SERFF v6.0. Bridget Kieras Senior Manager I, SERFF/OPTins April 9, National Association of Insurance Commissioners

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1 SERFF v6.0 Bridget Kieras Senior Manager I, SERFF/OPTins April 9, 2013

2 Release News SERFF v6 was released the evening of March 28. Binder preparation is underway. Templates being uploaded first templates validated yesterday!

3 Known Issues Patch version was released April 4. Known issues are posted to the SERFF splash page. To keep up to date, users should bookmark as the starting point for SERFF.

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5 Getting Help with SERFF Things to report to the SERFF Help Desk: Any SERFF system issues or errors. Submission Requirements questions General workflow questions or issues. NAIC Help Desk Hours 8am-5pm, Central, Monday to Friday. Expanded hours coming soon - 8am-8pm! Online Help available inside SERFF.

6 CMS Help Desk Exchange Operations Support Center (XOSC) Questions related to filing QHPs to Full FFEs. Any issues or questions dealing with contents of a federal data collection template. Via at CMS_FEPS@cms.hhs.gov Via phone at CMS-1515

7 State Implementation To date, 34 states are in production and ready for binder submissions in SERFF. More on the way! Industry users are encouraged to regularly review the Plan Management General Instructions. States are encouraged to use State Generated Messages to communicate with filers. Filings made be made in HIOS, SERFF, or both.

8 Templates Contact SERFF or XOSC with problems completing and validating the templates. Validation services are ready submit your templates! Contact SERFF Help Desk if you have a binder with 100 or more plans. Don t forget that you can zip your large files.

9 Training Training is more than half way done with great results. SERFF team continues to evaluate surveys and other feedback. Adjustments may be made to training based on early submission issues/concerns.

10 Questions Keep up to date on SERFF s Plan Management project at

11 SERFF Plan Management 2013 Outlook Bridget Kieras Senior Manager I SERFF/OPTins April 9, 2013

12 SERFF v6.1 Product Backlog Scheduled for release on May 23, Release scope anticipated to include: Support for dental only plans Transfer Plan Service PDF Pipeline Decertification

13 Dental Plan Business Requirements Support template requirements for stand alone dental plans. Support supporting documentation requirements for stand alone dental plans. Update user interface to identify and correctly display stand alone dental plans.

14 Supporting Dental Only Plans State implementation Issuer implementation Training Timing and state deadlines Federal exchanges using SERFF (SPE, MPM) State based exchanges

15 PDF Pipeline This existing feature will be extended to plan management. PDF Pipeline has many uses and will serve as an interim public access solution. It will function in an identical manner, including being restricted to PDF attachments.

16 Transfer Plans transferplan is the Web service that will push plan data to an exchange. Authorized users in SERFF control the timing and some of the content. SBEs will push to their exchange system; FFEs using SERFF will push to HIOS. Some return services are anticipated.

17 Releases in Q A July release expected for federal data reporting for state based exchanges. This release may contain additional features for plan management. A release late in Q3 is also possible.

18 Release in Q A release in Q4 is anticipated for final functionality related to renewal and decertification. Additional changes for plan year 2015 will be included. This release will also contain enhancements based on user feedback.

19 Questions Keep up to date on SERFF s Plan Management project at

20 Moving Toward Open Enrollment Joy Morrison Assistant Director SERFF/OPTins April 9, 2013

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22 Quarter 2 Activities Plan submission, review and certification Additional Filer Outreach? State Review Tools Stand Alone Dental - mid-may

23 Multi-State Plans Working with OPM on Workflow Multi-State Plans Submitted via SERFF MSPs submitted by OPM to the impacted states State manages workflow in SERFF

24 Financial Management Data Reporting SBE reporting obligation for federal financial management functions. Two parts data and attachments. SERFF will build functionality to help states meet these requirements. Key dates are July 31, August 31, and September 15.

