Last Updated: May 7, 2024
Comprehensive Health Rate Filing Requirements
Individual and Small Group Markets
For non-grandfathered individual and small group comprehensive health products issued on or after January 1, 2014, companies are required under federal law to develop rates based on a single, market-level index rate (single risk pool) adjusted pursuant to the rating rules prescribed in federal regulation, on and off the federally facilitated marketplace (FFM).
Federal regulations and guidance relevant to individual and small group comprehensive health insurance rate review may be found on the
Center for Consumer Information & Insurance Oversight (CCIIO) website.
In July 2011, Wisconsin was certified by the federal government as an Effective Rate Review Program (ERRP) in the individual and small group markets. In March 2013, Wisconsin obtained an additional ERRP certification in the individually underwritten association market. As an ERRP, Wisconsin is required to review rate filings for compliance with the federal rate review market rules and notify the FFM of its rate review findings. Please refer to the Comprehensive Health Rate Filing FAQs for more information on Wisconsin's rate review requirements.
With the transition to the single risk pool for all non-grandfathered individual and small group products, Wisconsin established separate sets of rate filing requirements for (1) Transitional Rate Filings, (2) Single Risk Pool Rate Filings, and (3) Grandfathered Rate Filings. Please follow the links below to access the appropriate requirements:
| Requirement Category | Category Definition
| Rate Filing Window |
|---|
|
Transitional | Rate filing requirements for changes to non-ACA compliant, non-grandfathered individual or small group products. | 30 days prior to the rate change effective date |
|
Single Risk Pool (SRP) | Rate filing requirements for rate changes effective January 1, 2014, or later that affect ACA-compliant individual or small group products | See the
Comprehensive Health Rate Filing FAQs for single risk pool rate filing submission timelines
|
|
Grandfathered | Rate filing requirements for rate changes that affect grandfathered individual or small group products | 30 days prior to the rate change effective date |