Title 45

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 Authority:42 U.S.C. 18021-18024, 18031-18032, 18041-18042, 18044, 18054, 18061, 18063, 18071, 18082, and 26 U.S.C. 36B. Link to an amendment published at 86 FR 6178, Jan. 19, 2021. Source:76 FR 77411, Dec. 13, 2011, unless otherwise noted.

45:2.0.1.1.14.1SUBPART A
Subpart A - General Provisions
45:2.0.1.1.14.1.1.1SECTION 156.10
   156.10 Basis and scope.
45:2.0.1.1.14.1.1.2SECTION 156.20
   156.20 Definitions.
45:2.0.1.1.14.1.1.3SECTION 156.50
   156.50 Financial support.
45:2.0.1.1.14.1.1.4SECTION 156.80
   156.80 Single risk pool.
45:2.0.1.1.14.2SUBPART B
Subpart B - Essential Health Benefits Package
45:2.0.1.1.14.2.1.1SECTION 156.100
   156.100 State selection of benchmark plan for plan years beginning prior to January 1, 2020.
45:2.0.1.1.14.2.1.2SECTION 156.105
   156.105 Determination of EHB for multi-state plans.
45:2.0.1.1.14.2.1.3SECTION 156.110
   156.110 EHB-benchmark plan standards.
45:2.0.1.1.14.2.1.4SECTION 156.111
   156.111 State selection of EHB-benchmark plan for plan years beginning on or after January 1, 2020, and annual reporting of state-required benefits.
