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 all QHP Application materials through HIOS, and issuers in states performing plan management functions submit all rate filing information through HIOS. See the HIOS Quick Reference Guide and HIOS Portal User Manual for information on how to register for and use HIOS.

HIOS Modules

  • 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 Rate and Form Filing (SERFF)

Issuers in states performing plan management functions and in State-based Exchange on the Federal Platform (SBE-FP) states submit their QHP Application through SERFF. Issuers in these states will also need to contact their state for any additional application requirements.

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 2020, even if they are not offering plans in 2021. First-time issuers and issuers that did not offer plans on the Exchange during 2020 are not required to submit a Plan ID Crosswalk Template for 2021. Visit the Plan Crosswalk webpage for more information.