Icon Legend 3 Transmitted to Exchange Certified Certification Denied Unique Plan Design Y Network Adequacy Reviewed The Binder at a Glance contains the following fields e State e View Binder Log Allows user to view the binder Log This log contains a record of key activity that has occurred on the binder e Company Name The company associ
28. igned SERFF State Manual Appendix Page 18 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Fees This is the section where plan fees are entered by the issuer and EFT information is displayed If a fee for QHP submissions is required the amount submitted per plan will be displayed Each plan is identified its corresponding Standard Component ID E The issuer may include the total amount due under one plan and bypass the remaining plans if a different fee structure exists or a flat fee is due for QHP submissions Plans Associate Fees Templates Supporting Company Correspondence Schedule Items Documentation and Contact 12345WY1230001 Amount Processed Date Transaction Fee Description 20 00 03 14 2013 11 43 AM 125000638EFTTESTEFTSEFTFILER201303141145318 Total 520 00 12345WY1 230002 Amount Processed Date Transaction Fee Description 20 00 03 14 2013 11 43 AM 125000639EFTTESTEFTSEFTFILER201303141145318 Total 520 00 12345WY1 230003 Amount Processed Date Transaction Fee Description Bypassed Total 50 00 Grand Total 540 00 SERFF State Manual Appendix Page 19 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Templates A template is a Microsoft Excel workbook intended to create a standard collection of plan and issuer level data for the use of QHP certification exchange operations and oversight activities State users w
29. ill only see us successfully validated templates on this tab Successfully validated templates will show a a icon next to the template Plans Associate Fees Tem plates Supporting Company Correspondence Schedule Items Documentation and Contact Administrative Data Template a Plan and Benefits Template ae Prescription Drug Template Network Template ae Service Area Template oF Essential Community Providers Template Rate Data Template Rating Business Rules Template Icon Legend ta Pending Validation a Successfully Validated Ta Validation Failed Al Draft binder boss an To collapse all of the templates To expand or collapse a single template SERFF State Manual Appendix Page 20 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved To expand all the templates and see the comments and or attachments submitted with the S Administrative Data Template Description Collects general company and contact information Review Status Approved Review Status Changed 04 03 2013 Date Template Attachment gt Admin Template xml P KS templates administrative xl Comments E Once a template is expanded the user will see a xml file and a xls file The reviewer may click on the xls version of the template to assist with plan review Supporting Documentation The Supporting Documentation tab provides functionality for a
30. lan Management General Instructions Edit Return to List HIX Exchange Support Plan Management Accepts EFT O General Instructions Last Modified On 02 26 2013 STATE ESSENTIAL HEALTH BENEFITS AND MANDATES To view Alabama s EHBs and mandates please visit www website gov SUBMISSION WINDOW AND DEADLINES In order to have adequate time to review QHP submissions Alabama requires all SERFF Binders containing Exchange plans to be submitted by April 30 2013 Submissions after this date will be handled on a case by case basis time permitting Alabama will complete all reviews and make certification decisions bu June 15 2013 OUTSIDE MARKET Alabama is using SERFF Plan Management for inside and outside Exchange plans All templates submitted should include all plans in the market regardless of Exchange participation Each insurer should submit no more than one binder per market one individual and one SHOP STAND ALONE DENTAL PLANS Additional details related to dental submissions will be provided at a later date NETWORK ADEQUACY Here are some details about our approach to network adequacy and what is required for it This could also be on a sub reg UNIQUE BENEFIT DESIGN If you are submitting a plan that you consider to have a unique benefit design this is what we allow and what you have to do for support Could also be sub req 5 Update the Plan Management General Instructions
