Subpart A - General Provisions.

§ 155.10 - Basis and scope.

§ 155.20 - Definitions.

Subpart B - General Standards Related to the Establishment of an Exchange

§ 155.100 - Establishment of a State Exchange.

§ 155.105 - Approval of a State Exchange.

§ 155.106 - Election to operate an Exchange after 2014.

§ 155.110 - Entities eligible to carry out Exchange functions.

§ 155.120 - Non-interference with Federal law and non-discrimination standards.

§ 155.130 - Stakeholder consultation.

§ 155.140 - Establishment of a regional Exchange or subsidiary Exchange.

§ 155.150 - Transition process for existing State health insurance exchanges.

§ 155.160 - Financial support for continued operations.

§ 155.170 - Additional required benefits.

Subpart C - General Functions of an Exchange

§ 155.200 - Functions of an Exchange.

§ 155.205 - Consumer assistance tools and programs of an Exchange.

§ 155.206 - Civil money penalties for violations of applicable Exchange standards by consumer assistance entities in Federally-facilitated Exchanges.

§ 155.210 - Navigator program standards.

§ 155.215 - Standards applicable to Navigators and Non-Navigator Assistance Personnel carrying out consumer assistance functions under §§ 155.205(d) and (e) and 155.210 in a Federally-facilitated Exchange and to Non-Navigator Assistance Personnel funded through an Exchange Establishment Grant.

§ 155.220 - Ability of States to permit agents and brokers and web-brokers to assist qualified individuals, qualified employers, or qualified employees enrolling in QHPs.

§ 155.221 - Standards for direct enrollment entities and for third-parties to perform audits of direct enrollment entities.

§ 155.222 - Standards for HHS-approved vendors of Federally-facilitated Exchange training for agents and brokers.

§ 155.225 - Certified application counselors.

§ 155.227 - Authorized representatives.

§ 155.230 - General standards for Exchange notices.

§ 155.240 - Payment of premiums.

§ 155.260 - Privacy and security of personally identifiable information.

§ 155.270 - Use of standards and protocols for electronic transactions.

§ 155.280 - Oversight and monitoring of privacy and security requirements.

§ 155.285 - Bases and process for imposing civil penalties for provision of false or fraudulent information to an Exchange or improper use or disclosure of information.

Subpart D - Exchange Functions in the Individual Market: Eligibility Determinations for Exchange Participation and Insurance Affordability Programs

§ 155.300 - Definitions and general standards for eligibility determinations.

§ 155.302 - Options for conducting eligibility determinations.

§ 155.305 - Eligibility standards.

§ 155.310 - Eligibility process.

§ 155.315 - Verification process related to eligibility for enrollment in a QHP through the Exchange.

§ 155.320 - Verification process related to eligibility for insurance affordability programs.

§ 155.330 - Eligibility redetermination during a benefit year.

§ 155.335 - Annual eligibility redetermination.

§ 155.340 - Administration of advance payments of the premium tax credit and cost-sharing reductions.

§ 155.345 - Coordination with Medicaid, CHIP, the Basic Health Program, and the Pre-existing Condition Insurance Plan.

§ 155.350 - Special eligibility standards and process for Indians.

§ 155.355 - Right to appeal.

Subpart E - Exchange Functions in the Individual Market: Enrollment in Qualified Health Plans

§ 155.400 - Enrollment of qualified individuals into QHPs.

§ 155.405 - Single streamlined application.

§ 155.410 - Initial and annual open enrollment periods.

§ 155.415 - Allowing issuer or direct enrollment entity application assisters to assist with eligibility applications.

§ 155.420 - Special enrollment periods.

§ 155.430 - Termination of Exchange enrollment or coverage.

Subpart F - Appeals of Eligibility Determinations for Exchange Participation and Insurance Affordability Programs

§ 155.500 - Definitions.

§ 155.505 - General eligibility appeals requirements.

§ 155.510 - Appeals coordination.

§ 155.515 - Notice of appeal procedures.

§ 155.520 - Appeal requests.

