Filing Information for Insurers
ACA PY 2025 Form & Rate Filing Information
On this website you will find updates about the Affordable Care Act (Public Laws 111-148 & 111-152) and what it means for the insurance industry. Please check back often for ongoing updates.
- NCDOI Plan Management Advisory Memo for Medical Plans PY 2025
- NCDOI Plan Management Advisory Memo for SADPs PY 2025
Contact Information: For questions or comments, please contact us at L&Hinbox@ncdoi.gov or 919-807-6055, and ask to speak to someone regarding federal health care reform.
For information about federal CCIIO trainings, register with the Technology Assistance Portal.
Advisory Memoranda
- Cost Share Reduction Advisory Memorandum PY 2025
- NCDOI Plan Management Advisory Memorandum for Rate Filings PY 2025
Rate Filing Information (Non-Grandfathered ACA-Compliant Plans Only)
NC Data Template
- NC Rate Review Data Template PY 2025 - Access via SERFF
- NC Rate Review Data Template Instructions PY 2025
Checklists
- NC Rate Review Checklist - Individual Accident and Health PY 2025
- NC Rate Review Checklist - Individual HMO PY 2025
- NC Rate Review Checklist - Individual Hospital Medical Service Corporation PY 2025
- NC Rate Review Checklist - Small Group Accident and Health PY 2025
- NC Rate Review Checklist - Small Group HMO PY 2025
- NC Rate Review Checklist - Small Group Hospital Medical Service Corporation PY 2025
Actuarial Memoranda
- NC Actuarial Memorandum Requirements - Individual PY 2025
- NC Actuarial Memorandum Requirements - Small Group PY 2025
Federal Unified Rate Review Template
Final Data Consistency
- NCDOI Plan Management Documentation Data Consistency - QHP - PY 2025
- NCDOI Plan Management Documentation Data Consistency - Non-QHP - Attestation - PY 2025
ACA 2nd Lowest Cost Silver Plan Rates By County Template
Geographic Rating Areas
On Friday, March 29, 2013 NCDOI received approval of the revised geographic rating area request which included 16 rating areas for the State.
- Approval letter from CCIIO on Geographic Rate Areas
- Map of NC 2014 Geographic Rating Areas
- List of NC 2014 Geographic Rating Areas by Rating Region
- Alphabetical List of NC 2014 Geographic Rating Area by County
- NCDOI State Rating Requirements Disclosure Form – 3-28-13
Contact Information: For questions or comments, please contact us at L&Hinbox@ncdoi.gov or 919-807-6055, and ask to speak to someone regarding Federal health care reform.
NC EHB Crosswalks
For ALL Plan Year Non-grandfathered ACA-compliant plans from Plan Year 2017 and forward
- EHB Crosswalk Template - Access via SERFF
- EHB Crosswalk Instructions PY 2025
Contact Information: For questions or comments, please contact us at L&Hinbox@ncdoi.gov or 919-807-6055, and ask to speak to someone regarding Federal health care reform.
Essential Health Benefits and Actuarial Value
Current NC Plan Year EHB Benchmark Information
- 2017 NC EHB Benchmark Plan- BCBSNC 2017 Plan Document
- CCIIO Summary Infor and Template for NC EHB Benchmark Plan
(the $10,000 limitation on the search for a donor is not applicable and does not meet EHB requirements.) - FEDVIP Info for Benchmark Plans
Supplemental Pediatric Dental and Vision Benchmarks
- Federal Employee Dental and Vision Insurance Program (FEDVIP) Largest Enrollment Dental Plan*
- Federal Employee Dental and Vision Insurance Program (FEDVIP) Largest Enrollment Vision Plan*
Federal Actuarial Value Calculator
2014-2016 EHB Benchmark Information - Historical
Student Health Insurance Regulatory Filings Information (Non-grandfathered Plans Only)
Contact Information: For questions or comments, please contact us at L&Hinbox@ncdoi.gov or 919-807-6055, and ask to speak to someone regarding Federal health care reform.
Non-Grandfathered Transitional Coverage Information
Federally Facilitated Marketplace/SHOP Information
Pursuant to Session Law 2013-5, North Carolina has a federally-facilitated marketplace (FFM).
Below are links to resources for insurers related to applying to be a Qualified Health Plan (QHP) or exchange-certified Stand Alone Dental Plan (SADP) in the federal exchange:
- Final 2025 CCIIO Letter to Issuers in the Federally-Facilitated Marketplaces
- QHP Application Submission
- QHP Application Submission Checklist
- QHP Issuer Certification Toolkit
- QHP Submission Timeline
- Key Changes for PY 2025
The federal exchange has also set up a helpdesk for insurers which can be accessed by phone at 855-CMS-1515 or by email at cms_feps@cms.hhs.gov.