25 Plan Transfer State Deadlines FFE Transfer Deadline, July 31 Financial Management Test Data by July 31 Final FM Data Transfer by August 31

26 Plan Preview Process may differ by model August for FFE Coordinated Effort with CCIIO

27 Questions Keep up to date on SERFF s Plan Management project at

28 Recertification & Renewal Bridget Kieras Senior Manager I, SERFF/OPTins April 9, 2013

29 Defining the Concepts Recertification is generally used to mean the process by issuers are approved to continue participation in a given exchange. Renewal is generally used to mean the process by which a plan sold on the exchange is approved and certified to be sold again the next year.

30 Related Concepts Decertification is the act of removing a plan from being sold on an exchange on the basis of regulatory actions, generally in the oversight and market conduct areas. Plan changes involve changes, additions, and corrections to a plan during the plan year. These may vary and are constrained by state and federal regulations.

31 Recertification Process and timing differ by state and exchange model. No SERFF specific functionality has been built for this, although some states do use SERFF for the process.

32 Renewal Two base assumptions SCIDs will not change form one year to the next. Most plans will have some changes (ie rates.) Process may differ by state and exchange model. Timing may differ, but some general consistency is expected.

33 Renewal Timing Plans sold in 2014 will need to renew to be sold in Amount of additional guidance that will be needed is unknown. Generally, expect renewals to begin in early to mid 2014 for 2015 plan year.

34 Enhancement Objectives Provide traceability for the same plan across plan years. Provide ease of use tools for filing plan renewals. Provide ease of use tools for reviewing plans submitted for renewal.

35 Potential Process Issuers creates a copy of the plan binder. Changes made to reflect the plans intended for Plans may be added or changed. Plan binders submitted for review, with indicators of new vs renewing plans. Plan review and certification process completed. Certified plans transmitted to exchange system.

36 Outstanding Issues Will states need better functionality for certification/recertification at the issuer level? Will the federal data collection templates change for plan year 2015? What modifications are allowed to a certified plan during renewal?

37 Questions Keep up to date on SERFF s Plan Management project at

38 Moving Between Models Joy Morrison Assistant Director SERFF/OPTins April 9, 2013

39 Current Conditions FFE is the largest bucket Partners and unbranded comprise one quarter SBEs are a third

40 Potential for Change Two-thirds of states could shift ~34% ~27 ~38% Full FFE Partnership SBE

41 Managing the Change Start early Communicate often Careful transition planning

42 Data Universal Implications Renewals Transfer Plan Timing Submission in the wrong system

43 From FFE to SPE Largest shifts Historic Data Additional State Specific Requirements

44 From FFE to SBE Smallest shifts Most resources needed for transition Timely communication is key Additional State Specific Requirements

45 Some shifts From SPE to SBE Considerations similar to FFE-SBE shift

46 Shifts in the 2014 Plan Year SBE to Partnership When Impact to issuers Transfer of plans

47 Things to Consider Has or will your state already overcome any policy issues preventing a model change? Has your state discussed or formed an exchange body and started resolving general governance issue? Does your state have the IT resources and review staff to make a change to another model? Have you begun issuer outreach? Have you talked with other states about lessons learned? Have you set transition plan milestones?

48 Questions Keep up to date on SERFF s Plan Management project at

49 Navigators, Producers, Company Licensing, Consumer Complaint and Enforcement Julie Fritz Chief Business Strategy Officer April 9, 2013

50 Navigators Licensing/Certification, etc. Verification/Validation

51 Producer Licensing and Appointments Licensing/Certification, etc. Verification/Validation

52 Licensing Certification Market Oversight Company Licensing

53 Consumer Complaints Triage and Tracking Reporting

54 Certification Market Oversight Enforcement

55 Questions Keep up to date on SERFF s Plan Management project at For Navigator, Producer, Company Licensing, Complaints and Enforcement contact Julie Fritz at jfritz@naic.org