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["Completeness and Redaction Justification Checklist"]
[]
["Instructions for Completion and Redaction Justification Checklist"]
["This checklist is required for all issuers submitting ACA-Compliant rates for 2019 comprehensive major medical rate filings and should be submitted, as supporting documentation, with each 2019 ACA-Compliant comprehensive major medical rate filing.   The checklist is organized by heading, section and subsection as outlined in the Draft 2019 ACA-Compliant Health Insurance Rate Filing Guidance (Guidance) released on February 12, 2018.  "]
["\"Completed\" Column\nThe first input column is labeled “Completed”.  In order for the filing to be considered complete and ready for department review, X must appear in each field in the column, except where data tables are marked “if applicable”.  The X indicates that the actuary has read the Guidance and has provided the requested information and data, as required in the PA Actuarial Memorandum and Rate Exhibits and further, that the data templates are completely and appropriately populated.  "]
["\"Redaction Justification\" Columns\nThe “Redaction Justification” section contains three columns.  If the issuer’s filing contains redacted information or data in the named section, “Y” must be populated in the \"Redacted\" column.  \n\nEach issuer must submit a \"Public Rate Filing PDF\" with the initial filing and with the final version that will be approved.   The PDF document must contain all required documents, tables and exhibits. If the issuers chooses to make the limited redactions anticipated by the Department, those redactions should be made only in this document. The \"Page # in Public PDF\" section should reference the page number of the Public Rate Filing PDF where the redacted information and/or data can be located."]
["If any informations is redacted, a justification must be submitted that specifically justifies why that information should be redacted.  Correspondingly, the “Justification” column should be populated with a \"Y\" in any rows where it is indicated that information is redacted, and with an \"NA\" if if information is not redacted.  To reiterate the redaction criteria contained in the Guidance, only information that is trade secret or confidential commercial or financial information as defined in HHS’s Freedom of Information Act (FOIA) regulations at 45 CFR§ 5.65 may be redacted. \n\nConsistent with prior, the Department does not anticipate redactions other than the following items: \n    1. AV screenshots\n    2. Statements specifying a company’s anticipated risk level in relation to the state average risk level (e.g.,          \n         the underlined portion could be redacted in the following statement: “we expect the risk level of \n         membership to be X% higher/lower than the state average risk level”)\n    3. Opining actuary’s name \n    4. Specific provider contracting information (note: such information was not submitted in prior rate     \n         filings and the department does not anticipate receiving such information in plan year 2019 rate filings)\n    5. Commission schedules\n\n Please remain cognizant that non-redacted information and data must be submitted for review."]
["You may contact Tracie Gray at tgray@pa.gov if you have any questions regarding this checklist."]

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["Issuer Name:"]
["Market:"]
["SERFF ID: "]
[]
["TOC #","Description","Completed\n(Mark with \"X\")","Redaction Justification"]
[null,null,null,"Redacted (Y/N)","Page # in Public PDF","Justification submitted (Y/NA)"]
["Federal Documents Required to Be Filed with PID"]
["A.2.","RFJ Part I - Unified Rate Review Template"]
[null,"RFJ Part II – Consumer Friendly Justification"]
[null,"RFJ Part III – Actuarial Memorandum"]
[null,"Federal Rates Template"]
["Summary Documents/Confirmation of HIOS & SERFF Submissions"]
["A.2.B.","HIOS Submission"]
["A.2.C.","SERFF Submission"]
["A.2.D.","SERFF Rate/Rule Schedule Tab"]
["B.","Cover Letter & PA Bulletin Information"]
["C.","Rate Change Request Summary"]
["PA Actuarial Memorandum and Rate Exhibits"]
["D.1.A.","Company Information"]
["D.1.B.","Rate History & Proposed Variation in Rate Changes"]
["D.1.C.","Average Rate Change"]
["D.1.D.","Membership Count"]
[null,"             PA Act. Exhibits Table 1"]
["D.1.E.","Benefit Changes"]
["D.1.F.","Experience Period Claims & Premium"]
[null,"             PA Act. Exhibits Table 2"]
["D.1.G.","Credibility of Data"]
[null,"             PA Act. Exhibits Tables 2b, 3b, 4b (if applicable)"]
["D.1.H.","Trend Identification"]
[null,"             PA Act. Exhibits Table 3"]
["D.1.I.","Historical Experience"]
[null,"             PA Act. Exhibits Table 4"]
["D.2.A.","Development of PAIR, MAIR and Total Allowed Claims"]
[null,"             PA Act. Exhibits Table 5"]
["D.2.B.","Retention Items"]
[null,"             PA Act. Exhibits Table 6"]
["D.2.C.","Normalized Market-Adjusted Projected Allowed Total Claims"]
[null,"             PA Act. Exhibits Table 7"]
["D.2.D.","Components of Rate Change"]
[null,"             PA Act. Exhibits Table 8"]
[null,"             PA Act. Exhibits Table 9"]
["D.3.","Plan Rate Development"]
[null,"             PA Act. Exhibits Table 10"]
["D.4.","Plan Premium Development for 21-Year-Old Non-Tobacco User"]
[null,"             PA Act. Exhibits Table 11"]
["D.5.A.","Age and Tobacco Factors"]
[null,"             PA Act. Exhibits Table 12"]
["D.5.B.","Geographic Factors"]
[null,"             PA Act. Exhibits Table 13"]
["D.5.C.","Network Factors"]
[null,"             PA Act. Exhibits Table 14"]
["D.5.D.","Service Area Composition"]
["D.5.E.","Composite Rating"]
["D.6.","Actuarial Certifications"]
["Additional Exhibits"]
["E.","Department Plan Design Summary & Rate Tables"]
[null,"Service Area Map"]
["Redaction Justification (must be submitted if any information is redacted)"]