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Code of Federal Regulations (Last Updated: April 5, 2024) |
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Title 45 - Public Welfare |
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Subtitle A - Department of Health and Human Services |
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SubChapter B - Requirements Relating to Health Care Access |
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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
| 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. |
| § 156.140 - 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. |
| § 155.286 - xxx |
| § 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. |
| § 156.298 - Meaningful difference standard for Qualified Health Plans in the Federally-facilitated Exchanges. |
| 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. |