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.
§ 156.105 Determination of EHB for multi-state plans.
§ 156.110 EHB-benchmark plan standards.
§ 156.111 xxx
§ 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.
§ 156.210 QHP rate and benefit information.
§ 156.215 Advance payments of the premium tax credit and cost-sharing reduction standards.
§ 156.220 Transparency in coverage.
§ 156.225 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.
§ 155.286 xxx
§ 156.290 Non-certification and decertification of QHPs.
§ 156.295 Prescription drug distribution and cost reporting.
§ 156.298 Meaningful difference standard for Qualified Health Plans in the Federally-facilitated Exchanges.
Subpart D—Standards for Qualified Health Plan Issuers on Federally-Facilitated Exchanges and State-Based Exchanges on the Federal Platform
§ 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 cost-sharing reductions and advance payments of the premium tax credit 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 Federally-Facilitated 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 in Federally-Facilitated Exchanges
§ 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 Acknowledgment 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 Confirmation of HHS payment and collections reports.
§ 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.
Subparts A–E [Reserved]
Subparts D-E [Reserved]
Subpart K-Cases Forwarded to Qualified Health Plans and Qualified Health Plan Issuers in Federally-facilitated Exchanges

Authority

Secs. 1301–1304, 1311–1312, 1321, 1322, 1324, 1334, 1342–1343, and 1401–1402, Pub. L. 111–148, 124 Stat. 119 (42 U.S.C. 18042).

Source

76 FR 77411, Dec. 13, 2011, unless otherwise noted.