2022 Prior Approval NYSOH and Outside NYSOH

Unless noted otherwise, the following items are in PDF format.

• Template - 2022 Rate adjustment notices (Word, updated 04/08/2021)
  • Initial (Group Certificate Holder)
  • Initial (Group Policyholder)
  • Initial (Individual Policyholder)
• 2022 Prior Approval Exhibits (Zip)
• Instructions for the Filing of 2022 Premium Rates
• Checklist for the Filing of 2022 Individual Premium Rates
• 2022 - AV Screenshots - Standard Plans
• 2022 - AV Screenshots - Alternate Standard Plans
• FINAL - Attachment B - Standard Benefit Design Cost Sharing Description Chart
• FINAL - Attachment C - Standard Benefit with 3 PCP Visits Design Cost Sharing Description Chart