Health Insurance Issuer Submission of the Preliminary Justification

Rate Increase Disclosure and Review Reporting Requirements (CMS-10379)

Preliminary Justification Submission Function

Health Insurance Issuer Submission of the Preliminary Justification

OMB: 0938-1141

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Exhibit A: Screenshot Illustration of the HIOS Rate Review Data Collection System:



Initial HIOS Sign-In screen.

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HIOS Main Page Menu



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Rate Review System Module Selected



Content Placeholder 2



Rate Review Submission Tab Selected

Content Placeholder 3

First Preliminary Justification Upload Screen (Issuers will use this Screen to locate products already stored in the HIOS system through the Plan Finder Reporting Requirements)

Content Placeholder 4







Second Preliminary Justification Upload Screen (Issuers will use this screen to upload the three parts of the Preliminary Justification.

Picture 2 Picture 2



Preliminary Justification Submission Confirmation



Picture 6



Submission of Supplemental Information Function



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Submission of Supplemental Information Function (continued)



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Modify Function



Picture 2

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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorCMS
File Modified0000-00-00
File Created2021-01-25

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