Student Health Plan General Filing Instructions

In preparing student health plan form and rate filings, issuers should review all statutory requirements that govern these filings, per the applicable licensed product, to ensure all new requirements are adhered to.

Minnesota has compiled a Checklist Guide for Commerce Department analysts(.pdf) to use in reviewing student health plan product filings submitted to the Department for approval.

Additional state or Federal requirements may exist to the extent that they apply to provisions not typically found in policy forms or certificates. Compliance with these additional requirements, if applicable to the product filing, would still be required even though they are not listed in this Checklist Guide.

While the Department is making this Checklist Guide publicly available, companies or student health plan issuers should refer to all relevant Minnesota Statutes and Rules and applicable Federal law in developing the product filings that they submit to the Department for approval.

Timeline
Requirements
Schedule
Supporting Documentation

Review & Submission Timelines

General Health Plan Filing Requirements

According to Minnesota Statutes, section 62A.02, subdivision 3(a), filings are to be reviewed within 60 days of receipt. A health plan form shall not be issued, nor shall any application, rider, endorsement, or rate be used in connection with it, until the expiration of 60 days after it has been filed unless the commissioner approves it before that time.

Response Letters

You must respond to an objection or request for additional information, within thirty (30) days or sooner, if requested. If an appropriate response is not received within the required time period, the filing will be disapproved by the Department. Resubmissions must address all objections before returning it for review. Do not submit responses separately.

Annual Filings

Annual filings are expected for student health plans, as core information will be reviewed for compliance based on key parameter changes, as well as to confirm compliance with emerging federal guidance and new state law changes. For example, annual changes are common for the following items:
- Actuarial value, due to annual trending of the Actuarial Value Calculator
- Anticipated loss ratio
- Past loss ratio, enrollment experience updates
- Annual trend expectations/experience
- Benefit design parameters applicable to specific institutions
- Certifying actuary
- Preventive Services covered at 100%, based on changes to U.S. PSTF recommendations to Lists A and B
- Essential Health Benefit changes as benchmark changes
- State statute impact on forms
- SBC template changes
- Federal guidance changes to student health plans as well as the individual market, when applicable
General Information Requirements

Status Inquiries

Status requests for filings submitted more than 45 days prior should be directed to the assigned analyst. If you have not received a response to your status request within 3 business days, please contact:

Melinda Domzalski-Hansen
Director of Health Insurance Programs
melinda.domzalski-hansen@state.mn.us

Status requests for filings submitted more than 45 days prior should be directed to the assigned actuary. If you have not received a response to your status request within 3 business days contact:

Laura Rickbeil
Insurance Division
Principal Health & Life Actuary
Laura.Rickbeil@state.mn.us

Type of Insurance (TOI)

Under 45 CFR §147.145, student health insurance coverage is considered a type of individual health insurance coverage that, subject to certain limited exceptions, must comply with the PHS Act requirements that apply to individual health insurance coverage.

To demonstrate compliance with this Federal regulation, the Minnesota Department of Commerce will no longer allow student health plan filings to be submitted under various types of insurances in SERFF (for example: individual health, blanket or group). Instead, issuers must file using the TOI H22 Student Health Insurance and Sub-TOI H22.000 Student Health Insurance. Further, use of terms within the filing that were previously acceptable, such as the terms “group” and “blanket,” will be cause for objections that could delay the form and rate filing approval process.

Filing Description

Issuers are required to describe their filing under the section Filing Description, within the General Information tab. Cover letters are not required, but if one is submitted, they should be attached under the Supporting Documentation tab.

If the submitted forms are related to a previously approved form filing, state the SERFF Tracking number and all corresponding form filings, under the Filing Description.

In addition to the information listed above, please submit the following, within the filing description:
- Explanation if the filing is new, or is a revision of a previously approved form
- Explanation if the filing establishes one or more risk pools, and/or rating tier, per institution.
- Explanation of which educational institution(s) are, or could be, included in the risk pool.
- An explanation of the changes made since the prior approved filing.
In past CMS guidance, risk pooling of student health plans by issuer, and by state, was required. For the 2016/2017 policy year and beyond, each student health plan may be separately pooled. Issuers may choose to continue to submit one filing for all universities in the state, if pooling of risks is opted to continue. In that case, endorsements can be used to describe the plan design and rates that exist for each school. However, issuers may instead elect to submit a separate filing for each school, or student classification within a school, based upon how the pooling of risk is designed.

