Staying compliant in the ACA marketplace has never been more complex—or more critical. From shifting regulations to rising rate pressures, issuers that lack the right resources risk delays, objections, and even penalties.
In this episode of Regulatory Joe, ClearFile President Joe Boyle shares five essentials every health plan needs in their ACA compliance toolkit to streamline filings, strengthen relationships with regulators, and gain speed to market.
Tool #1: Proactive Regulator Engagement in the ACA Filing Cycle
Many issuers “file and wait,” leaving regulators to interpret rate actions or product changes on their own. Proactive communication—before, during, and after submission—strengthens trust and prevents roadblocks.
- Pre-submission: Share anticipated rate increases and portfolio strategies early to reduce surprises and minimize the chance of rate hearings.
- During review: Respond quickly to questions and objections, clarifying intent to speed approvals.
- Leadership engagement: Meet regulators at NAIC and state-level convenings to align on long-term goals.
This engagement not only accelerates speed to market, but also reduces risk of fines, hearings, or disbarment.
Tool #2: Strengthen ACA Compliance with Health Plan Association Partnerships
State associations carry a collective influence that individual issuers can’t match. Especially as sweeping changes like the One Big Beautiful Bill Act reshape ACA operations, association advocacy helps regulators understand the real-world impact on plans of different sizes and strategies.
For new or regional issuers, this tool is even more powerful. Regular participation in association meetings ensures your plan’s perspective is represented while strengthening compliance across the market as a whole.
Tool #3: ACA Filing Technology That Reduces Errors and Saves Time
Spreadsheets and ad hoc systems may have worked in the early years of the ACA, but today’s complexity demands enterprise-level solutions. Filing technology like ClearFile brings deadlines, task management, workflow automation, and SERFF-ready templates into one place.
The payoff is significant: fewer upload errors, less rework, and faster approvals. Issuers that adopt modern filing platforms often cut filing time in half and reduce the volume of regulator objections—freeing their teams to focus on strategy instead of version control.
Tool #4: Robust Reporting Infrastructure for ACA Compliance
Certification is just the beginning—issuers must also meet year-round reporting requirements like network adequacy, PCP turnover, and transparency in coverage.
- Harmonize data: Align ACA and Medicare Advantage reporting sources to ensure consistency
- Standardize formats: Streamline regulator reviews by submitting data in predictable templates.
- Plan for cadence: Automate recurring reports to avoid last-minute scrambles.
Strong internal reporting protects issuers from gaps that can stall expansion or renewal efforts.
Tool #5: Strategic Vendor Partnerships to Support ACA Filing Success
No compliance toolkit is complete without external support. Rate filings, forms, and binder submissions each require specialized expertise—and outsourcing one or more of these functions can reduce errors and objections.
The key is choosing partners who act as an extension of your team, not just contractors. The best vendors track dependencies across filings, maintain transparent version control, and anticipate regulatory changes rather than reacting to them. With the right support in place, issuers can scale without overwhelming internal teams.
Why a Complete ACA Compliance Toolkit Reduces Risk
Every filing season brings new risks—missed deadlines, reporting gaps, regulatory hearings. With the five tools outlined above, issuers can mitigate those risks while staying prepared for shifting federal and state requirements.
Proactive regulator engagement, strong associations, modern filing technology, robust reporting, and trusted vendors together create a framework that keeps compliance on track and protects your plan’s ability to grow in competitive markets.
