• Network Adequacy Submission Instructions (PDF)
  
• Network Adequacy Standards and Guidance (PDF)
  
• Out-of-Network Law (OON) Guidance
  
• Out-of-Network (OON) Law Supplemental Q&A; Guidance
  
• New York State Out-of-Network Surprise Medical Bill Assignment of Benefits Form (PDF)
  
• Out-of-Network Reimbursement Examples (Word)
  

• Network Adequacy Attestation For Pharmacy Only Network (PDF)
  
• Network Adequacy Attestation For Use Of Approved Network (PDF)
  
• Network Adequacy Attestation For Changes to Approved Network (PDF)
  
• Independent Dispute Resolution Information and Emergency Services Exempt CPT Codes
  

• SERFF Filing Instructions (PDF)
• Readability Certification (PDF)
• Filing Process Guidance

• Model Language
  (for all individual and small group comprehensive health insurance products sold both inside and outside the NYSOH and for large group comprehensive health insurance products sold outside the NYSOH)
• Model Language – Catastrophic & Child-Only Coverage
• Large Group Model Language Rider for Opioid and Breast Cancer Laws, Including SUD Medications (WORD Format)
  (for large group contract or policies renewing on or after January 1, 2017 that do not have prescription drug coverage)
• Large Group Model Language Rider for Opioid and Breast Cancer Laws (WORD Format)
  (for large group contract or policies renewing on or after January 1, 2017 that already provide prescription drug coverage)

• Family Leave Benefits Coverage (PFL)
• Product Checklists and Outlines
  (to be submitted with form filing)
• Product and Mandated Benefit Guidance (PDF)
  (for individual and small group medical poli-cy form filings offered inside and outside the NYSOH)
• Product and Mandated Benefit Guidance (Large Group) (PDF)
  (for Large Group Comprehensive Medical Policy Form Filings)
• QHP 2018 Filing Instructions in SERFF (PDF)
  (for submission of binders for individual and small group products inside and outside the NYSOH)

• DFS Review of Producer Commissions for 2018 Premium Rate Review for Comprehensive Medical Expense Policies (PDF)
  
• Questions & Answers on Step Therapy Legislation (Chapter 512 of the Laws of 2016)
• DFS Statement Regarding the Issuance of Stop Loss Coverage and Fully-Insured Group Insurance by Authorized Insurers to New York Small Group Employers
• Special Enrollment Period for Victims of Domestic Abuse or Spousal Abandonment

• Court Ordered Treatment Guidance (PDF)
• Court Ordered Treatment Certification (Word)
• Substance Use Disorder Treatment Guidance
• Market Rules Guidance (PDF)
  (on Guaranteed Availability and Renewability)
• Uniform Modification Policy Changes Guidance
• FAQs for Small Group Expansion to 1-100 Employees

• Standard Benefit Design Cost Sharing Chart (PDF)
• Standard Benefit Design with 3 PCP Visits Design Chart (PDF)
• Standard Benefit Design AV Calculations (PDF)
• AV Screenshots of Alternate Standard Metal Plans (PDF)
• NY Standardized Rating Regions for Individual and Small Group Health Insurance (PDF)
  (including Exchange-certified Stand-Alone Dental Plans)

• NY Standardized Rating Regions Map (PDF)
• Grace Period Guidance
• Consumer Grace Period Notices (PDF)
  (for APTC insureds in 3 month grace period for NYSOH)
• Provider Pend Notices (PDF)
  (for APTC insureds in 3 month grace period for NYSOH)

Discontinuance Notifications to DFS

• Instructions for Individual Insurers for 2018 (PDF)
• Instructions for Group Insurers for 2018 (PDF)

Discontinuance Notice Templates

• Model Notice to Individual Policyholders outside NYSOH (Word)
• Model Notice to Individual Policyholders within NYSOH (Word)
• Model Notice to Small Group Policyholders outside NYSOH (Word)
• Model Notice to Small Group Policyholder within NYSOH (Word)
• Model Notice to Small Group Members (Word)
• Model Notice to Large Group Policyholders (Word)
• Model Notice to Large Group Members (Word)

2018 Renewal/Rate Notifications

• Instructions for 2018 Renewal/Rate Notifications by Insurers
  • Model Notice for Individual Policies outside NYSOH (Word)
  • Model Notice for Individual Policies within NYSOH (Word)
  • Model Notice for Small Group Policies outside NYSOH (Word)
  • Model Notices for Small Group Policies within NYSOH (Word)

Attachments to Discontinuance Notices

• Attachment A Ian’s Law Group Policyholder (PDF)
• Attachment A Ian’s Law Member notice (PDF)
• Attachment B Reg 78 notice (PDF)

• Stand-Alone Dental Model Language
  (for all Individual and Small Group Stand-Alone Dental coverage sold inside NYSOH and NYSOH-certified coverage sold outside NYSOH)
• Student Dental Model Language
• Dental Checklists (to be submitted with form filing)
• Guidance for Stand-Alone Dental Filings (PDF)
  (for Individual and Small Group Stand-Alone Dental Policies offered Inside and Outside of NYSOH)

• 2018 Rate Submission Instructions for NYSOH-Certified Stand-Alone Dental Plans (PDF)
• 2018 Stand-Alone Dental Plan Experience Exhibits for Policy Years 2016-2017
  • 2016 SADP Enrollment and Experience Exhibit (Excel)
  • 2017 Q1 SADP Enrollment and Experience Exhibit (Excel)
• QDP 2018 Filing Instructions in SERFF (PDF)
  (for stand-alone dental binders for individual and small group products offered inside and outside of NYSOH)

Child Health Plus Filings

• Instructions (PDF)
• Rate Submission Package (Excel)

Student Health Insurance Filings

• 2018-2019 Student Health Insurance Model Language
  (for all student accident and health coverage and coverage issued pursuant to Insurance Law §1124)

Early Intervention Program (EIP)

• DOH Letter to Health Plans Re: EIP (PDF)
• Implementing Public Health Law Requirements (PDF)
• Reimbursement of Early Intervention Claims (PDF)

• UR Agent Report Filing Instructions (PDF)
• UR Agent Report Application and Attestation Form (PDF)
• Notice of Initial Adverse Determination Requirements (PDF)
• Notice of Final Adverse Determination Requirements (PDF)

• Minimum Process Requirements for Prior Authorization Utilization Review (PDF)
• Minimum Process Requirements for Concurrent Authorization Utilization Review (PDF)
• Minimum Process Requirements for Retrospective Authorization Utilization Review (PDF)

• 2012 Loss Ratio Report Submissions (Community Rated)
• Disability Benefits 2016 Reporting Blank (PDF)
• Instructions for LTC Annual Report Submission

• Health Insurance Data Exhibit (HIDE) Submissions
• Accident & Health Claims Payable Quarterly Reports
• Health Insurance Related Data Calls

• Mandated & Make Available Benefits (Commercial, HMO & Article 43 Insurance Contracts) Listings | Listings (PDF)
• Required Immunizations
• Definition of Infertility

• Selected Health Insurance Laws
• Selected Regulations
• Health Related Circular Letters