Qualified Dental Plan (QDP) SERFF Filing Instructions

2027 Qualified Dental Plan (QDP) SERFF Filing Instructions

Updated (5/1/26)

Each QDP filing contains a binder with all the data necessary for stand-alone dental plans offered inside the New York State of Health (NYSOH) for the individual marketplace and SHOP. Binders should also be filed for pediatric dental EHB certified plans offered outside NYSOH in the individual market only. Small group off Exchange-only binders do not need to be submitted. Issuers should submit one binder per market type (individual or small group) for each NAIC Company Code. Also, if an issuer uses two different DBAs (or marketing name) within the same NAIC Company Code, it should submit separate binders for each DBA.

NYSOH Filings

Issuers should file QDP binders with all required templates in SERFF. If an issuer is offering a QDP inside the NYSOH and the same plan outside the NYSOH as a pediatric dental EHB certified plan, the issuer should indicate, as described below in the Plans & Benefits Template, that the particular HIOS Plan ID is available both inside and outside the NYSOH under the QDP/Non-QDP field. Issuers should not submit duplicate plans in a separate off Exchange binder. Issuers should not include any specific HIOS Plan ID in more than one binder. If an issuer wants QDPs to display on the Marketplace portal for SHOP, the HIOS Plan IDs must be marked as available both inside and outside the NYSOH in the QDP/Non-QDP field.

Off NYSOH Filings

The issuer should submit at binder for plans available outside the NYSOH for the individual market only. Binders are not required for small group pediatric dental EHB certified plans offered outside NYSOH that the issuer does not want to display on the Marketplace portal. A separate binder should be submitted per licensee.

General Instructions for QDP Filing

Build your QDP filing according to any instructions provided by SERFF. Follow the instructions below for the submission of QDP filings to New York. The following templates are required for QDP Binder filings:

Submission Requirements on the Supporting Documentation Tab. Each issuer must submit the following documents or attachments on the Supporting Documentation Tab:

1. Statement of Detailed Attestation Responses for SBMs Issuers (required for on Exchange binders only)
2. Logo File (required for on Exchange binders only)
3. Administrative Template

Associate Schedule Items Tab. When building the QDP filing, use the Associated Schedule Item Tab to link forms and any variable material to a HIOS Plan ID. Do not associate any other items from the form and rate filing, such as the rate manual, any certifications forms, or checklists. Issuers may only associate schedule items submitted using the same SERFF instance.

Network Adequacy Review. The Service Area Template and Network Template should be submitted but no additional information regarding network adequacy should be submitted through SERFF. See the NYSOH Plan Invitation for submission of network adequacy information. Please note that the Department of Financial Services (DFS) does not collect the Essential Community Providers or Network Adequacy Templates.

URLs. Issuers should submit the NYSOH URL Template along with their Plan Invitation for on Exchange binders. URLs are not needed for off Exchange binders.

Technical Requirements

1. Form and Rate Filings. Issuers should also submit their traditional form and rate filing in SERFF before creating their binder so that they can associate schedule items such as forms to their QDP filing.
   • Form and rate filing instructions, checklists, and model form language are here on the DFS website.
2. SERFF Instance. Issuers must submit the binder using the same SERFF instance as the previously submitted form and rate filings.
3. Apostrophes. None of the content in any of the SERFF templates fields can contain apostrophes for binders to be transmitted to NYSOH. The transmission will fail for the entire binder.

Template Instructions

Issuers should use the 2027 template versions when submitting their 2027 binder filings through SERFF. Copies of templates, detailed instructions provided by CCIIO including explanations of fields, data dictionary, and other more technical information regarding the data templates is available on the CMSQHP Certification website.

New York specific instructions below are intended to assist issuers when submitting QDP filings to New York. Before submitting a binder through SERFF, issuers are strongly encouraged to run their templates through the Data Integrity Tool to avoid data submission errors.

Service Area Template

1. Enter the HIOS Issuer ID and State.
2. Click the Create Service Area IDs button. Create as many Service Areas as necessary to indicate the various area QDPs will be available. For example, if the issuer has a limited network plan only available in two out of the five counties within their overall service area, the issuer will need to create two Service Area IDs. The issuer will then use the Service Area IDs in the Plans & Benefits Template to associate QDPs to a particular Service Area.
3. Select a Service Area ID that was generated by the template.
4. Enter a name in Service Area Name.
5. Indicate whether the Service Area covers the entire state.
6. If the Service Area does not cover the entire state, choose each county that is within the Service Area.
7. Repeat steps 4-6 for every county within a Service Area.
8. If the issuer has more than one Service Area, repeat steps 3-7 for each Service Area.
9. One Service Area Template may include multiple Service Areas.
10. Verify that each service area matches the service area outlined in the Definitions section of the Certificate, Contract or Policy associated with that specific HIOS Plan ID on the Associated Schedule Items Tab.
11. An issuer must create separate service area IDs for Individual market service areas and small group market service areas. An issuer must use the same Service Area Template across all binders or ensure that no service area IDs repeat across the binders.
12. If an issuer is a dual-product issuer (QHPs and QDPs),it must create two different service area IDs, one each for QHPs and QDPs, regardless of whether the service area is intended to serve both plan types. For example, if an issuer offers QHP, SHOP, and QDP, they must have three different service area ID’s, even if the service area is the same for all three programs. For dual-product issuers, the word “dental” should be used in the service area name to distinguish it from the QHP service area.

