Submission Systems

The system issuers use to submit the majority of their QHP Application materials depends on their state’s Exchange model. 

Health Information Oversight System (HIOS)

HIOS is the system that aggregates QHP Application data. Issuers in Federally-facilitated Exchange (FFE) states submit the majority of their QHP Application materials through HIOS; issuers in states performing plan management functions submit all rate filing, administrative, and marketing URL information through HIOS. See the HIOS Quick Reference Guide and HIOS Portal User Manual for information on how to register for and use HIOS. Review the QHP Certification Issuer Toolkit for additional details on which submission systems issuers use to submit their QHP Application components.

HIOS Modules

Issuers submit parts of their QHP Application(s) in the following HIOS Modules; reference the corresponding user guides for technical assistance throughout QHP certification.
  • Issuer Module: Where FFE issuers submit, review, and modify QHP Application data related to their business processes. See the Issuer Module User Guide for instructions.
  • Benefits & Service Area Module: Where FFE issuers submit, review, and modify data on the benefits, service areas, provider networks, and prescription drugs for each of the plans they intend to offer. See the Benefits & Service Area Module User Guide for instructions.
  • Rating Module: Where issuers in FFE states and states performing plan management functions provide plan rating data to determine consumer premiums and benefit costs for the plans they intend to offer. See the Rating Module User Guide for instructions.
  • Unified Rate Review System Module: Where all QHP applicants provide the data required to review rate increases and ensure issuer compliance with the single risk pool and allowable market-level index rate adjustments. See the Unified Rate Review System Module User Guide for instructions.
  • Supplemental Submission Module: Where all QHP applicants provide URL data for CMS review; these URLs display to consumers on HealthCare.gov. See the Supplemental Submission Module User Guide and Supplemental Submission Module Quick Start Guide for instructions.

System for Electronic Rates & Forms Filing (SERFF)

Issuers in states performing plan management functions and in State-based Exchanges on the Federal Platform (SBE-FPs) submit their QHP Application(s) through SERFF. Issuers in these states must contact their state for any additional application requirements, and should follow state guidance on the timeline and process for application submission. Current SERFF users can access the plan management functionality at the following site, using their existing ID and password.

Questions about SERFF can be submitted to the SERFF Help Desk at serffhelp@naic.org. For information about state systems, contact the state directly. 

Plan Management (PM) Community

Issuers required to submit Plan ID Crosswalk Templates and supporting documentation to CMS should do so in the “Plan ID Crosswalk” tab of the PM Community. Issuers are required to submit Plan ID Crosswalk Templates for certified on-Exchange individual plans offered in 2021, even if they are not offering plans in 2022. First-time issuers and issuers that did not offer plans on the Exchange during 2021 are not required to submit a Plan ID Crosswalk Template for 2022. Visit the Plan Crosswalk webpage for more information.

State Plan Management Systems

Throughout the QHP certification process, CMS collects information from states via HIOS or SERFF, depending on the state’s Exchange type. The following chart indicates the system in which issuers seeking certification of QHPs should file applications and supporting data for plan year (PY) 2022. “Not applicable” indicates that a state operates a State-based Exchange. 

State

Exchange Type— Individual

Exchange Type— SHOP

System for Collecting QHP Applications— Individual Market

System for Collecting QHP Applications— SHOP Market

Alabama

FFE

FFE

HIOS

HIOS

Alaska

FFE

FFE

HIOS

HIOS

Arizona

FFE

FFE

HIOS

HIOS

Arkansas

SBE-FP

SBE

SERFF

SERFF

California

SBE

SBE

Not Applicable

Not Applicable

Colorado

SBE

SBE

Not Applicable

Not Applicable

Connecticut

SBE

SBE

Not Applicable

Not Applicable

Delaware

State performing plan management functions

State performing plan management functions

SERFF

SERFF

District of Columbia

SBE

SBE

Not Applicable

Not Applicable

Florida

FFE

FFE

HIOS

HIOS

Georgia

FFE

FFE

HIOS

HIOS

Hawaii

State performing plan management functions

SBE

SERFF

SERFF

Idaho

SBE

SBE

Not Applicable

Not Applicable

Illinois

State performing plan management functions

State performing plan management functions

SERFF

SERFF

Indiana

FFE

FFE

HIOS

HIOS

Iowa

State performing plan management functions

State performing plan management functions

SERFF

SERFF

Kansas

State performing plan management functions

State performing plan management functions

SERFF

SERFF

Kentucky

SBE-FP

SBE-FP

SERFF

SERFF

Louisiana

FFE

FFE

HIOS

HIOS

Maine

SBE-FP

SBE-FP

SERFF

SERFF

Maryland

SBE

SBE

Not Applicable

Not Applicable

Massachusetts

SBE

SBE

Not Applicable

Not Applicable

Michigan

State performing plan management functions

State performing plan management functions

SERFF

SERFF

Minnesota

SBE

SBE

Not Applicable

Not Applicable

Mississippi

FFE

FFE

HIOS

HIOS

Missouri*

FFE-DE

FFE-DE

HIOS

HIOS

Montana

State performing plan management functions

State performing plan management functions

SERFF

SERFF

Nebraska

State performing plan management functions

State performing plan management functions

SERFF

SERFF

Nevada

SBE

SBE

Not Applicable

Not Applicable

New Hampshire

State performing plan management functions

State performing plan management functions

SERFF

SERFF

New Jersey

SBE

SBE

Not Applicable

Not Applicable

New Mexico

SBE-FP

SBE-FP

SERFFF

SERFF

New York

SBE

SBE

Not Applicable

Not Applicable

North Carolina

FFE

FFE

HIOS

HIOS

North Dakota

FFE

FFE

HIOS

HIOS

Ohio

State performing plan management functions

State performing plan management functions

SERFF

SERFF

Oklahoma*

FFE-DE

FFE-DE

HIOS

HIOS

Oregon

SBE-FP

SBE

SERFF

SERFF

Pennsylvania

SBE

SBE

Not Applicable

Not Applicable

Rhode Island

SBE

SBE

Not Applicable

Not Applicable

South Carolina

FFE

FFE

HIOS

HIOS

South Dakota

State performing plan management functions

State performing plan management functions

SERFF

SERFF

Tennessee

FFE

FFE

HIOS

HIOS

Texas*

FFE-DE

FFE-DE

HIOS

HIOS

Utah

State performing plan management functions

State performing plan management functions

SERFF

SERFF

Vermont

SBE

SBE

Not Applicable

Not Applicable

Virginia

SBE-FP

SBE-FP

SERFF

SERFF

Washington

SBE

SBE

Not Applicable

Not Applicable

West Virginia

State performing plan management functions

State performing plan management functions

SERFF

SERFF

Wisconsin

FFE

FFE

HIOS

HIOS

Wyoming*

FFE-DE

FFE-DE

HIOS

HIOS


*These states currently do not have the authority to enforce or are not otherwise enforcing the Affordable Care Act market reform provisions pursuant to 45 CFR 150.101. Issuers in these states should refer to the Form Filing Instructions.

Legend
FFE: Federally-facilitated Exchange
FFE-DE: Federally-facilitated Exchange Direct Enforcement
SBE-FP: State-based Exchange on the Federal Platform
SBE: State-based Exchange