Part 156 — Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to Exchanges
Subpart A — General Provisions
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.
- § 156.140— 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.
- § 156.201— Standardized plan options.
- § 156.202— Non-standardized plan option limits.
- § 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— Network adequacy standards.
- § 156.235— Essential community providers.
- § 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
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
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
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
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.