§ 155.525 - Eligibility pending appeal.

§ 155.530 - Dismissals.

§ 155.535 - Informal resolution and hearing requirements.

§ 155.540 - Expedited appeals.

§ 155.545 - Appeal decisions.

§ 155.550 - Appeal record.

§ 155.555 - Employer appeals process.

Subpart G - Exchange Functions in the Individual Market: Eligibility Determinations for Exemptions

§ 155.600 - Definitions and general requirements.

§ 155.605 - Eligibility standards for exemptions.

§ 155.610 - Eligibility process for exemptions.

§ 155.615 - Verification process related to eligibility for exemptions.

§ 155.620 - Eligibility redeterminations for exemptions during a calendar year.

§ 155.625 - Options for conducting eligibility determinations for exemptions.

§ 155.630 - Reporting.

§ 155.635 - Right to appeal.

Subpart H - Exchange Functions: Small Business Health Options Program (SHOP)

§ 155.700 - Standards for the establishment of a SHOP.

§ 155.705 - Functions of a SHOP for plan years beginning prior to January 1, 2018.

§ 155.706 - xxx

§ 155.710 - Eligibility standards for SHOP.

§ 155.715 - Eligibility determination process for SHOP for plan years beginning prior to January 1, 2018.

§ 155.716 - xxx

§ 155.720 - Enrollment of employees into QHPs under SHOP for plan years beginning prior to January 1, 2018.

§ 155.721 - xxx

§ 155.725 - Enrollment periods under SHOP for plan years beginning prior to January 1, 2018.

§ 155.726 - xxx

§ 155.730 - Application standards for SHOP for plan year beginning prior to January 1, 2018.

§ 155.731 - xxx

§ 155.735 - Termination of SHOP enrollment or coverage for plan years beginning prior to January 1, 2018.

§ 155.740 - SHOP employer and employee eligibility appeals requirements for plan years beginning prior to January 1, 2018.

§ 155.741 - xxx

Subparts I--J - XXX

Subpart K - Exchange Functions: Certification of Qualified Health Plans

§ 155.1000 - Certification standards for QHPs.

§ 155.1010 - Certification process for QHPs.

§ 155.1020 - QHP issuer rate and benefit information.

§ 155.1030 - QHP certification standards related to advance payments of the premium tax credit and cost-sharing reductions.

§ 155.1040 - Transparency in coverage.

§ 155.1045 - Accreditation timeline.

§ 155.1050 - Establishment of Exchange network adequacy standards.

§ 155.1055 - Service area of a QHP.

§ 155.1065 - Stand-alone dental plans.

§ 155.1075 - Recertification of QHPs.

§ 155.1080 - Decertification of QHPs.

§ 155.1090 - Request for reconsideration.

Subpart L - XXX

Subpart M - Oversight and Program Integrity Standards for State Exchanges

§ 155.1200 - General program integrity and oversight requirements.

§ 155.1210 - Maintenance of records.

Subpart N - State Flexibility

§ 155.1300 - Basis and purpose.

§ 155.1302 - Coordinated waiver process.

§ 155.1304 - Definitions.

§ 155.1308 - Application procedures.

§ 155.1312 - State public notice requirements.

§ 155.1316 - Federal public notice and approval process.

§ 155.1318 - Modification from the normal public notice requirements during an emergent situation.

§ 155.1320 - Monitoring and compliance.

§ 155.1322 - Pass-through funding for approved waivers.

§ 155.1324 - State reporting requirements.

§ 155.1328 - Periodic evaluation requirements.

§ 155.1330 - Waiver amendment.

§ 155.1332 - Waiver extension.

Subpart O - Quality Reporting Standards for Exchanges

§ 155.1400 - Quality rating system.

§ 155.1405 - Enrollee satisfaction survey system.

Subpart P - Improper Payment Pre-Testing and Assessment (IPPTA) for State-based Exchanges

§ 155.1500 - Purpose and scope.

§ 155.1505 - Definitions.

§ 155.1510 - Data submission.

§ 155.1515 - Pre-testing and assessment procedures.