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FEDERAL · 45 CFR

Part 155 — Exchange Establishment Standards and Other Related Standards Under the Affordable Care Act

115 sections · Title 45: Public Welfare

§ 155.10Basis and scope.
§ 155.20Definitions.
§ 155.30Severability.
§ 155.100Establishment of a State Exchange.
§ 155.105Approval of a State Exchange.
§ 155.106Election to operate an Exchange after 2014.
§ 155.110Entities eligible to carry out Exchange functions.
§ 155.120Non-interference with Federal law and non-discrimination standards.
§ 155.130Stakeholder consultation.
§ 155.140Establishment of a regional Exchange or subsidiary Exchange.
§ 155.150Transition process for existing State health insurance exchanges.
§ 155.160Financial support for continued operations.
§ 155.170Additional required benefits.
§ 155.200Functions of an Exchange.
§ 155.205Consumer assistance tools and programs of an Exchange.
§ 155.206Civil money penalties for violations of applicable Exchange standards by consumer assistance entities in Federally-facilitated Exchanges.
§ 155.210Navigator program standards.
§ 155.215Standards 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.
§ 155.220Ability of States to permit agents and brokers and web-brokers to assist qualified individuals, qualified employers, or qualified employees enrolling in QHPs.
§ 155.221Standards for direct enrollment entities and for third-parties to perform audits of direct enrollment entities.
§ 155.222Standards for HHS-approved vendors of Federally-facilitated Exchange training for agents and brokers.
§ 155.225Certified application counselors.
§ 155.227Authorized representatives.
§ 155.230General standards for Exchange notices.
§ 155.240Payment of premiums.
§ 155.260Privacy and security of personally identifiable information.
§ 155.270Use of standards and protocols for electronic transactions.
§ 155.280Oversight and monitoring of privacy and security requirements.
§ 155.285Bases and process for imposing civil penalties for provision of false or fraudulent information to an Exchange or improper use or disclosure of information.
§ 155.300Definitions and general standards for eligibility determinations.
§ 155.302Options for conducting eligibility determinations.
§ 155.305Eligibility standards.
§ 155.310Eligibility process.
§ 155.315Verification process related to eligibility for enrollment in a QHP through the Exchange.
§ 155.320Verification process related to eligibility for insurance affordability programs.
§ 155.330Eligibility redetermination during a benefit year.
§ 155.335Annual eligibility redetermination.
§ 155.340Administration of advance payments of the premium tax credit and cost-sharing reductions.
§ 155.345Coordination with Medicaid, CHIP, the Basic Health Program, and the Pre-existing Condition Insurance Plan.
§ 155.350Special eligibility standards and process for Indians.
§ 155.355Right to appeal.
§ 155.400Enrollment of qualified individuals into QHPs.
§ 155.405Single streamlined application.
§ 155.410Initial and annual open enrollment periods.
§ 155.415Allowing issuer or direct enrollment entity application assisters to assist with eligibility applications.
§ 155.420Special enrollment periods.
§ 155.430Termination of Exchange enrollment or coverage.
§ 155.500Definitions.
§ 155.505General eligibility appeals requirements.
§ 155.510Appeals coordination.
§ 155.515Notice of appeal procedures.
§ 155.520Appeal requests.
§ 155.525Eligibility pending appeal.
§ 155.530Dismissals.
§ 155.535Informal resolution and hearing requirements.
§ 155.540Expedited appeals.
§ 155.545Appeal decisions.
§ 155.550Appeal record.
§ 155.555Employer appeals process.
§ 155.600Definitions and general requirements.
§ 155.605Eligibility standards for exemptions.
§ 155.610Eligibility process for exemptions.
§ 155.615Verification process related to eligibility for exemptions.
§ 155.620Eligibility redeterminations for exemptions during a calendar year.
§ 155.625Options for conducting eligibility determinations for exemptions.
§ 155.630Reporting.
§ 155.635Right to appeal.
§ 155.700Standards for the establishment of a SHOP.
§ 155.705Functions of a SHOP for plan years beginning prior to January 1, 2018.
§ 155.706Functions of a SHOP for plan years beginning on or after January 1, 2018.
§ 155.710Eligibility standards for SHOP.
§ 155.715Eligibility determination process for SHOP for plan years beginning prior to January 1, 2018.
§ 155.716Eligibility determination process for SHOP for plan years beginning on or after January 1, 2018.
§ 155.720Enrollment of employees into QHPs under SHOP for plan years beginning prior to January 1, 2018.
§ 155.721Record retention and IRS Reporting for plan years beginning on or after January 1, 2018.
§ 155.725Enrollment periods under SHOP for plan years beginning prior to January 1, 2018.
§ 155.726Enrollment periods under SHOP for plan years beginning on or after January 1, 2018.
§ 155.730Application standards for SHOP for plan year beginning prior to January 1, 2018.
§ 155.731Application standards for SHOP for plan years beginning on or after January 1, 2018.
§ 155.735Termination of SHOP enrollment or coverage for plan years beginning prior to January 1, 2018.
§ 155.740SHOP employer and employee eligibility appeals requirements for plan years beginning prior to January 1, 2018.
§ 155.741SHOP employer and employee eligibility appeals requirements for plan year beginning on or after January 1, 2018.
§ 155.1000Certification standards for QHPs.
§ 155.1010Certification process for QHPs.
§ 155.1020QHP issuer rate and benefit information.
§ 155.1030QHP certification standards related to advance payments of the premium tax credit and cost-sharing reductions.
§ 155.1040Transparency in coverage.
§ 155.1045Accreditation timeline.
§ 155.1050Establishment of Exchange network adequacy standards.
§ 155.1055Service area of a QHP.
§ 155.1065Stand-alone dental plans.
§ 155.1075Recertification of QHPs.
§ 155.1080Decertification of QHPs.
§ 155.1090Request for the reconsideration of a denial of certification.
§ 155.1200General program integrity and oversight requirements.
§ 155.1210Maintenance of records.
§ 155.1300Basis and purpose.
§ 155.1302Coordinated waiver process.
§ 155.1304Definitions.
§ 155.1308Application procedures.
§ 155.1312State public notice requirements.
§ 155.1316Federal public notice and approval process.
§ 155.1318Modification from the normal public notice requirements during an emergent situation.
§ 155.1320Monitoring and compliance.
§ 155.1322Pass-through funding for approved waivers.
§ 155.1324State reporting requirements.
§ 155.1328Periodic evaluation requirements.
§ 155.1330Waiver amendment.
§ 155.1332Waiver extension.
§ 155.1400Quality rating system.
§ 155.1405Enrollee satisfaction survey system.
§ 155.1500Purpose and scope.
§ 155.1505Definitions.
§ 155.1510Data submission.
§ 155.1515Pre-testing and assessment procedures.