On Mar. 20, DEL INS guided on affordability standards data submission
DEL INS issued Bulletin 138, manual and template for entities subject to Regulation 1322 when completing 2026 Affordability standards data submission (ASDS) template.
Aims to achieve compliance with Reg 1322, Requirements for mandatory minimum payment innovations in health insurance, DEL admin codeDEL INS 18-1300-1322.
Follows DEL INS Mar. 2024 bulletin on 2025 mandatory payments, see #204978.
ASDS Template Updates
Template updated primary care code set to reflect additional service, taxonomy, and place of service codes, including primary care and care management codes from CMS.
Also, updated codes related to primary care and care management services that are aligned with the Office of Value Based Health Care Delivery (OVBHCD)'s definition.
For 2026, compliance with Section 7.0 of 1322 dictates that carriers’ price trends must not exceed 5.50% for each Inpatient Hospital, Outpatient Hospital, and Other Medical.
Carriers must reimburse providers at least at Medicare rates for primary care and chronic care management services, must include the codes on list of covered services.
Carriers must complete the ASDS template annually, for each line of business.
Must also submit the completed template to the OVBHCD as part of their rate filings.
Template must exclude American rescue plan act (ARPA) premium tax credit considerations, and once complete, must be sent no later than the applicable deadline.
Deadlines
ASDS template submission deadline is Jun. 20, 2025, for individuals or small groups.
Submission deadline for large groups is Sep. 19, 2025, for ASDS template submission.
Regulators
DEL INS
Entity Types
Ins
Reference
Bul 138, 3/20/2025; Form, 3/14/2025; Gd, 3/6/2025; Citation: DEL INS 18-1300-1322;
