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Code of Federal Regulations (Last Updated: July 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 155 - Exchange Establishment Standards and Other Related Standards Under the Affordable Care Act |
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Subpart K - Exchange Functions: Certification of Qualified Health Plans |
§ 155.1080 - Decertification of QHPs.
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§ 155.1080 Decertification of QHPs.
(a) Definition. The following definition applies to this section:
Decertification means the termination by the Exchange of the certification status and offering of a QHP.
(b) Decertification process. Except with respect to multi-State plans and CO-OP QHPs, the Exchange must establish a process for the decertification of QHPs, which, at a minimum, meets the requirements in this section.
(c) Decertification by the Exchange. The Exchange may at any time decertify a health plan if the Exchange determines that the QHP issuer is no longer in compliance with the general certification criteria as outlined in § 155.1000(c).
(d) Appeal of decertification. The Exchange must establish a process for the appeal of a decertification of a QHP.
(e) Notice of decertification. Upon decertification of a QHP, the Exchange must provide notice of decertification to all affected parties, including:
(1) The QHP issuer;
(2) Exchange enrollees in the QHP who must receive information about a special enrollment period, as described in § 155.420;
(3) HHS; and
(4) The State department of insurance.
[77 FR 18467, Mar. 27, 2012, as amended at 77 FR 31515, May 29, 2012]