Federal Health Insurance

OIR developed the following worksheets to assist insurance companies and health maintenance organizations in making form filings that are compliant with the Affordable Care Act (ACA) requirements, effective January 1, 2014.

OIR encourages companies to download, complete, scan and upload these forms as part of all form filings intended to be compliant with the 2014 ACA requirements submitted to OIR via I-File. This will expedite the review process and increase speed to the market.

These worksheets will be updated on a continuing bases as additional federal guidance is provided. You are encouraged to use the most recently updated version. The worksheets may not contain all of the requirements of the ACA. OIR offers these worksheets as guidance only, and should not be considered a directive by OIR.

• HMO Master Group Application (version 5/20/2014)
• HMO Small and Large Group Contract (version 5/21/2015)
• Individual Major Medical Outline of Coverage (version 5/22/2015)
• Individual Major Medical Health CATASTROPHIC Contract (version 5/21/2015)
• Individual Major Medical Contract (version 5/21/2015)
• Major Medical Group Health Application (version 5/20/2014)
• HMO Individual Application (version 5/20/2014)
• Individual Health Application (version 5/20/2014)
• Small and Large Group Major Medical Health Contract (version 5/21/2015)
• HMO Individual Contract (version 5/21/2015)
• Small and Large Group Stand-Alone Dental Contract (version 5/21/2015)
• Stand-Alone Dental Individual Contract (version 5/21/2015)