CurrentBlue Cross Blue Shield - WisconsinPolicy N/A

California Plain‑Language Rate Filing Description (template and instructions)

Template and instructions for producing the California-required plain-language rate filing description for website posting under Health & Safety Code 1385.07(d) and Insurance Code 10181.7(d); intended for the insurer's compliance staff preparing rate filings for California.

Policy Summary

PayerBlue Cross Blue Shield - Wisconsin

PolicyCalifornia Plain‑Language Rate Filing Description (template and instructions)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionInclude justification for any unreasonable rate increases and attach supporting documentation.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Sections 1,3,4Key sections referenced

MultipleBenefit categories

CAStatutory citation

Data Fields Required for Cost and Trend Reporting

Data fields for cost and projected trend reporting

Requested data fields to be completed by the filer for each aggregate benefit category:

Data fields for each aggregate benefit category must be provided as specified below.

Hospital Inpatient

ALL of the following
- Dollar Cost: (enter dollar amount)
- Cost as Percentage of Medicare: (enter percentage, if available)

Hospital Outpatient (including ER)

ALL of the following

Policy Summary

PayerBlue Cross Blue Shield - Wisconsin

PolicyCalifornia Plain‑Language Rate Filing Description (template and instructions)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionInclude justification for any unreasonable rate increases and attach supporting documentation.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Aggregate Benefit Categories and Numeric Thresholds

Aggregate benefit categoriesmixed

Hospital Inpatient	Dollar Cost; Cost as Percentage of Medicare
Hospital Outpatient (including ER)	Dollar Cost; Cost as Percentage of Medicare
Physician/other professional services	Dollar Cost; Cost as Percentage of Medicare
Prescription Drug	Dollar Cost; Cost as Percentage of Medicare
Laboratory (other than inpatient)	Dollar Cost; Cost as Percentage of Medicare
Radiology (other than inpatient)	Dollar Cost; Cost as Percentage of Medicare
Capitation (professional)	Dollar Cost and Description
Capitation (institutional)	Dollar Cost and Description
Capitation (other)	Dollar Cost and Description
Other	Dollar Cost and Description

No numeric thresholds provided

SummaryForm requests dollar costs and percentage-of-Medicare values and asks filers to attribute projected trend components (use of services, price inflation, fees and risk) for each aggregate benefit category; no numeric cutoffs or thresholds are provided in the form.

Requested cost fieldsDollar Cost for each aggregate benefit category (e.g., Hospital Inpatient, Hospital Outpatient, Physician services, Prescription Drug, Laboratory, Radiology, Capitation, Other).

Requested comparative fieldCost as Percentage of Medicare for specified categories (Hospital Inpatient, Hospital Outpatient, Physician services, Prescription Drug, Laboratory, Radiology).

Trend components requestedFor each category, separate trend attributions: trend attributable to use of services; trend attributable to inflation/price; trend attributable to fees and risk.

Rate Increase Justification and Supporting Documentation

Documentation Required

Rate increase justification required

Provider must include a clear justification for any rate increase deemed unreasonable. The justification should explain why the increase is warranted and must include all supporting documentation. Attach all supporting documents (e.g., actuarial memos, financial statements, utilization reports, assumptions, and methodology) to the submission file.

Include a narrative explanation describing the reasons for the rate increase and why it is reasonable.
Attach supporting documentation: actuarial memoranda, financial statements, utilization reports, cost trend analyses, and any assumptions or methodologies used.
If applicable, provide regulatory filings, prior approvals, or correspondence that support the increase.
Ensure all attachments are included with the submission PDF and clearly labeled.

California Public Posting Requirement

California public posting description (Health & Safety Code 1385.07(d); Insurance Code 10181.7(d))

Statutory purposePlain‑language rate filing description for web posting to satisfy Health & Safety Code 1385.07(d) and Insurance Code 10181.7(d).

Location/authorTemplate titled 'California Plain‑Language Rate Filing Description' (Shelley Rouillard, Director).

Required content — justificationA justification section requiring filers to include all information explaining why any rate increase is justified and to attach supporting documentation.

Filing identifiersFields for Company Name, SERFF Tracking Number, and Department File Number (to be completed by Department).