45 CFR Part 156
PART 156—HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES
- PART 156—HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES
- Subtitle A—Department of Health and Human Services › Subchapter B—Requirements Relating to Health Care Access
- Subpart A—General Provisions
- § 156.10 Basis and scope.
- § 156.20 Definitions.
- § 156.50 Financial support.
- § 156.80 Single risk pool.
- Subpart B—Essential Health Benefits Package
- § 156.100 State selection of benchmark plan for plan years beginning prior to January 1, 2020.
- § 156.105 Determination of EHB for multi-state plans.
- § 156.110 EHB-benchmark plan standards.
- § 156.111 State selection of EHB-benchmark plan for plan years beginning on or after January 1, 2020.
- § 156.115 Provision of EHB.
- § 156.120 Collection of data to define essential health benefits.
- § 156.122 Prescription drug benefits.
- § 156.125 Prohibition on discrimination.
- § 156.130 Cost-sharing requirements.
- § 156.135 AV calculation for determining level of coverage.
- § 156.136 Expanded cost-sharing parameters.
- § 156.140 Levels of coverage.
- § 156.145 Determination of minimum value.
- § 156.150 Application to stand-alone dental plans inside the Exchange.
- § 156.155 Enrollment in catastrophic plans.
- Subpart C—Qualified Health Plan Minimum Certification Standards
- § 156.200 QHP issuer participation standards.
- § 156.210 QHP rate and benefit information.
- § 156.215 Advance payments of the premium tax credit and cost-sharing reduction standards.
- § 156.220 Transparency in coverage.
- § 156.221 Access to and exchange of health data and plan information.
- § 156.222 Access to and exchange of health data for providers and payers.
- § 156.223 Prior authorization requirements.
- § 156.225 Marketing and benefit design of QHPs.
- § 156.230 Provider access standards for network plans.
- § 156.235 Essential community provider standards for network plans.
- § 156.236 Provider access and essential community providers standards for non-network plans.
- § 156.245 Treatment of direct primary care medical homes.
- § 156.250 Meaningful access to qualified health plan information.
- § 156.255 Rating variations.
- § 156.260 Enrollment periods for qualified individuals.
- § 156.265 Enrollment process for qualified individuals.
- § 156.270 Termination of coverage or enrollment for qualified individuals.
- § 156.272 Issuer participation for the full plan year.
- § 156.275 Accreditation of QHP issuers.
- § 156.280 Segregation of funds for abortion services.
- § 156.285 Additional standards specific to SHOP for plan years beginning prior to January 1, 2018.
- § 156.286 Additional standards specific to SHOP for plan years beginning on or after January 1, 2018.
- § 156.290 Non-certification and decertification of QHPs.
- § 156.295 Prescription drug distribution and cost reporting by QHP issuers.
- Subpart D—Standards for Qualified Health Plan Issuers for Specific Types of Exchanges
- § 156.330 Changes of ownership of issuers of Qualified Health Plans in Federally-facilitated Exchanges.
- § 156.340 Standards for downstream and delegated entities.
- § 156.350 Eligibility and enrollment standards for Qualified Health Plan issuers on State-based Exchanges on the Federal platform.
- Subpart E—Health Insurance Issuer Responsibilities With Respect to Advance Payments of the Premium Tax Credit and Cost-Sharing Reductions
- § 156.400 Definitions.
- § 156.410 Cost-sharing reductions for enrollees.
- § 156.420 Plan variations.
- § 156.425 Changes in eligibility for cost-sharing reductions.
- § 156.430 Payment for cost-sharing reductions.
- § 156.440 Plans eligible for advance payments of the premium tax credit and cost-sharing reductions.
- § 156.460 Reduction of enrollee's share of premium to account for advance payments of the premium tax credit.
- § 156.470 Allocation of rates for advance payments of the premium tax credit.
- § 156.480 Oversight of the administration of the advance payments of the premium tax credit, cost-sharing reductions, and user fee programs.
- Subpart F—Consumer Operated and Oriented Plan Program
- § 156.500 Basis and scope.
- § 156.505 Definitions.
- § 156.510 Eligibility.
- § 156.515 CO-OP standards.
- § 156.520 Loan terms.
- Subpart G—Minimum Essential Coverage
- § 156.600 The definition of minimum essential coverage.
- § 156.602 Other coverage that qualifies as minimum essential coverage.
- § 156.604 Requirements for recognition as minimum essential coverage for types of coverage not otherwise designated minimum essential coverage in the statute or this subpart.
- § 156.606 HHS audit authority.
- Subpart H—Oversight and Financial Integrity Standards for Issuers of Qualified Health Plans in Federally-Facilitated Exchanges
- § 156.705 Maintenance of records for Federally-facilitated Exchanges.
- § 156.715 Compliance reviews of QHP issuers in Federally-facilitated Exchanges.
- Subpart I—Enforcement Remedies in the Exchanges
- § 156.800 Available remedies; Scope.
- § 156.805 Bases and process for imposing civil money penalties in Federally-facilitated Exchanges.
- § 156.806 Notice of non-compliance.
- § 156.810 Bases and process for decertification of a QHP offered by an issuer through a Federally-facilitated Exchange.
- § 156.815 Plan suppression.
- Subpart J—Administrative Review of QHP Issuer Sanctions
- § 156.901 Definitions.
- § 156.903 Scope of Administrative Law Judge's (ALJ) authority.
- § 156.905 Filing of request for hearing.
- § 156.907 Form and content of request for hearing.
- § 156.909 Amendment of notice of assessment or decertification request for hearing.
- § 156.911 Dismissal of request for hearing.
- § 156.913 Settlement.
- § 156.915 Intervention.
- § 156.917 Issues to be heard and decided by ALJ.
- § 156.919 Forms of hearing.
- § 156.921 Appearance of counsel.
- § 156.923 Communications with the ALJ.
- § 156.925 Motions.
- § 156.927 Form and service of submissions.
- § 156.929 Computation of time and extensions of time.
- § 156.931 Acknowledgement of request for hearing.
- § 156.935 Discovery.
- § 156.937 Submission of briefs and proposed hearing exhibits.
- § 156.939 Effect of submission of proposed hearing exhibits.
- § 156.941 Prehearing conferences.
- § 156.943 Standard of proof.
- § 156.945 Evidence.
- § 156.947 The record.
- § 156.951 Posthearing briefs.
- § 156.953 ALJ decision.
- § 156.955 Sanctions.
- § 156.957 Review by Administrator.
- § 156.959 Judicial review.
- § 156.961 Failure to pay assessment.
- § 156.963 Final order not subject to review.
- Subpart K—Cases Forwarded to Qualified Health Plans and Qualified Health Plan Issuers in Federally-facilitated Exchanges
- § 156.1010 Standards.
- Subpart L—Quality Standards
- § 156.1105 Establishment of standards for HHS-approved enrollee satisfaction survey vendors for use by QHP issuers in Exchanges.
- § 156.1110 Establishment of patient safety standards for QHP issuers.
- § 156.1120 Quality rating system.
- § 156.1125 Enrollee satisfaction survey system.
- § 156.1130 Quality improvement strategy.
- Subpart M—Qualified Health Plan Issuer Responsibilities
- § 156.1210 Dispute submission.
- § 156.1215 Payment and collections processes.
- § 156.1220 Administrative appeals.
- § 156.1230 Direct enrollment with the QHP issuer in a manner considered to be through the Exchange.
- § 156.1240 Enrollment process for qualified individuals.
- § 156.1250 Acceptance of certain third party payments.
- § 156.1255 Renewal and re-enrollment notices.
- § 156.1256 Other notices.
Feedback