45:2.0.1.1.14.2.1.5SECTION 156.115
   156.115 Provision of EHB.
45:2.0.1.1.14.2.1.6SECTION 156.120
   156.120 Collection of data to define essential health benefits.
45:2.0.1.1.14.2.1.7SECTION 156.122
   156.122 Prescription drug benefits.
45:2.0.1.1.14.2.1.8SECTION 156.125
   156.125 Prohibition on discrimination.
45:2.0.1.1.14.2.1.9SECTION 156.130
   156.130 Cost-sharing requirements.
45:2.0.1.1.14.2.1.10SECTION 156.135
   156.135 AV calculation for determining level of coverage.
45:2.0.1.1.14.2.1.11SECTION 156.140
   156.140 Levels of coverage.
45:2.0.1.1.14.2.1.12SECTION 156.145
   156.145 Determination of minimum value.
45:2.0.1.1.14.2.1.13SECTION 156.150
   156.150 Application to stand-alone dental plans inside the Exchange.
45:2.0.1.1.14.2.1.14SECTION 156.155
   156.155 Enrollment in catastrophic plans.
45:2.0.1.1.14.3SUBPART C
Subpart C - Qualified Health Plan Minimum Certification Standards
45:2.0.1.1.14.3.1.1SECTION 156.200
   156.200 QHP issuer participation standards.
45:2.0.1.1.14.3.1.2SECTION 156.210
   156.210 QHP rate and benefit information.
45:2.0.1.1.14.3.1.3SECTION 156.215
   156.215 Advance payments of the premium tax credit and cost-sharing reduction standards.
45:2.0.1.1.14.3.1.4SECTION 156.220
   156.220 Transparency in coverage.
45:2.0.1.1.14.3.1.5SECTION 156.221
   156.221 Access to and exchange of health data and plan information.
45:2.0.1.1.14.3.1.6SECTION 156.225
   156.225 Marketing and Benefit Design of QHPs.
45:2.0.1.1.14.3.1.7SECTION 156.230
   156.230 Network adequacy standards.
45:2.0.1.1.14.3.1.8SECTION 156.235
   156.235 Essential community providers.
45:2.0.1.1.14.3.1.9SECTION 156.245
   156.245 Treatment of direct primary care medical homes.
45:2.0.1.1.14.3.1.10SECTION 156.250
   156.250 Meaningful access to qualified health plan information.
45:2.0.1.1.14.3.1.11SECTION 156.255
   156.255 Rating variations.
45:2.0.1.1.14.3.1.12SECTION 156.260
   156.260 Enrollment periods for qualified individuals.
45:2.0.1.1.14.3.1.13SECTION 156.265
   156.265 Enrollment process for qualified individuals.
45:2.0.1.1.14.3.1.14SECTION 156.270
   156.270 Termination of coverage or enrollment for qualified individuals.
45:2.0.1.1.14.3.1.15SECTION 156.272
   156.272 Issuer participation for the full plan year.
45:2.0.1.1.14.3.1.16SECTION 156.275
   156.275 Accreditation of QHP issuers.
45:2.0.1.1.14.3.1.17SECTION 156.280
   156.280 Separate billing and segregation of funds for abortion services.
45:2.0.1.1.14.3.1.18SECTION 156.285
   156.285 Additional standards specific to SHOP for plan years beginning prior to January 1, 2018.
45:2.0.1.1.14.3.1.19SECTION 156.286
   156.286 Additional standards specific to SHOP for plan years beginning on or after January 1, 2018.
45:2.0.1.1.14.3.1.20SECTION 156.290
   156.290 Non-certification and decertification of QHPs.
45:2.0.1.1.14.3.1.21SECTION 156.295
   156.295 Prescription drug distribution and cost reporting.
45:2.0.1.1.14.4SUBPART D
Subpart D - Standards for Qualified Health Plan Issuers on Federally-Facilitated Exchanges and State-Based Exchanges on the Federal Platform
45:2.0.1.1.14.4.1.1SECTION 156.330
   156.330 Changes of ownership of issuers of Qualified Health Plans in Federally-facilitated Exchanges.
45:2.0.1.1.14.4.1.2SECTION 156.340
   156.340 Standards for downstream and delegated entities.
45:2.0.1.1.14.4.1.3SECTION 156.350
   156.350 Eligibility and enrollment standards for Qualified Health Plan issuers on State-based Exchanges on the Federal platform.
45:2.0.1.1.14.5SUBPART E
Subpart E - Health Insurance Issuer Responsibilities With Respect to Advance Payments of the Premium Tax Credit and Cost-Sharing Reductions
45:2.0.1.1.14.5.1.1SECTION 156.400
   156.400 Definitions.
45:2.0.1.1.14.5.1.2SECTION 156.410
   156.410 Cost-sharing reductions for enrollees.
45:2.0.1.1.14.5.1.3SECTION 156.420
   156.420 Plan variations.
45:2.0.1.1.14.5.1.4SECTION 156.425
   156.425 Changes in eligibility for cost-sharing reductions.
45:2.0.1.1.14.5.1.5SECTION 156.430
   156.430 Payment for cost-sharing reductions.
45:2.0.1.1.14.5.1.6SECTION 156.440
   156.440 Plans eligible for advance payments of the premium tax credit and cost-sharing reductions.
45:2.0.1.1.14.5.1.7SECTION 156.460
   156.460 Reduction of enrollee's share of premium to account for advance payments of the premium tax credit.
45:2.0.1.1.14.5.1.8SECTION 156.470
   156.470 Allocation of rates for advance payments of the premium tax credit.
45:2.0.1.1.14.5.1.9SECTION 156.480
   156.480 Oversight of the administration of the cost-sharing reductions and advance payments of the premium tax credit programs.
45:2.0.1.1.14.6SUBPART F
Subpart F - Consumer Operated and Oriented Plan Program
45:2.0.1.1.14.6.1.1SECTION 156.500
   156.500 Basis and scope.
45:2.0.1.1.14.6.1.2SECTION 156.505
   156.505 Definitions.
45:2.0.1.1.14.6.1.3SECTION 156.510
   156.510 Eligibility.
45:2.0.1.1.14.6.1.4SECTION 156.515
   156.515 CO-OP standards.
45:2.0.1.1.14.6.1.5SECTION 156.520
   156.520 Loan terms.
45:2.0.1.1.14.7SUBPART G
Subpart G - Minimum Essential Coverage
45:2.0.1.1.14.7.1.1SECTION 156.600
   156.600 The definition of minimum essential coverage.
45:2.0.1.1.14.7.1.2SECTION 156.602
   156.602 Other coverage that qualifies as minimum essential coverage.
45:2.0.1.1.14.7.1.3SECTION 156.604
   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.
45:2.0.1.1.14.7.1.4SECTION 156.606
   156.606 HHS audit authority.
45:2.0.1.1.14.8SUBPART H
Subpart H - Oversight and Financial Integrity Standards for Issuers of Qualified Health Plans in Federally-Facilitated Exchanges
45:2.0.1.1.14.8.1.1SECTION 156.705
   156.705 Maintenance of records for Federally-facilitated Exchanges.
45:2.0.1.1.14.8.1.2SECTION 156.715
   156.715 Compliance reviews of QHP issuers in Federally-facilitated Exchanges.
45:2.0.1.1.14.9SUBPART I
Subpart I - Enforcement Remedies in Federally-Facilitated Exchanges
45:2.0.1.1.14.9.1.1SECTION 156.800
   156.800 Available remedies; Scope.
45:2.0.1.1.14.9.1.2SECTION 156.805
   156.805 Bases and process for imposing civil money penalties in Federally-facilitated Exchanges.
45:2.0.1.1.14.9.1.3SECTION 156.806
   156.806 Notice of non-compliance.
45:2.0.1.1.14.9.1.4SECTION 156.810
   156.810 Bases and process for decertification of a QHP offered by an issuer through a Federally-facilitated Exchange.
45:2.0.1.1.14.9.1.5SECTION 156.815
   156.815 Plan suppression.
45:2.0.1.1.14.10SUBPART J
Subpart J - Administrative Review of QHP Issuer Sanctions in Federally-Facilitated Exchanges