Network Template

1. Enter the HIOS Issuer ID and State.
2. Click the Create Network IDs button. Indicate the number of networks the issuer has.
3. Enter Network Name. Include the word “Marketplace” in the network name for all Marketplace binders.
4. Select a Network ID that was generated by the template to associate with the Network Name.
5. If the issuer has more than one network, repeat steps 2-4 for each network. One Network Template may include multiple networks.
6. If an issuer participates in both the Individual and SHOP markets, do not use the same network ID for both networks. An issuer should use the same Network Template across all binders or ensure that no network IDs repeat across the binders.
7. If an issuer is a dual-product issuer (QHPs and QDPs), it must create two different network IDs, one each for QHPs and QDPs, regardless of whether the specific network is intended to serve both product types. For example, the Individual Market network ID should be NYN001, the SHOP network ID should be NYN002, and the QDP network ID should be NYN003. For dual-product issuers, the word “dental” should be used in the Network ID name to distinguish it from the QHP Network ID.

Plans & Benefits Template

General Information

1. The Service Area and Network Templates should be completed prior to completing the Plans & Benefits Template.
2. All fields indicated with a red asterisk are required.
3. Download the most recent version of the 2027 Plans & Benefits Add-In file.

HIOS Plan IDs (Standard Component IDs)

1. The HIOS Plan ID is the key identifier used by the NYSOH to populate the QDPs on the web portal, associate the corresponding provider network, associate the corresponding quality information, and complete enrollment. QDPs that were sold in 2026 must keep the same HIOS Plan ID in 2027. New HIOS Plan IDs may only be assigned when a new QDP is being submitted for certification.
2. The issuer must register their HIOS Plan IDs (Standard Component IDs) via HIOS.
3. Any variation in benefits or cost-sharing must be submitted using separate HIOS Plan IDs.
4. A HIOS Plan ID should only be submitted to the State in one binder.

HIOS Plan ID Limitations: The current limit of HIOS Plan IDs in a single binder is 350. If an issuer has a binder that will exceed that limit, contact the SERFF Help Desk. SERFF can temporarily increase the limit in order to allow the submission of the binder. Do not split the binder up into multiple binders.

Benefits Package Tab

1. A Benefits Package Tab consists of all QDPs that have the identical plan structure (including any quantitative limits and exclusions.) QDPs should be grouped together as much as possible to minimize the use of added Benefit Package Tabs. Added Benefit Package Tabs may be needed if the explanation provided for the “Design” box is different among plans.
2. Cost sharing variations will be defined in the Cost Share Variances Tab.
3. Complete the top section of each Benefits Package worksheet that contains the HIOS Issuer ID, Issuer State, Market Coverage, and Dental Only Plan.

Plan Identifiers

1. Complete this section for each Benefit Package.
2. Complete a line per each HIOS Plan ID (Standard Component ID) for each QDP.

Plan Attributes

1. Indicate whether the plan is a new or existing plan.
2. Select Plan Type and Level of Coverage.
3. For the QHP/non-QHP field, indicate whether the plan will be offered inside the NYSOH, outside the NYSOH or both. Do not assign more than one HIOS Plan ID to the same plan that is offered both inside and outside the NYSOH.
4. Child-Only Plans: The standard pediatric dental plan should be marked Allows Child Only. All other plans should be marked either Allows Child if non-standard plan covers pediatric dental benefits only or Allows Child and Adults if the plan covers both pediatric and adult dental benefits.

Stand-Alone Dental Only

1. Complete the fields required for stand-alone dental plans.
2. EHB Apportionment for Pediatric Dental: Enter the percentage of the monthly premium that is allocated for the pediatric dental EHB. If the rates are age-banded, use the EHB percent that applies to the pediatric rates. If the rates are family-tiered, use the EHB percent of the individual rate assuming a child enrollment. This percentage is used to determine the amount of the advance payment of the premium tax credit required under 45 CFR 155.340(e)(2).
3. New for plan year 2027: Indicate whether there is a waiting period for adult dental services.
4. New for plan year 2027: If yes was selected for adult dental services waiting period, provide the duration of the waiting period. Entries should be numeric weeks/months (e.g., 30 days or 6 months).

