the issuer’s service area, must be set at 7 1.00. If the insurer is new to the 8 Washington state market, the geographic 9 area with the greatest number of counties must be set at 1.00. 9 If your service area varies by plan, for each plan, list the plan’s See Section I, Table 2 below. HIOS ID, the plan name, and the service area and county. a Do you have any plan with a unique benefit design? 10 b 1 If yes, for each unique plan, provide a brief description why See Section I, Table 2 below. the plan is unique. 2 Provide the specific actuarial certification language under 45 See Checklist #21 CFR §156.135(b)(2) or 45 CFR §156.135(b)(3). 3 See checklist # 21 in Section II for special requirements for See Checklist #21. submitting AV screenshots. For each plan, explain in detail whether the pediatric dental See Section I, Table 2 below. 11 benefits are included as an embedded set of benefits, or through a combination of a health benefit plan and a stand- alone dental plan that includes pediatric dental benefits certified as a qualified dental plan. See WAC 284-43-5702.
the issuer’s service area, must be set at 1.00. If the insurer is new to the Washington state market, the geographic area with the greatest number of counties must be set at 1.00. 7 8 9 9 If your service area varies by plan, for each plan, list the plan’s HIOS ID, the plan name, and the service area and county. See Section I, Table 2 below. 10 a Do you have any plan with a unique benefit design? b 1 If yes, for each unique plan, provide a brief description why the plan is unique. See Section I, Table 2 below. 2 Provide the specific actuarial certification language under 45 CFR §156.135(b)(2) or 45 CFR §156.135(b)(3). See Checklist #21 3 See checklist # 21 in Section II for special requirements for submitting AV screenshots. See Checklist #21. 11 For each plan, explain in detail whether the pediatric dental benefits are included as an embedded set of benefits, or through a combination of a health benefit plan and a stand- alone dental plan that includes pediatric dental benefits certified as a qualified dental plan. See WAC 284-43-5702. See Section I, Table 2 below.
cl-rates-19-ind-nongrandfathered-health-plan.docx