The State of New Jersey
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Common Rate Filing Questions (revised 05/12/2017)
Individual (IHC) and Small Employer (SEH)

Q1. What are the due dates for IHC and SEH rate filings?

A. IHC and SEH rate filing
s are due to the Department on the same date the filings are due to CMS:

2017 Quarterly SEH rate filings are due 105 days prior to the effective date which means:

    • 2Q2017 rate filings effective 04/01/2017 were due by 12/17/2016.
    • 3Q2017 rate filings effective 07/01/2017 were due by 03/18/2017.
    • 4Q2017 rate filings effective 10/01/2017 are due by 06/18/2017.

2018 Annual IHC and SEH rate filings are due no later than 06/21/2017. 

2018 Quarterly SEH rate filings are due 105 days prior to the effective date which means:

    • 2Q2018 rate filings effective 04/01/2018 are due by 12/18/2017.
    • 3Q2018 rate filings effective 07/01/2018 are due by 03/18/2018.
    • 4Q2018 rate filings effective 10/01/2018 are due by 06/18/2018.

Q2. Are SEH carriers permitted to introduce new plans mid-year for non-SHOP business? 
A.Yes. New SEH plans may be introduced mid-year within the following parameters:

  • Plans may only be offered off-SHOP;
  • Rate development for these plans must be based on the single risk pool;
  • Benefit designs for these plans must be included in the rate filings;
  • Network(s) for these new plans must have been filed with, and approved by the Department; evidence of the approval included in the rate filing; and
  • Plans must be offered as guarantee issue meaning the participation and contribution requirements cannot be applied to any small employer for such new plans for the balance of the calendar year. 

Q3. What specific data elements are to be included in the IHC and SEH rate filings?
A.  Rate filings must contain the following elements:

  1. NJ State Template version 4.00 – Save and submit only as an Excel.xls file.

Note: NJ State Template version 4.00 contains a field for the HIOS Submission Tracking Number. Rate filings must be submitted to HIOS before they are submitted to the state via SERFF so this tracking number is included on the NJ State Template.
  2. Part I Unified Rate Review Template (URRT) (45 CFR 154.215) 
  3. Part II Written Description Justification (45 CFR 154.215) – A written description justifying all plan level threshold increases

Note: For SHOP, the Annual Part II must specifically address all plan level threshold increases for the year, by quarter.

  4. Part III Actuarial Memorandum (AM) (45 CFR 154.215) – A NJ state-specific actuarial memorandum is not required and should not be submitted. However, the Part III AM must contain those additional actuarial memorandum data elements required by New Jersey regulation at: N.J.A.C. 11:20-6.3 (IHC) and N.J.A.C. 11:21-9.3 (SEH).
  5. Actuarial Value (AV) Calculator “Screen Shots” – one for each plan in the rate filing.  For IHC carriers, this includes the three CSR variations (73%, 87%, and 94%) for Silver plans offered through the Marketplace. 
  6. A Table of Contents, Plan Schedule(s) and a Rate Manual
  • A Table of Contents shall include the date of the current filing, a list of documents, and page numbers.
  • A Plan Schedule (Benefit Summary Table) for each of the standard health benefits plans offered.
  • A Rate Manual.
  • A 3-part footer which contains: (1) Carrier name, SERFF# and document name, (2) page #, and (3) date created or revised. If revisions are made to the filing, each page shall be dated clearly and distinctively with the revision date.
  7. Carrier Specific Rate Chart – updated to reflect carrier rate information as of the current effective date. For carriers with more than one entity, the Rate Chart must include rates for all entities and be submitted, via SERFF, with each entity’s rate filing. The content of the standardized rate chart template, including the footnote numbering, must not be changed.
  8. Completed Benefit Summary Tables – one for each plan to facilitate our review of the benefit information. These tables must be formatted to print on 8.5" x 11" paper and should be e-mailed to Ellen DeRosa, Executive Director, IHC and SEH Programs ( at the same time they are submitted with the rate filing in SERFF.
  • To capture information associated with out-of-network benefits, we created a table specific to plans that have out-of-network benefits.  Similarly, plans that feature tiered network benefits should be described on the appropriate table specific to tiered benefits. 
  • The footnotes include direction to submit evidence regarding network approval as well as documentation to support copays applicable to certain services.  If the same documentation applies to multiple plans it is not necessary to enclose the documentation for each plan. 
  • Please note that final NJDOBI action with respect to a rate filing will be pended until the Benefit Summary Tables along with the documentation specified in the footnotes has been received and found complete and satisfactory. 
  9. Completed Data Change Request Forms – SHOP quarterly rate filing updates, at the time of the SERFF submission, must include the three completed Data Change Request forms required by CMS to submit a revised Federal Rate Table template in the HIOS PM module: Issuer, State, and Worksheet A.