Plan Dates

1. Enter the appropriate Plan Effective Date and Plan Expiration Date. For NYSOH filings, the Plan Effective Date must be 1/1/2027 and the Plan Expiration Date must be 12/31/2027 for both the Individual Marketplace and the SHOP Marketplace.

Geographic Coverage

1. Indicate whether the QDP provides coverage outside the U.S. or outside the service area.

Benefit Specific Information

1. Standard QDPs: Click the Refresh EHB button. Use the benefits the template provides without any changes.
2. Design. For all NYSOH filings, add a custom benefit called “Design”. This field will be used to describe the benefit design features that are not otherwise obvious to the consumer. Limit your explanation to 1,500 characters. If more characters are needed, contact your Plan Manager. Be sure to select “NO” for the Quantitative Limit. Include the following description in the design field:
   • Whether or not referrals are required to access care (i.e., gatekeeper);
   • Custom network features (e.g., tiered network) (NOTE: The Marketplace currently is designed to only display one tier of cost-sharing); and
   • The type of deductible the plans have, either embedded or family. This may mean that issuers may need to add more “Benefit Package” tabs so that the type of deductible is the same for all plans on the tab.
   • Other features of the benefit design that will aid consumers in making their plan selection decisions.
   • All Standard Dental Products are required to have the following line as the last statement in the Design field: This plan offers standard adult benefits with a $50 Individual/$150 embedded, combined in-network and out-of-network Family deductible, and $1500 annual benefit maximum per plan year.
   • Non-Standard Dental Products should follow the same format as the bullet above and modify the cost-sharing accordingly.
3. Benefit Explanation and Mapping to Model Language: Issuers should add language to each benefit explanation box to describe the dental benefit, adding examples of items or services covered under each benefit. Issuers should use the following guide to map the benefits to the model language on the pediatric dental benefit and add appropriate explanations based on the model language.

Non-Standard QDPs

2. Use the benefits the template provides for the pediatric essential health benefit. Use the adult dental benefits provided in the template. Benefits may be added (e.g., cosmetic orthodontia) but do not manually add any benefits already listed on the template.
3. Issuers may add benefits (e.g., cosmetic orthodontia) to a non-standard QDP in accordance with guidance found in the NYSOH Application and in the product checklists found on the DFS website.
4. If only varying the limits on the benefits listed above, then edit the limits without adding any new benefits. Identify any major benefit limitations (i.e., annual or lifetime limit on cosmetic orthodontia, age limit for cosmetic orthodontia, or annual limit on adult dental services). If adding the benefits below, follow these instructions:
   1. Adult Dental Care: Use the benefits (Routine Dental Services (Adult); Basic Dental Care – Adult; Major Dental Care –Adult; Orthodontia – Adult), as applicable, available on the main benefit list.
   2. Any Other Additional Benefits: If the benefit the issuer wants to add is not otherwise listed, then use the Add Benefits Button. Use the drop-down list of benefits to see if it matches a benefit there first. If not, then issuers may add a Custom Benefit using the Add Benefits Button. For NYSOH filings, if you add a Custom Benefit that you would like displayed on the Marketplace, please notify your Plan Manager as the information needs to be coded into the Marketplace system.
5. Benefit Explanation. Issuers should add language to each benefit explanation box to describe the dental benefit, adding examples of items or services covered under each benefit. Any waiting periods or benefit maximums for adult dental care benefits must be clearly listed in the benefit explanation field.
6. EHB Variance Reason: For any variation from EHB or additional benefit, indicate why the issuer is varying from EHB by selecting the appropriate reason (substitution, above EHB, etc.).
7. Out of Pocket Exceptions Fields: Complete these fields with the appropriate Yes/No answer. For EHB, the benefits should not be excluded from the Out-of-Pocket Limit. For additional benefits beyond EHB, select the appropriate answers.

Cost Share Variance Tab

General Information

1. Confirm all the QDPs are listed on the Benefits Package sheet before creating the Cost Share Variance Sheet.
2. Once the Benefits Package sheet is complete, click the Create Cost Share Variance Sheet button. When the Create Cost Share Variance Sheet is created, it will automatically create each of the necessary variant plans by adding a hyphen and a two-digit number to the HIOS Plan ID. Enter data (cost-sharing amounts, deductible & out-of-pocket amounts) for the standard plans (-01) first before entering information for any of the required cost sharing information for the variant plans. The two-digit numbers indicate the following: