CurrentBlue Cross Blue Shield - WisconsinPolicy N/A

California plain-language rate filing description

Template for California rate filing disclosure required by Health & Safety Code 1385.07(d) and Insurance Code 10181.7(d); intended for the insurer to provide justification and cost/trend breakdowns by aggregate benefit category for posting on a website. Applies to the company's California rate filing submission process.

Policy Summary

PayerBlue Cross Blue Shield - Wisconsin

PolicyCalifornia plain-language rate filing description

Policy CodePolicy N/A

Change TypeInformational/template

Effective Date

Next Review Date

Key ActionProvide written justification and supporting documentation for any unreasonable rate increases and report dollar costs and projected trend breakdowns by aggregate benefit category.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Multiplecategories requested (hospital inpatient, outpatient, physician, drugs, lab, radiology, capitation, other)

3trend breakdowns requested (use of services, price inflation, fees and risk)

Policy Summary & Scope

This template is the California rate filing disclosure required for insurer submissions under Health & Safety Code 1385.07(d) and Insurance Code 10181.7(d). It is intended to be completed as part of the company’s California rate filing process and requires the insurer to provide a written justification for any unreasonable rate increases and to report actual dollar costs and, where requested, cost as a percentage of Medicare for multiple aggregate benefit categories (for example: hospital inpatient, hospital outpatient including ER, physician/other professional services, prescription drug, laboratory, radiology, capitation categories, and other). The form also requires a projected trend breakdown for each category attributable separately to use of services, price inflation, and fees and risk, and is intended for information that will be posted on a website as part of the filing.

At-a-Glance Metrics

categories requestedMultiple aggregate benefit categories

trend breakdowns requested3 trend components per category

Required Actions for Filers

Policy Summary

PayerBlue Cross Blue Shield - Wisconsin

PolicyCalifornia plain-language rate filing description

Policy CodePolicy N/A

Change TypeInformational/template

Effective Date

Next Review Date

Key ActionProvide written justification and supporting documentation for any unreasonable rate increases and report dollar costs and projected trend breakdowns by aggregate benefit category.

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.

Documentation Required

Filing must include justification for rate increases

Provide a written justification for any unreasonable rate increases and attach supporting documentation to the filing PDF.

Company Name
SERFF Tracking Number
Department File Number (to be completed by Department)
Contact Name and Address (Shelley Rouillard, Director shown as example)

Documentation Required

Provide actual costs by aggregate benefit category

Supply dollar cost and, where requested, cost as a percentage of Medicare for each aggregate benefit category listed below; include dollar cost and percentage of Medicare where the form requests it.

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 (describe) — Dollar Cost and Description

Documentation Required

Provide projected trend breakdowns

For each aggregate benefit category, report the projected trend broken down separately into trend attributable to use of services, trend attributable to price inflation, and trend attributable to fees and risk.

Provide separate trend values for: use of services; price inflation (price); fees and risk
Report these three trend components for each category: Hospital Inpatient; Hospital Outpatient (including ER); Physician/other professional services; Prescription Drug; Laboratory; Radiology; Capitation (professional/institutional/other); Other (describe)

Form fields to include with filing

Company Name

SERFF Tracking Number

Department File Number (to be completed by Department)

Contact Name and Address (Shelley Rouillard, Director shown as example)

Legal basis: completion of this disclosure is required by Health & Safety Code 1385.07(d) and Insurance Code 10181.7(d) as shown on the form.

Defined Terms

Key Definitions

Aggregate Benefit CategoryHigh-level grouping of services for which dollar costs and trend components must be reported (e.g., hospital inpatient, outpatient, physician services, prescription drugs, laboratory, radiology, capitation, other).

Background and Purpose

Background: The form requests supporting documentation and a written explanation to justify any unreasonable rate increases, and it itemizes required reporting across a set of aggregate benefit categories so costs and trends can be presented transparently. For each category the insurer must supply actual dollar costs (and cost as a percentage of Medicare where requested) and, separately, the amount of projected trend attributable to use of services, price inflation, and fees and risk. This information is intended for public posting to provide clarity on the components and drivers of rate changes and to support regulatory review of the filing.

California plain-language rate filing description

Policy Summary & Scope

Required Actions for Filers

Defined Terms

Background and Purpose

Other Policies to Review