Q4. What actuarial analysis should be added to the Actuarial Memorandum to help DOBI evaluate the reasonableness of the rate increases proposed for 2018?
A.  Given the array of regulatory and procedural changes impacting the premium rates proposed for 2018, the Department’s Rate Review team recommends that the Part III Actuarial Memorandum include an attribution analysis section to explain (both quantitatively and qualitatively) the impact of the key cost drivers, especially:

  • Federal market stabilization rules (e.g., new AV ranges, shortened enrollment period, limits on SEP, etc.)
  • Changes to the enforcement of the Individual Mandate
  • Uncertainty related to CSRs
  • New benefit mandates, if applicable
  • Claims experience in 2016 and 1Q 2017
  • Medical trend
  • Drug trend
  • Other important items (e.g., competitive landscape, surplus position, plan designs, and OON issues)

Q5. Does the Department use a checklist when reviewing IHC and SEH rate filings?
A.  Yes. These checklists may be found here: IHC Checklist or SEH Checklist.

Q6. Does the Department have required Age Curves which are to be used in the development of IHC and SEH Rates?
A. Yes. These Age Curves, revised for 2018 rates, may be found here:

Q7. How does the Department review rate filings for single risk pool compliance?
A. The carrier is required to provide support that the single risk pools in the New Jersey state IHC and SEH markets are established according to the requirement in 45 CFR 156.80. The Department will review such support with respect to the following:

  1. Does the claims experience satisfy the requirements in 45 CFR 156.80 (a) – (b)?
  2. Does the index rate effective January 1, 2018 satisfy the requirements in 45 CFR 156.80 (d)(1)?
  3. Are all permitted plan-level adjustments to the index rate actuarially justified, as required by 45 CFR 156.80 (d)(2)?

With respect to item 3 above, induced utilization plan-level adjustments will be reviewed by directly comparing the proposed plan-level adjustments to the induced utilization factors found in Table 10 – Cost Sharing Reductions Adjustments in the Proposed HHS Notice of Benefit and Payment Parameters for 2018 (Federal Register, September 6, 2016.)

Note: All single risk pool related support documents must be included within the Part III Actuarial Memorandum tab in SERFF.

Q8. How are rate filings to be submitted to the Department?
All rate filings must be submitted via SERFF; the SERFF filing rules have been updated and include reference documents and standardized templates, if required.

Q9. How should carriers indicate changes or revisions to data elements in the rate filing?
A. All elements of the rate filing are required to include a three-part footer showing: (1) Carrier name, SERFF# and document name, (2) page #, and (3) date created or revised.

Q10. How do carriers revise Excel files (e.g., Rate Chart Template) previously submitted?
A. Corrections to previously submitted files are permitted.  However, carriers should never change the Department-generated content (format, formulas, footnotes or footers) on a standardized Excel spreadsheet created by the Department.  Changes to the layout of these spreadsheets will slow the review process and require a resubmission.

Q11. When will the review of rate filings be completed by the Department?
A. For annual filings with an effective date of January 1, the Department strives to complete its reviews 45 days prior to the Annual Open Enrollment. For quarterly rate filings, our goal is to finalize the filings 45 days prior to the effective date of the rates. However, the actual timing for the review will vary depending on the completeness and accuracy of the filings.

Q12. When will the IHC and SEH rates be posted to the DOBI web site?
A. The IHC and SEH Annual rate charts and rate calculators will be published on the Department web site prior to the Annual Open Enrollment period. The SEH Quarterly rate charts and calculators will be posted to the web site prior to the state of the quarter.

Q13. Where can carriers find the rate filing requirements for IHC and SEH?
N.J.A.C. 11:20-6 (IHC) and N.J.A.C. 11:21-9 (SEH) contain the rate filing requirements.  Bulletin 13-14 addresses amendments to the rate filing rules specifically for IHC and SEH. The requirements apply to all Marketplace, non-Marketplace, SHOP and non-SHOP plan offerings.

