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FEDERAL · 45 CFR

Part 156 — Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to Exchanges

115 sections · Title 45: Public Welfare

§ 156.10Basis and scope.
§ 156.20Definitions.
§ 156.50Financial support.
§ 156.80Single risk pool.
§ 156.100State selection of benchmark plan for plan years beginning prior to January 1, 2020.
§ 156.105Determination of EHB for multi-state plans.
§ 156.110EHB-benchmark plan standards.
§ 156.111State selection of EHB-benchmark plan for plan years beginning on or after January 1, 2020.
§ 156.115Provision of EHB.
§ 156.120Collection of data to define essential health benefits.
§ 156.122Prescription drug benefits.
§ 156.125Prohibition on discrimination.
§ 156.130Cost-sharing requirements.
§ 156.135AV calculation for determining level of coverage.
§ 156.140Levels of coverage.
§ 156.145Determination of minimum value.
§ 156.150Application to stand-alone dental plans inside the Exchange.
§ 156.155Enrollment in catastrophic plans.
§ 156.200QHP issuer participation standards.
§ 156.201Standardized plan options.
§ 156.202Non-standardized plan option limits.
§ 156.210QHP rate and benefit information.
§ 156.215Advance payments of the premium tax credit and cost-sharing reduction standards.
§ 156.220Transparency in coverage.
§ 156.221Access to and exchange of health data and plan information.
§ 156.222Access to and exchange of health data for providers and payers.
§ 156.223Prior authorization requirements.
§ 156.225Marketing and benefit design of QHPs.
§ 156.230Network adequacy standards.
§ 156.235Essential community providers.
§ 156.245Treatment of direct primary care medical homes.
§ 156.250Meaningful access to qualified health plan information.
§ 156.255Rating variations.
§ 156.260Enrollment periods for qualified individuals.
§ 156.265Enrollment process for qualified individuals.
§ 156.270Termination of coverage or enrollment for qualified individuals.
§ 156.272Issuer participation for the full plan year.
§ 156.275Accreditation of QHP issuers.
§ 156.280Segregation of funds for abortion services.
§ 156.285Additional standards specific to SHOP for plan years beginning prior to January 1, 2018.
§ 156.286Additional standards specific to SHOP for plan years beginning on or after January 1, 2018.
§ 156.290Non-certification and decertification of QHPs.
§ 156.295Prescription drug distribution and cost reporting by QHP issuers.
§ 156.330Changes of ownership of issuers of Qualified Health Plans in Federally-facilitated Exchanges.
§ 156.340Standards for downstream and delegated entities.
§ 156.350Eligibility and enrollment standards for Qualified Health Plan issuers on State-based Exchanges on the Federal platform.
§ 156.400Definitions.
§ 156.410Cost-sharing reductions for enrollees.
§ 156.420Plan variations.
§ 156.425Changes in eligibility for cost-sharing reductions.
§ 156.430Payment for cost-sharing reductions.
§ 156.440Plans eligible for advance payments of the premium tax credit and cost-sharing reductions.
§ 156.460Reduction of enrollee's share of premium to account for advance payments of the premium tax credit.
§ 156.470Allocation of rates for advance payments of the premium tax credit.
§ 156.480Oversight of the administration of the advance payments of the premium tax credit, cost-sharing reductions, and user fee programs.
§ 156.500Basis and scope.
§ 156.505Definitions.
§ 156.510Eligibility.
§ 156.515CO-OP standards.
§ 156.520Loan terms.
§ 156.600The definition of minimum essential coverage.
§ 156.602Other coverage that qualifies as minimum essential coverage.
§ 156.604Requirements for recognition as minimum essential coverage for types of coverage not otherwise designated minimum essential coverage in the statute or this subpart.
§ 156.606HHS audit authority.
§ 156.705Maintenance of records for Federally-facilitated Exchanges.
§ 156.715Compliance reviews of QHP issuers in Federally-facilitated Exchanges.
§ 156.800Available remedies; Scope.
§ 156.805Bases and process for imposing civil money penalties in Federally-facilitated Exchanges.
§ 156.806Notice of non-compliance.
§ 156.810Bases and process for decertification of a QHP offered by an issuer through a Federally-facilitated Exchange.
§ 156.815Plan suppression.
§ 156.901Definitions.
§ 156.903Scope of Administrative Law Judge's (ALJ) authority.
§ 156.905Filing of request for hearing.
§ 156.907Form and content of request for hearing.
§ 156.909Amendment of notice of assessment or decertification request for hearing.
§ 156.911Dismissal of request for hearing.
§ 156.913Settlement.
§ 156.915Intervention.
§ 156.917Issues to be heard and decided by ALJ.
§ 156.919Forms of hearing.
§ 156.921Appearance of counsel.
§ 156.923Communications with the ALJ.
§ 156.925Motions.
§ 156.927Form and service of submissions.
§ 156.929Computation of time and extensions of time.
§ 156.931Acknowledgement of request for hearing.
§ 156.935Discovery.
§ 156.937Submission of briefs and proposed hearing exhibits.
§ 156.939Effect of submission of proposed hearing exhibits.
§ 156.941Prehearing conferences.
§ 156.943Standard of proof.
§ 156.945Evidence.
§ 156.947The record.
§ 156.951Posthearing briefs.
§ 156.953ALJ decision.
§ 156.955Sanctions.
§ 156.957Review by Administrator.
§ 156.959Judicial review.
§ 156.961Failure to pay assessment.
§ 156.963Final order not subject to review.
§ 156.1010Standards.
§ 156.1105Establishment of standards for HHS-approved enrollee satisfaction survey vendors for use by QHP issuers in Exchanges.
§ 156.1110Establishment of patient safety standards for QHP issuers.
§ 156.1120Quality rating system.
§ 156.1125Enrollee satisfaction survey system.
§ 156.1130Quality improvement strategy.
§ 156.1210Dispute submission.
§ 156.1215Payment and collections processes.
§ 156.1220Administrative appeals.
§ 156.1230Direct enrollment with the QHP issuer in a manner considered to be through the Exchange.
§ 156.1240Enrollment process for qualified individuals.
§ 156.1250Acceptance of certain third party payments.
§ 156.1255Renewal and re-enrollment notices.
§ 156.1256Other notices.