Filing Guidance for Individual and Small Employer Major Medical Plans and Stand‑Alone Dental Plans in Nebraska
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Provides Nebraska Department of Insurance filing instructions, deadlines, documentation, rating and network requirements for issuers of individual, small group and stand-alone dental plans for Plan Year 2019; affects insurers submitting plans on- and off-Federal Facilitated Marketplace.
No material clinical or coverage changes in this revision.
Filing and Plan Requirements
Filing and plan requirements for Plan Year 2019
Key filing and plan requirements for Plan Year 2019 — plans and filings will be accepted and reviewed only when these conditions are met:
Actuarial Value and Minimums
| Platinum | 90% AV |
| Gold | 80% AV |
| Silver | 70% AV |
| Bronze | 60% AV |
Submission, Binder Contents, and Dental Attestations
SERFF submission and identifiers
Submit all binders, templates and forms through SERFF Plan Management. Issuers must provide their HIOS/Carrier identifiers where required and submit individual and small group filings under separate SERFF tracking numbers. Follow the General Instructions for Nebraska in SERFF, including checklists and trade secret protection guidance.
- Both on‑Marketplace and off‑Marketplace plans must be submitted in SERFF Plan Management.
- All filings are required to be in binders when entered in SERFF.
- Individual and Small Group filings must be submitted under separate SERFF tracking numbers.
- Follow the General Instructions for Nebraska in SERFF for checklists and trade secret protection.
Binder contents and required documentation
Provide a complete binder for each market (separate binders for Individual and Small Group) that includes the 2019 Health Insurance Form Review Checklist, redline versions, Nebraska Filing Form, URRT, Actuarial Memorandum, templates, SBC for each plan variation (no variability), Readability Certification, attestations, provider network information, and a cover letter.
- Binders must include forms, rates and templates; Individual and Small Group binders must be separate.
- Include: 2019 Health Insurance Form Review Checklist, redlines showing changes from previously approved forms, Nebraska Filing Form, URRT, Actuarial Memorandum, templates, SBC for each plan variation (no variability allowed), Readability Certification, Accreditation Certificate, attestations, any Justifications, copy of the Provider Network, and cover letter information.
- Each metal level must have a separate non‑variable schedule with a unique form number.
Dental checklist and network attestations
SADP filers must complete and submit the Pediatric Dental Checklist and all issuers must provide documentation and a signed attestation verifying network adequacy; denote any narrow network products and include the product name, location of the narrow network, and provider information.
- All SADP filers must complete the Pediatric Dental Checklist.
- Issuers must provide documentation verifying network adequacy, including a signed attestation.
- For narrow network products, indicate the product name, location of the narrow network, and provider information for the narrow network.
Small Employer Definitions
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