Questions pertaining to HIOS Rate Filing/Rate Review requirements

4. Which rate filing documents are required for the different system modules in HIOs?
A. There are 3 systems in HIOS that are used for the rate filing and rate review processes:

  1. Unified Rate Review (URR) is the repository for rate review documents related to IHC and SEH ACA-compliant Qualified Health Plans (QHPs).
  • Parts I and III are required for all rate filings; and
  • Parts II and the State Determination are required for all plan level threshold increases.
  2. Rate Review Justification (RRJ) is the repository for rate review documents related to Transitional Policies and Student Health Plans.
  • Part I, II and III are required for all rate filings that meet, or exceed, the “subject to review” threshold.

Note: Parts I and III must be filed in SERFF for all Transitional and SHP rate filings.  Part II must be filed in SERFF if the filing contains product level increases that meet, or exceed, the “subject to review” threshold.

  3. Plan Management (PM) is the repository for all QHP related information, much of which is displayed on  This includes the annual and quarterly rates reported to HIOS PM, by the carriers, on the Federal Rate Template table.

Q15. When submitting an updated quarterly rate filing to the State, via SERFF, what corresponding forms must be submitted to CMS, via HIOS?
A. For IHC & SEH Rate Filings:

HIOS Unified Rate Review (URR) Module – Parts I, II, and III

CMS has determined that NJ has an Effective Rate Review Program. It is our understanding, from the URR Instructions, that updated rate submissions for 2Q, 3Q and 4Q, if filed, must contain rates for each of the remaining quarters – regardless of whether or not the rates shown for the subsequent quarters have changed from what was reported for those quarters in the Annual (1Q) filing.

If updated quarterly rates are submitted, the Part I URRT must reflect, in worksheet 2, line 27, the ‘Cumulative Rate Change % (over 12 months prior)’ for each renewing plan, as compared to the rates currently on file for the same time period of the previous year.

HIOS Plan Management (PM) Module – Federal Rate Table template

CMS provides correction windows for issuers to submit Small Business Health Option Program (SHOP) 2nd, 3rd and 4th quarter rate updates. 

  • Issuers must complete the Rates Table Template according to the CMS instructions and follow the CMS data change request process.
  • Rates on the Rate Table template must match the rates in the Part I (URRT).
  • The rates that the issuer submits to CMS must be the final reviewed and/or approved rates endorsed by the issuer's rate reviewer.

Note: As per the URR Instructions, carriers are prohibited from changing or removing SHOP quarterly rates or worksheets retrospectively.

Q16. Are carriers required to confirm that the rate filing information in SERFF is consistent with the rate filing information in HIOS?
A. Yes. If a carrier is unable to confirm that the information is consistent, a written statement is required at the time of the SERFF submission.

Note: CMS asks states to verify that all rate information submitted to HIOS (in URR and PM) matches the rate information submitted in SERFF. The Department, in turn, asks the carriers to confirm this information (or advise that it has not done so).

Student Health Plans (SHP)

Where can carriers find the New Jersey rate filing requirements for Student Health Plans (SHP)?
N.J.S.A. 17B:27A-9 and N.J.A.C. 11:20-6.3 (IHC) contain the informational rate filing requirements for carriers that offer individual health benefits plans. Order A16-106 addresses the rate filing requirements specifically for SHP. 

Note: Carriers are responsible for submitting related SHP policy forms filings for each rate filing and for including the policy form SERFF tracking # in the corresponding rate filing submission.

Q18. Do these requirements apply to all SHP rate filings?
Yes. The requirements apply to all SHP plan offerings.

Q19. Where can the Federal requirements for SHP be found?
The Rate Review Justification (RRJ) Instructions for Transitional Policies and Student Health Plans are found here:

Q20. What are the due dates for SHP rate filings?
A. SHP rate filings are due at least 90 days prior to the effective date of the rates
and should be submitted via SERFF.

Q21. How can carriers get answers to SHP-specific rate filing questions?
A. E-mail
questions to

Contact Information

Q22.  What if carriers have other questions?

A. Questions should be addressed to the following:

Joanne Petto (
Don Henson (
Gary Weiss (
Vivien Cosner (

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