Last Updated: June 3, 2020
Comprehensive Health Form Filing Requirements
Non-grandfathered individual and small group comprehensive health insurance products issued on or after January 1, 2014, must comply with all requirements of the Affordable Care Act (ACA) including, but not limited to, essential health benefits (EHBs), actuarial value (AV) requirements (also referred to as metal levels), guaranteed availability, and rating rules. For more information on the ACA, refer to the Center for Consumer Information & Insurance Oversight (CCIIO) website.
Submission Requirements and Checklists
Form filings affecting plans submitted to the federally facilitated marketplace for Qualified Health Plan (QHP) certification for Plan Year (PY) 2021 must be received at the Office of the Commissioner of Insurance or have a submission date in SERFF of no later than July 1, 2020. Form filings affecting only plans that will be non-QHPs in PY2021 must be submitted by October 1, 2020, per s. 631.20, Wis. Stat. (30 days prior to the individual open enrollment period). Filings will be reviewed in order of receipt and will be accepted at any point prior to the deadlines listed above.
Benchmark Plan - Essential Health Benefits
Wisconsin's benchmark plan is the largest plan by enrollment in the largest product by enrollment in the small group market. The benchmark plan serves as the standard for Essential Health Benefits (EHBs) that must be offered in the state. Plans are not restricted to only EHBs, so additional benefits may be offered.
Current Wisconsin Benchmark Plan (BMP) (2017-2021):
All benefits in the Wisconsin benchmark plan are EHBs. All plans in the individual and small group markets must offer, at a minimum, benefits that are substantially equal to the EHB benchmark plan. Please note that the summary documents above are guides and may not capture all the benefits included in the relevant benchmark plan.