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- 45 CFR 153.610 · