Submission Systems
The system issuers use to submit the majority of their QHP Application materials depends on their state’s Exchange model.
Health Insurance 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 and State-based Exchanges on the Federal Platform (SBE-FP) submit a subset of materials directly in HIOS, and also submit the groups of their QHP Application via the HIOS MPMS Module. 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 each component of the QHP Application.
HIOS Modules
- Marketplace Plan Management System (MPMS) Module: Where all issuers can validate plan data prior to submission, as well as submit QHPs and SADPs to CMS for review and certification. Issuers in states performing plan management functions and SBE-FP states will submit their QHP Applications to CMS in the MPMS Module after their data is transferred from SERFF by their state. See the MPMS Module User Guide for instructions.
- Instructional Video Series: Navigating the MPMS Module
- How to Create a QHP Application
- How to Use the Plan Validation Workspace
- How to Submit a QHP Application (Coming soon!)
- How to Submit URL Data
- Plan Finder Module: Where all QHP applicants provide administrative information to CMS. See the HIOS Plan Finder – Issuer User Manual for instructions.
- Unified Rate Review System Module: Where issuers in states without an Effective Rate Review Program or in states that do not have access to SERFF (currently OK, WY, and FL) 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.
System for Electronic Rates & Forms Filing (SERFF)
Issuers in states performing plan management functions and in SBE-FPs submit the majority of their QHP Application materials through SERFF, for transfer to the MPMS Module, where the application will be submitted to CMS. 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.
States not enforcing market-wide reforms (currently TX, OK, WY, & MO) must submit form filings into SERFF for CMS review. Additionally, rate filings in all states (except OK, WY, & FL as mentioned above in the Unified Rate Review System description) must be submitted through the URRT tab in SERFF.
Questions about SERFF can be submitted to the SERFF Help Desk at serffhelp@naic.org. For information about state systems, contact the state directly.