Py-17 version 2 15b-1 2017 qhp application instructions chapter 15b: stand-alone dental plan� description of ehb allocation please fill in the following information.. Dental form and rate filing requirements - stand-alone dental plans and other dental insurance plans. insurers wishing to offer in wisconsin a marketplace-certified stand-alone dental plan (sadp) that meets the standards related to the pediatric dental essential health benefits must comply with all wisconsin policy form and rate filing requirements.. Describe the methods and specific bases used to perform the allocation and demonstrate that the allocation meets the standards set forth in 45 code of federal regulations 156.470(d): stand alone dental plan description of ehb allocation created date:.
That is specific to dental carriers (i.e. stand alone dental plans � actuarial value supporting documentation and justifications� and �stand-alone dental plans � description of ehb allocation)�.. Stand - alone dental plan actuarial value supporting documentation and justification stand - alone dental plans - description of ehb allocation unique plan design justification conditional ehb-substituted benefit (actuarial equivalent) justification conditional discrimination-cost sharing outlier justification conditional. Supporting documentation and justifications� and �stand-alone dental plans � description of ehb allocation)�. 4. please indicate the form and page number where the benefit is described in the page# and document column if applicable..
