General Information and Guidance
Data Submissions and Filing Resources
- Healthy NY Monthly Data Submissions
- Health Equity Data Submissions
- Qualified Health Plan (QHP) 2026 Filing Instructions in SERFF (PDF)
Common Forms
- Contraceptive Exception Request Form (PDF)
- Court Ordered Treatment Certification Form (PDF)
- Discontinuance and Renewal Model Notices and Requirements
- Network Adequacy and OON Model Forms and Disclosures
Select Information and Guidance
- Network Adequacy and Out-of-Network Guidance
- Definition of Sepsis for Purposes of Health Insurance Coverage
- Guidance Regarding Rate Guarantees and New Business Discounts (PDF)
- Guidance for Individual and Small Group Comprehensive Policy Forms Offered Inside and Outside NYSOH (PDF)
- Guidance for Large Group Comprehensive Medical Policy Form Filings (PDF)
- Implementation of the Market Stabilization Pool Decision for 2017
- Mandated & Make Available Benefit Listing as of 2018
- Market Rules Guidance on Guaranteed Availability and Renewability
- Special Enrollment Period for Victims of Domestic Abuse or Spousal Abandonment
- Uniform Modification Policy Changes Guidance 2018
SERFF Public Access to Accident & Health Form Filings
The Department makes certain accident & health insurance policy form filings and Plan Management binder filings available for public viewing online, via the NAIC SERFF State Filing Access website. Filings disposed of on and after February 27, 2018 are available through SERFF Public Access. The public may also obtain access to filings by submitting a Freedom of Information Law (FOIL) request to the Department. Note Filings may be updated or changed by a subsequent filing. Search for the most recent version of the filing. The Department is not responsible for any errors in or omissions from the filings. Filings may contain or incorporate material that is protected by U.S. or foreign copyright laws, and no person may reproduce, redistribute, or make commercial use of any such material in violation of those laws.
New York State of Health (NYSOH) Coverage
Forms, Maps, Charts and Notices
- NY Standardized Rating Regions for Individual and Small Group Health Insurance (including Exchange-certified Stand-Alone Dental Plans) (PDF)
- NY Standardized Rating Regions Map (PDF)
- Grace Period Guidance
For APTC insureds in 3 month grace period for NYSOH
FAQs for Insurers and Providers
- Association Health Plans (AHPs) FAQs
- Compensation and Commissions Circular Letter No. 20 FAQs (2017) and FAQs about Supplement No. 1 to CL No. 20 (2017)
- Court Ordered Treatment FAQs
- Early Intervention Services Coverage FAQs (2022)
- Health Care Claims Reporting FAQs
- Health Equity FAQs for Insurers
- Insulin Cost-Sharing Limit FAQs
- IVF and Fertility Preservation Law FAQs (Updated 9/4/2020)
- Mental Health and Substance Use Disorder (MHSUD) FAQs
- Network Adequacy and Access Standards for Behavioral Health Services FAQs (11 NYCRR 38)
- OON Law and No Surprises Act Guidance and FAQs
- Opioid treatment, PrEP, colorectal cancer screening, rabies, prescription drug coverage, and Donate Life Registry FAQs about laws passed in 2021-2023
- Small Group Expansion to 1-100 Employees FAQs
- Step Therapy Legislation FAQs
- Substance Use Disorder Treatment and Opioid Legislation (Chapters 69 and 71 of the Laws of 2016) FAQs
- Telehealth Services Coverage FAQs for Insurers and Providers
General Filing Instructions
- Filing Process Guidance
- Product Checklists and Outlines
- Model Language and Notices
- Student Medical Model Language
- Rate Adjustment Filings - Prior Approval Checklist and Exhibits
- HIDE Report Submissions
- LTC Annual Reports
- Child Health Plus and EIP
- Medicare Supplement Rate Filings
- Health Care Claims Reporting
- Health Equity Data Submission
- Healthy NY Monthly Data Submission
- Mental Health and Substance Use Disorder Parity Compliance Program Annual Certification
- Mental Health and Substance Use Disorder Parity Reporting
Network Adequacy and OON
Guidance, Filing Instructions, and Other Resources
- OON Law and No Surprises Act Guidance and FAQs
- Network Adequacy FAQs
- Network Adequacy Requirements, Standards, and Provider Network Submission Instructions
- New Plan Request Form (MS Word)
- Network Adequacy Attestation for Certification of Adequacy: Pharmacy Only Network (PDF)
Model Forms and Disclosures
- Out-of-Network Reimbursement Examples (MS Word)
- Model Provider Disclosure of Balance Billing Protections (MS Word)
- Model Issuer Disclosure of Balance Billing Protections Model (MS Word)
Independent Dispute Resolution (IDR) Process
Rate Adjustment Filings
Paid Family Leave (PFL)
- Insurance Companies with Approved Paid Family Leave (PFL) Insurance Policy Forms
- Paid Family Leave (PFL) Information for Insurers, including Premium Rate Decisions, SERFF Filing Instructions, and Carrier Registration and Reporting Requirements
Checklists and Model Language
- Model Language (MS Word)
- Model Language Redlined (MS Word)
- PFL SERFF Checklist (PDF)
Outside Resources
- Employers, consumers and health care providers looking to learn more about Paid Family Leave in New York should visit the New York State Paid Family Leave Program site.
Dental and Vision Filings
Instructions, Forms and Exhibits
- Guidance for Stand-Alone Dental Filings
- Guidance for Stand-Alone Dental Filings (PDF)
- Dental Product Checklists and Outlines
- 2027 Rate Submission Instructions for Pediatric EHB Certified Stand-Alone Dental Plans (PDF)
- 2027 Pediatric EHB Certified Combined Dental Exhibits (Excel)
- 2027 Qualified Dental Plan (QDP) Filing Instructions for SERFF (PDF)
Dental Checklists
- Accident and Health Product Checklists and Outlines
- NYSOH and Pediatric Dental EHB Certified Individual Stand-Alone Dental
- NYSOH and Pediatric Dental EHB Certified Stand-Alone Dental Group Checklist
- Large Group and Non Pediatric Dental EHB Certified Small Group Dental Checklist
Dental Model Language
Utilization Review (UR) Agents
A Utilization Review Agent is any insurer subject to Insurance Law Articles 32 or 43 (insurers) and any municipal cooperative health benefit plan certified pursuant to Insurance Law Article 47 performing utilization review (UR) on their own behalf and any independent utilization review agent performing UR under contract with such insurer or municipal cooperative health benefit plan.
An independent utilization review agent must file with the Department prior to contracting with any such insurer or municipal cooperative health benefit plan.
All UR agents must file a UR report with DFS every two (2) years pursuant to Insurance Law Article 49.
- Learn more about Utilization Review (UR) Agent Application and Reporting Requirements.
Discontinuance and Renewal Notifications
Notification of the planned discontinuance should be submitted as an informational filing to the Department of Financial Services at least 30 business days prior to any notices of discontinuance being mailed to policyholders. Notices should not be submitted via SERFF.