Filing Certification Statement

All filing submissions must contain a certification that the filing submission is in compliance with all statutes and administrative rules. A separate filing certification form is not required. Instead, please incorporate your certification language within the Filing Description, within the SERFF filing.

Language similar to the following is generally acceptable:

“I certify that I have reviewed the contents of this filing, and all applicable Minnesota statutes and administrative rules prior to its submission. I understand that if this filing does not comply with Minnesota statutes and administrative rules, the Minnesota Department of Commerce may take administrative action, including levying of fines against the company.”

Attachment Information and File Formats Accepted

Form filings must be submitted in PDF format. Do not place security or protections on a document that requires a password.

Resubmissions of Previously Disapproved or Withdrawn Filings

When filing a previously disapproved or withdrawn filing, include the previously disapproved or withdrawn filing's SERFF Tracking number in the General Information Filing Description.

Form and Rate Filings Must be Filed Together

Student health plan form and rate filings should be filed together in one single rate/form filing. If you have any questions about this process, please send an inquiry to Melinda Domzalski-Hansen for clarification.

K-12 Student Plans Are Not Student Health Plans

Based on CMS guidance, K-12 institutions do not meet the definition of student health plans.

Federal Register / Rules and Regulations (.pdf)

“The proposed definition would not include coverage provided under an agreement between an issuer and a high school, as the definition of an institution of higher education under the Higher Education Act does not include secondary institutions.”

Possible solutions for K-12 students (for example, boarding school students) include major medical coverage available on a child-only basis through the individual market in the student’s state of residence, assuming a plan is available that has network access near the boarding school.

Company Address Changes –Filing Fees Required

In-force contracts must be amended to reflect the new address. An endorsement setting forth the new address must be submitted for approval and sent to all in-force policyholders, contract holders, and certificate holders. The filing description must state that all in-force contracts will be amended by the endorsement. Attach a list of all affected forms to the Supporting Documentation tab of the SERFF Filing. The list should include the form name, form number, approval date, SERFF Tracking Number, and State Tracking Number (if applicable).

Company Officer Name Changes – Filing Fees Required

Officer Name Change filings only, filers should:
1. File cover/signature pages with the new officer name(s) and a revision date as a part of the form number in the SERFF Filing Form Schedule.
2. Include change of officers’ names from previous officers to new officers in SERFF Filing General Information.
Attach a list of all affected, previously approved forms, by attaching the list to the Supporting Documentation tab. The list should include the form name, form number, approval date, SERFF Tracking Number, and State Tracking Number (if applicable).

Further Guidance Expected from CMS on University Students that Qualify as Employees

Based on recent Federal guidance, we expect that graduate students who are employed by universities might instead be subject to ERISA, and state and Federal group market and employee benefit rules, rather than the student health plan rules described herein. Until Federal guidance is issued on that subject, Minnesota will continue to allow the treatment of this classification of persons as students or employees, as decided by the university and applied in a nondiscriminatory manner to such classes of graduate students.
Form Schedule Requirements

Matrix Filings – Not Accepted

The Department does not accept matrix language on new contract/policy filings. Forms must be formatted in a manner that allows the Department to determine how the forms (contract/policy, rider, etc.), will look at issue.

Rate Requirements

Rate/Rule Schedule

Overall average rate change (since prior year) and enrollment (most recent covered lives) should be supplied on the Rate/Rule Schedule tab.

Actuarial Memorandum

The actuary should clearly state the anticipated loss ratio (xx.x%) within the Actuarial Memorandum.

Rates must be either fully community rated by student classification within the university, or must follow Minnesota’s unique age curve as applicable to the individual market.

If the Actuarial Value Calculator cannot handle special plan design features, special actuarial adjustments made to the Actuarial Value should be documented by the Actuary in the Actuarial Memorandum, or a separate certification document should be filed under the Supporting Documentation section.

The Actuarial Value of the plan design must be over 60% using the Actuarial Value Calculator tool applicable to the policy year. The actuary should describe which version of the Actuarial Value Calculator was used.

The Actuarial Memorandum must include descriptions of the data sources, assumptions and methods used to create rates. Filing of a rating manual is optional, and often does not make sense any longer, given the community rated basis for each school’s rates, and the common choice of a single risk pool basis. The Actuarial Memorandum should also include descriptions of adjustments made, such as for coverage additions needed to comply with coverage changes to preventive coverage and compliance with the Minnesota set of Essential Health Benefits.

The Actuarial Memorandum should include at least a five year history of loss ratios, rate changes, and enrollment with the student health plan risk pool in question, and various student classifications. If any rating tiers are created for student classifications within a school, the actuary should supply enough data on the basis for the divergent rating schema so that another actuary can assess the reasonability of all rates and the statistical credibility of the past experience by student classification. The State will take exception to small groupings of student classifications that cannot be statistically proven as credible.