45:2.0.1.1.14.10.1.1SECTION 156.901
   156.901 Definitions.
45:2.0.1.1.14.10.1.2SECTION 156.903
   156.903 Scope of Administrative Law Judge's (ALJ) authority.
45:2.0.1.1.14.10.1.3SECTION 156.905
   156.905 Filing of request for hearing.
45:2.0.1.1.14.10.1.4SECTION 156.907
   156.907 Form and content of request for hearing.
45:2.0.1.1.14.10.1.5SECTION 156.909
   156.909 Amendment of notice of assessment or decertification request for hearing.
45:2.0.1.1.14.10.1.6SECTION 156.911
   156.911 Dismissal of request for hearing.
45:2.0.1.1.14.10.1.7SECTION 156.913
   156.913 Settlement.
45:2.0.1.1.14.10.1.8SECTION 156.915
   156.915 Intervention.
45:2.0.1.1.14.10.1.9SECTION 156.917
   156.917 Issues to be heard and decided by ALJ.
45:2.0.1.1.14.10.1.10SECTION 156.919
   156.919 Forms of hearing.
45:2.0.1.1.14.10.1.11SECTION 156.921
   156.921 Appearance of counsel.
45:2.0.1.1.14.10.1.12SECTION 156.923
   156.923 Communications with the ALJ.
45:2.0.1.1.14.10.1.13SECTION 156.925
   156.925 Motions.
45:2.0.1.1.14.10.1.14SECTION 156.927
   156.927 Form and service of submissions.
45:2.0.1.1.14.10.1.15SECTION 156.929
   156.929 Computation of time and extensions of time.
45:2.0.1.1.14.10.1.16SECTION 156.931
   156.931 Acknowledgment of request for hearing.
45:2.0.1.1.14.10.1.17SECTION 156.935
   156.935 Discovery.
45:2.0.1.1.14.10.1.18SECTION 156.937
   156.937 Submission of briefs and proposed hearing exhibits.
45:2.0.1.1.14.10.1.19SECTION 156.939
   156.939 Effect of submission of proposed hearing exhibits.
45:2.0.1.1.14.10.1.20SECTION 156.941
   156.941 Prehearing conferences.
45:2.0.1.1.14.10.1.21SECTION 156.943
   156.943 Standard of proof.
45:2.0.1.1.14.10.1.22SECTION 156.945
   156.945 Evidence.
45:2.0.1.1.14.10.1.23SECTION 156.947
   156.947 The record.
45:2.0.1.1.14.10.1.24SECTION 156.951
   156.951 Posthearing briefs.
45:2.0.1.1.14.10.1.25SECTION 156.953
   156.953 ALJ decision.
45:2.0.1.1.14.10.1.26SECTION 156.955
   156.955 Sanctions.
45:2.0.1.1.14.10.1.27SECTION 156.957
   156.957 Review by Administrator.
45:2.0.1.1.14.10.1.28SECTION 156.959
   156.959 Judicial review.
45:2.0.1.1.14.10.1.29SECTION 156.961
   156.961 Failure to pay assessment.
45:2.0.1.1.14.10.1.30SECTION 156.963
   156.963 Final order not subject to review.
45:2.0.1.1.14.11SUBPART K
Subpart K - Cases Forwarded to Qualified Health Plans and Qualified Health Plan Issuers in Federally-facilitated Exchanges
45:2.0.1.1.14.11.1.1SECTION 156.1010
   156.1010 Standards.
45:2.0.1.1.14.12SUBPART L
Subpart L - Quality Standards
45:2.0.1.1.14.12.1.1SECTION 156.1105
   156.1105 Establishment of standards for HHS-approved enrollee satisfaction survey vendors for use by QHP issuers in Exchanges.
45:2.0.1.1.14.12.1.2SECTION 156.1110
   156.1110 Establishment of patient safety standards for QHP issuers.
45:2.0.1.1.14.12.1.3SECTION 156.1120
   156.1120 Quality rating system.
45:2.0.1.1.14.12.1.4SECTION 156.1125
   156.1125 Enrollee satisfaction survey system.
45:2.0.1.1.14.12.1.5SECTION 156.1130
   156.1130 Quality improvement strategy.
45:2.0.1.1.14.13SUBPART M
Subpart M - Qualified Health Plan Issuer Responsibilities
45:2.0.1.1.14.13.1.1SECTION 156.1210
   156.1210 Dispute submission.
45:2.0.1.1.14.13.1.2SECTION 156.1215
   156.1215 Payment and collections processes.
45:2.0.1.1.14.13.1.3SECTION 156.1220
   156.1220 Administrative appeals.
45:2.0.1.1.14.13.1.4SECTION 156.1230
   156.1230 Direct enrollment with the QHP issuer in a manner considered to be through the Exchange.
45:2.0.1.1.14.13.1.5SECTION 156.1240
   156.1240 Enrollment process for qualified individuals.
45:2.0.1.1.14.13.1.6SECTION 156.1250
   156.1250 Acceptance of certain third party payments.
45:2.0.1.1.14.13.1.7SECTION 156.1255
   156.1255 Renewal and re-enrollment notices.
45:2.0.1.1.14.13.1.8SECTION 156.1256
   156.1256 Other notices.