Issuers must enter the rates for each subscriber type offered within the parameters of the premium rate they are able to charge for each type of enrollee a plan covers. These rates are based on variables such as rate effective date, rate expiration date, age, rating area ID, and tobacco. These rates, in conjunction with the data from the Business Rules Template, are used to calculate premiums for each enrollment group.

Key Changes for PY2025:
  • There are no key changes to the 2025 Rates Table Template.
Tips for the Rates Table Section
  • Use separate worksheets in the Rates Table Template for medical plans and dental plans.
  • Use separate worksheets for Individual Market plans and Small Business Health Options Program (SHOP) plans.
  • For Individual Market plans, the rate effective date must be January 1, 2025.
  • For SHOP plans with trended quarterly rates, the rate effective date must correspond with the calendar quarters (January 1, April 1, July 1, and October 1). Each worksheet is bound to a separate effective date range. If the issuer submits SHOP trended quarterly rates, a separate worksheet must be submitted for each date range that a set of rates will be effective.
  • If the issuer submits in HIOS, a single Rates Table Template that contains rate data for all the issuer’s plans (QHPs and SADPs) must be submitted in MPMS. If the issuer submits via the System for Electronic Rates & Forms Filing (SERFF), this requirement does not apply.
Application Resources