We respectfully submit the above referenced Rates and Actuarial Memorandum for your review and approval. These rates will be used with forms, M-6014DC et. al. which were submitted simultaneously to your Department under SERFF Filing Number FDLT-129246869.
The forms provide a fixed-dollar indemnity limited benefit coverage to trust groups, and are being filed as an “excepted benefit” pursuant to the Affordable Care Act. This is not a substitute for major medical insurance. It is not designed to qualify as minimum essential health. All benefits are variable, except the Hospital Confinement benefit. Coverage options are selected by the group. Members may enroll in the packaged plan elected by the group.
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