The Actuarial Memorandum should be signed and dated by a certified actuary who is a Member of the American Academy of Actuaries.

Issuers must submit the Part II Consumer Narrative and certain rate summary information within the RRJ Template of HIOS if the increase is 10% or more.

CMS Portal

CCIIO recently provided guidance that prohibits retrospective premium agreements. If such agreements are included, the Actuarial Memorandum should explicitly identify the terms and the rating consequences of such agreements. Such agreements may be cause for objection, based on the direction of emerging guidance from CCIIO.
Supporting Documentation Requirements

Summary of Benefits and Coverage (SBC)

The Federal government requires all healthcare issuers and group health plan sponsors to provide this document to plan participants at certain times beginning September 23, 2012. In addition, the Department requires student health plan issuers to file their plan SBCs for review.

The documents must be attached to the form and rate filing, under Supporting Documentation. When submitting SBC documents, they must be attached in PDF form. Issuers must file one SBC per plan.

On March 11, 2015, CMS and DOL, HHS and Treasury published two FAQs regarding SBCs. The Departments will be closely monitoring the proposed and final instructions for 2017 SBCs and would like to remind issuers to do the same. Please refer to the CMS regulatory web pages for further guidance and direction:
- CMS regulatory web page
- FAQ 30; CMS FAQ
- SBC Materials and Supporting Documents (Authorized for use prior to April 1, 2017):
- SBC Materials and Supporting Documents (Authorized for use on and after April 1, 2017):
Prescription Drug Template

Minnesota requires student health plan issuers to file a Prescription Drug Template for review, within their corresponding form and rate filing. This document will be used to ensure the Student Health Plan’s compliance with the Essential Health Benefits benchmark and drug list. The document must be attached to the filing, under Supporting Documentation, in the Excel format.

Federal template and instructions

Issuers should also submit completed Federal justification documents as applicable and place them under the Supporting Documentation tab. These documents include, but are not limited to:
- Formulary - Inadequate Category/Class Count Supporting Documentation and Justification
- Discrimination - Formulary Outlier Review Supporting Documentation and Justification
- Discrimination - Formulary Clinical Appropriateness Supporting Documentation and Justification
Demonstration of Essential Health Benefit Compliance (State of Minnesota) Grandfathered form filings may not be filed with non-grandfathered form filings.

Statement of Variability Requirements

A Statement of Variability (SOV)/ Memorandum of Variability (MOV) must be submitted for each form containing brackets requesting variability, and follow the instructions provided below:
- The SOV/MOV must thoroughly explain the extent of variability. Provide bracketed [ ] ranges for fields when applicable.
- When including brackets around phrases, sentences or sections provide the alternative language that would replace the variable language and/or explain what variable language that would be deleted entirely.
- Submit the SOV/MOV under the Supporting Documentation tab. The SOV/MOV will be accepted as informational upon approval of the form filing.
- Submit a red-lined copy of both the form(s) and SOV/MOV reflecting ONLY the currently revised changes for each revision of the form(s).
The Department does not accept bracketing of company contact information (address, phone number, logo, website, email, officer signatures, etc.) per Minnesota Rule Part 2605.0400 and Minnesota Statute, section 60A.08 Subd. 5.

The approval of the form filing is limited to the variable language provided in the SOV/MOV.

Actuarial Value Screen Shots

Issuers are required to upload an Excel or PDF screenshot of Actuarial Value (AV) calculator results for each plan, regardless of whether or not the plan design required a special actuarial adjustment. Screenshots enable us to determine whether the AVs are reasonable in relation to the plan design information supplied on the SBC and forms, and will greatly speed up the approval process over plan designs and rates.

Red-lined Policy Form Requirements

Within the form filing, issuers are required to submit a red-line version of all student health plan forms (Policy, Contract, Application, Rider, etc.), reflecting the changes made to previously approved forms, under the Supporting Documentation tab.

Whenever submitting a red-lined copy of changes made to previously approved forms, provide a red-lined version of the revised forms reflecting ONLY the current changes for each revision of the form.

In addition, when responding to objection letters, provide a new red-lined version of the policy forms, which reflects ONLY the current revised changes in response to the most recent objection letter.

Riders, Endorsements, Applications and Amendments

Multiple riders, applications, endorsements and/or amendments may be included as one filing, though consider that each filing represents one single risk pool.