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{"sheet":"Instructions","index":0,"n_rows":33,"n_cols":3,"rows_kept":33,"cut":false,"hidden":false,"merged":[[52,0,52,8],[53,0,53,8],[54,0,54,8],[55,0,55,8],[56,0,56,8],[39,0,39,8],[28,0,28,8],[29,0,29,8],[30,0,30,8],[31,0,31,8],[32,0,32,8],[34,0,34,8],[35,0,35,8],[36,0,36,8],[37,0,37,8],[38,0,38,8],[33,0,33,8],[48,0,48,8],[49,0,49,8],[50,0,50,8],[51,0,51,8],[40,0,40,8],[41,0,41,8],[42,0,42,8],[43,0,43,8],[44,0,44,8],[45,0,45,8],[46,0,46,8],[47,0,47,8],[13,0,13,8],[15,0,15,8],[18,0,18,8],[26,0,26,8],[27,0,27,8],[23,0,23,8],[21,0,21,8],[19,2,19,4],[16,2,16,4],[0,0,0,8],[1,0,1,8],[2,0,2,8],[5,0,5,8],[3,0,4,8],[6,0,6,8],[7,0,7,8],[10,0,10,8],[12,0,12,8],[9,0,9,8]]}
["Small Group Medical Plan Rate Schedule Format"]
[]
["Purpose"]
["The rate schedule format is for issuers filing small group health plans. This format must be used to submit the rates for these plans in the corresponding rate filing."]
[]
[]
["Instructions"]
["The sheet named \"Enter HIOS Plan ID\" is the rate schedule form require to submit the rates for your plans. The rate schedule Excel file that you submit to the OIC via SERFF must include one \"Enter HIOS Plan ID\" sheet for each plan in your small group market portfolio."]
[]
["Setup Rate Schedules"]
["You may copy and setup one \"Enter HIOS Plan ID\" sheet for each plan manually or use the macro program on the \"Setup\" sheet."]
[]
["Completing the Rate Schedule"]
["All items highlighted red, as seen below, require a user selection or entry. After the user has made a selection or entry the highlight will be removed."]
[]
["Selection cells require the user to make a selection from a dropdown. Click on the highlighted cell, an arrow will appear to the right of the cell, click one of the options available."]
[null,"Example:","Select one"]
[]
["Entry cell require the user to type in an entry."]
[null,"Example:","Enter this plan's name"]
[]
["Standard and wellness rates: If you do not use a wellness factor in your rate development or the wellness factor is 1. Then the standard and wellness rates must be the same, do not leave wellness rates blank or enter \"N/A\"."]
[]
["Rename the plan's worksheet so the sheet name is the HIOS Plan ID"]
[null,"Example:"]
[]
["Finalizing the Rate Schedule File"]
["After a rate schedule is completed for each plan in your small group market portfolio, finalize the rate schedule by:"]
["Running the macro program on the \"Finalize\" sheet; or"]
["1. Delete the Instructions, Setup, and Finalize sheets."]
["2. Save the workbook and rename it \"Rate Schedule DUPLICATE.xlsx\"."]
["3. Save another copy of the workbook in PDF format and name it \"Rate Schedule.pdf\"."]
["4. Submit both Excel and PDF copies in your small group rate filing via SERFF."]

{"sheet":"Setup","index":1,"n_rows":8,"n_cols":2,"rows_kept":8,"cut":false,"hidden":false,"merged":[[0,0,0,1],[4,0,5,0]]}
["Rate Schedules Setup"]
[]
["STEPS","INSTRUCTIONS"]
["Step 1","To use this macro program, macros must be enabled. If macros are disabled by default, you may have a notification above where you can enable macros."]
["Step 2","Number of Plans:"]
[null,"Enter the number of plans in your small group market portfolio"]
["Step 3","Click the Setup button."]
["Step 4","Setup is complete, a rate schedule has been copied for each plan in your portfolio. Please fill each rate schedule with the corresponding plan's information"]

{"sheet":"Index","index":2,"n_rows":6,"n_cols":5,"rows_kept":6,"cut":false,"hidden":true,"merged":[]}
["YesNoList",null,"ExchStatusList",null,"MetalLevelList"]
["Select one",null,"Select one",null,"Select one"]
["Yes",null,"In the exchange",null,"Bronze"]
["No",null,"Outside the exchange",null,"Silver"]
[null,null,"Both inside and outside the exchange",null,"Gold"]
[null,null,null,null,"Platinum"]

{"sheet":"Finalize","index":3,"n_rows":5,"n_cols":2,"rows_kept":5,"cut":false,"hidden":false,"merged":[[0,0,0,1]]}
["Finalize for Submission"]
[]
["STEPS","INSTRUCTIONS"]
["Step 1","To use this macro program, macros must be enabled. If macros are disabled by default, you may have a notification above where you can enable macros."]
["Step 2","Click the Finalize button."]

{"sheet":"Enter HIOS Plan ID-Q#","index":4,"n_rows":72,"n_cols":11,"rows_kept":72,"cut":false,"hidden":false,"merged":[[15,2,15,10],[16,2,16,10],[0,0,0,10],[1,0,1,10],[19,1,19,5],[19,6,19,10],[11,2,11,10],[12,2,12,10],[13,2,13,10],[14,2,14,10]]}
["Enter Issuer Name"]
["RATE SCHEDULE"]
["Plan Information"]
["Plan Name:","Enter this plan's name"]
["HIOS Plan ID:","Enter this plan's HIOS Plan ID"]
["Effective Date:","Enter the effective date","Quarter:","Enter Quarter Number"]
["Market Type:","Small Group"]
["Exchange Status:","Select one"]
["Metal Level:","Select one"]
[]
["Plan Geographic Availability"]
["Area Number","Available in area?","Counties where this plan is available"]
[1,"Select one","Enter the names of all counties in this area where this plan is available, separated each counties with a comma. If plan is not available in this area, enter \"N/A.\""]
[2,"Select one","Enter the names of all counties in this area where this plan is available, separated each counties with a comma. If plan is not available in this area, enter \"N/A.\""]
[3,"Select one","Enter the names of all counties in this area where this plan is available, separated each counties with a comma. If plan is not available in this area, enter \"N/A.\""]
[4,"Select one","Enter the names of all counties in this area where this plan is available, separated each counties with a comma. If plan is not available in this area, enter \"N/A.\""]
[5,"Select one","Enter the names of all counties in this area where this plan is available, separated each counties with a comma. If plan is not available in this area, enter \"N/A.\""]
[]
["Plan Rates"]
["Age","Standard Rates",null,null,null,null,"Wellness Discount Rates (if applicable)"]
["Band","Area 1","Area 2","Area 3","Area 4","Area 5","Area 1","Area 2","Area 3","Area 4","Area 5"]
["0-14"]
[15]
[16]
[17]
[18]
[19]
[20]
[21]
[22]
[23]
[24]
[25]
[26]
[27]
[28]
[29]
[30]
[31]
[32]
[33]
[34]
[35]
[36]
[37]
[38]
[39]
[40]
[41]
[42]
[43]
[44]
[45]
[46]
[47]
[48]
[49]
[50]
[51]
[52]
[53]
[54]
[55]
[56]
[57]
[58]
[59]
[60]
[61]
[62]
[63]
["64 and over"]