31. late If the template is revised and resubmitted the fields will also be updated if changed e Standard Component ID s are the level of the submission to which plans are certified Once a binder has been submitted by the issuer the Standard Component ID s will never change In the event of a revision where additional plans are added for example a new binder must be created and submitted Associate ees emplates u in Company Correspondence Schedule Items Documen tation Standard Component ID Plan Name Metal Level Availability State Status Disposition Status Network Exchange Workflow Status Adequacy 12345WY1230001 Newco Individual Plan Gold Gold On Exchange 12345WY1230002 Newco Individual Plan Platinum Platinum Off Exchange 12345WY1230003 Newco Individual Plan Silver Silver On Exchange SERFF State Manual Appendix Page 17 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Associate Schedule ltems The Associated Schedule ltems tab contains Rate and Form filing information linked to each plan within a binder This feature allows the user to review submitted Rate and Form filing data that is related to the QHP submission The user can view SERFF filing attachments without leaving the Plan Management workspace as they review a binder Things to keep in mind when reviewing Associated Schedule ltems e Industry users cannot associate items that are in draft form e For each Ass
32. ll as the applicable plan year for the QHPs being submitted 3 Numeric Value A numeric string that when combined with the Instance Identifier and State and Binder Year Identifier create a unique SERFF Binder Tracking Number This portion of the tracking number is created by the SERFF application SERFF State Manual Appendix Page 3 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Plan Management User Roles The ability to perform Plan Management functions within SERFF is based on the roles assigned to a SERFF User Name Some users may have a role assigned to their ID that permits greater access while other users may have a role with limited access to SERFF Plan Management functions Roles have pre determined permissions within the SERFF application that dictate role related responsibilities The SERFF Help Desk maintains and assigns roles for all users Below is a table that explains the permissions associated with each state SERFF Plan Management User role ee ee ee State Plan Management User Allows a State User to review submitted binders create correspondence including Dispositions edit Plan Management General Instructions and assign Reviewers Certify Plan User This role gives the user permission to certify plans This gives the user access to all of the certification functionality create edit delete draft and submit Plan Management Read only This role allows read only ac
33. m filing EFT submissions SERFF State Manual Appendix Page 41 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved
34. mall Group PBN 03122013 D Closed 03 13 2013 Geisinger Health Plan Small Group PBN 03122013 V Assigned 03 13 2013 There are several buttons at the top of the page Some of the buttons may not display depending on the access of the user and the status of the binder Allows the assignment of the binder to one or more reviewers Puts the binder in edit mode and allows the update of certain fields Allows plans to be transferred to the Exchange Creates a PDF of the binder with options to include the entire binder or selected portions Allows the user to reopen the binder for further updates SERFF State Manual Appendix Page 12 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Assign Reviewers Update Transmit to Exchange PDF Pipeline Minnesota View Binder Loo Company Name Health Company SERFF Tracking Num STO1 MN14 125000022 SERFF Status Submitted Binder Name Individual 2014 State Tracking Num Date Submitted 06 05 2013 Plan Year 2014 Company Tracking Num Market Type Individual Reviewers Binder Type Medical Authors Lacey Seemann State Binder Description Plans Associate j Fees y Templates J Supporting Company J Correspondence Schedule Items Documentation and Contact Standard Plan Name Metal Awailability State Disposition Network Exchange Component ID Level Status Status Adequacy Workflow Status 98765MN0000100 On Exchange Gold on Plan A Exchan
35. mitted 06 05 2013 Plan Year 2014 Company Tracking Num Market Type Individual Reviewers Binder Type Medical Authors Lacey Seemann State Binder Description 2 Anew window will open containing a list of all activity on a binder The activity is listed in chronological order with the most recent activity on top The View Binder Log hyperlink is available on open and closed binders Binder Name Individual 2014 Plan Year 2014 Market Type Individual Authors Lacey Seemann SERFF Tracking Num STO1 MN14 125000022 State Minnesota State Tracking Num Reviewers Binder Type Medical SERFF Status Submitted Company Health Company Company Tracking Num Date Detail Originator 06 05 2013 11 02 AM Binder STO1 MN14 125000022 was submitted by Lacey Seemann on 06 05 2013 11 02 AM Lacey Seemann 2 Once review of the binder activity has been completed click The user will be returned to the binder SERFF State Manual Appendix Page 16 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Plans Tab The Plans tab contains the Standard Component ID Plan Name Metal Level Availability Unique Plan Design indicator State Status Disposition Status Network Adequacy and Exchange Workflow Status All fields outside of the Standard Component ID State Status Disposition Status Network Adequacy and Exchange Workflow Status are imported from a successfully validated Plans Benefits Temp
36. ociated Schedule Item attachment the most recent version is always displayed e For each Associated Schedule Item listed the corresponding and most current SERFF filing s status is displayed e Associated Schedule Items may be viewed by Plan or by Schedule Items Associate Fees Templates Supporting Company Correspondence Schedule Items Documentation and Contact By Plans By Schedule Items 12345WY 1230001 Form Schedule Items SERFF Tracking Number Form Name Form Number Date Added Attachments Filing Status GSHP 127696678 Geisinger_v6 0 P 0312 2013_v6 0 03 12 2013 2 Geisinger Policy Assigned GSHP 127696678 Geisinger_v6 0 END ENDO3122013 03 12 2013 2 Geisinger Endorsement_03 04 2013 6 0 pdf Assigned Supporting Document Items SERFF Tracking Number Document Name Date Added Attachments Filing Status GSHP 127696678 PPACA Uniform Compliance Summary 03 12 2013 Final PPACA UniformComplianceSummaryClean pdf Assigned 12345WY 1230002 Form Schedule Items SERFF Tracking Number Form Name Form Number Date Added Attachments Filing Status GSHP 127696678 Geisinger_v6 0 P 0312 2013_v6 0 03 12 2013 Geisinger Policy 03 042013 6 0 pdf Assigned GSHP 127696678 Geisinger_v6 0 END ENDO3122013 03 12 2013 Assigned Supporting Document Items SERFF Tracking Number Document Name Date Added Attachments Filing Status GSHP 127696678 PPACA Uniform Compliance Summary 03 12 2013 Final PPACA UniformComplianceSummaryClean pdf Ass
37. ontact Supporting Documentation Correspondence 80799 08 0799123 Illinois LAH 80799 Issuer State Market Type Product Type Accreditation Status wy Commercial PPO Commendable Issuer State Market Type Accreditation Status WY Commercial Full Expiration Date 03 01 2014 Expiration Date 03 01 2014 Accreditation information provided by NCQA and URAQ is displayed on the Company and Contact tab The Accreditation IDs are entered on the Company maintenance screen E If a NCQA or URAQ ID is added after binder creation it will not be reflected on the binder The following NCQA and URAQ fields will be displayed under Accreditation Information e Issuer Name Issuer State e Market Type e Product Type Accreditation Status Expiration Date SERFF State Manual Appendix Page 22 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Correspondence The Correspondence tab is where communication between industry and state is stored The Correspondence tab contains Notes to Reviewer Notes to Filer Reviewer Notes Objections Letters Amendments Response Letters Dispositions and Certifications Correspondence Objection Letters No Objection Letters Amendment Letters No Amendments Dispositions No Dispositions _ Create Disposition Certifications Mot Certified Binder Notes No Binder Notes Icon Legend L l Draft Correspondence It
38. rate PDF for Generate PDF Cancel The generated PDF will contain all avallable content If you wish to remove unwanted pages you can do so by extracting pages using your PDF software Generate PDF Cancel Generate PDF 3 Click the button to create the PDF SERFF State Manual Appendix Page 38 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved a pa dl 7 Comment share 4 AA P Binder at a Glance Denisi Oriy P Flans i ATOM 126000073 p Fees LP co mpany and Contact LP Te mplates Supporting Documentation Correspondence Summary FOF Epra br SG Peeing dd T rc eee eT So iah SO rs 3 The binder PDF file will open in a new window Click on the individual bookmarks to navigate to the different sections of the filing FE amp Click on the button to save the PDF file outside of the SERFF system Non PDF attachments and attachments that are larger than 3 MB will not appear in the PDF Pipeline SERFF State Manual Appendix Page 39 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved EFT Report The EFT Report allows the user to run a report for all EFT transactions for a given date range Running an EFT Report 1 Navigate to the Plan Management Tab Filings Plan Management Messages Settings My Binders EFT Report EFT Report 2 Click the button SERFF EFT Reports
39. sis time permitting Alabama will complete all reviews and make certification decisions bu June 15 2013 OUTSIDE MARKET Alabama is using SERFF Plan Management for inside and outside Exchange plans All templates submitted should include all plans in the market regardless of Exchange participation Each insurer should submit no more than one binder per market one individual and one SHOP STAND ALONE DENTAL PLANS Additional details related to dental submissions will be provided at a later date NETWORK ADEQUACY Here are some details about our approach to network adequacy and what is required for it This could also be on a sub reg UNIQUE BENEFIT DESIGN If you are submitting a plan that you consider to have a unique benefit design this is what we allow and what you have to do for support Could also be sub req lf there are attachments they will be displayed at the bottom of the page Attachments Attachments 2 Addendum pdf Date Uploaded 12 20 2012 12 11 PM Editing Plan Management General Instructions You must have the State Plan Manager role assigned to your SERFF user ID to edit Plan Management General Instructions 1 Click the Plan Management tab 2 Click on the link 3 Choose the Plan Management General Instructions to edit SERFF State Manual Appendix Page 10 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved View the AlabamaLife P
40. statuses will be updated Filter On Exchange Standard Component ID Off Exchange Both Blank Plan Availability Certification Status 39159CT0080001 39159CT0080002 39159CT0080003 39159CT0080005 39159CT0080006 3 Once plans are selected click the SERFF State Manual Appendix On Exchange On Exchange On Exchange On Exchange On Exchange Transfer Page 34 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved 4 The system will display a confirmation prompt Select OK to transfer the plans to the exchange or Cancel to return to the list of plans without transferring You are about to transfer plans Are you sure Plans Standard Component ID Plan Name Metal Level Availability State Status Disposition Status Network Exchange Workflow Status Adequacy La 39159CT0080001 Aetna Premier 1000 PD Gold On Exchange Approved Approved La 39159CT0080002 Aetna Advantage 3000 PD Silver On Exchange Approved Approved La 39159CT0080003 Aetna Classic 3250 PD Bronze On Exchange Approved Approved La 39159CT0080005 Aetna AdvantagePlus 5500 PD Bronze On Exchange Approved Approved a 39159CT0080006 Aetna Basic PD Catastrophic OnExchange Approved Approved Icon Legend 3 Transferred to Exchange Certified Certification Denied hi Decertified a Unique Plan Design Network Adequacy Reviewed After clicking OK the plan s selected will be queued for processin
41. ttaching information to a binder that may be required by the state Most states require Federal Supporting Documentation which is listed on this tab Clicking the tab displays a list of requirements that have been satisfied or bypassed Supporting Company n A State QHP Application Attestations Description Digitally sign and attach your attestation 9 AttestationForm pdf Comment Attachments Sample Attestation signed pdf Submitted Date Submitted 03 14 2013 By TC SERFF Support SERFF State Manual Appendix Documentation and Contact Correspondence Schedule Item Status Please Select 03 19 2013 Page 21 of 41 Copyright 2013 National Association of Insurance Commissioners All rights reserved Company and Contact This Is the section of the binder where the state views the company and contact information Templates Plans Associate Fees Schedule Items Plan Binder Contact Information ii ahin 1100 Walnut Street 816 783 Phone Suite 1500 Kansas City MO 64106 Plan Binder Company Information Celtic Insurance Company CoCode 1100 Walnut Ave Group Code Suite 1500 Era tenn Kansas City MO 64106 FEIN F in pu 8161783 8747 Phone dase RR State of Domicile Company Type HHS Issuer ID Accreditation Information NCA NCQA Organization ID 28000 Issuer Mame ABC Test Company URAC URAC Application Number HIX0D1565 Issuer Name ABC Test Company company and C

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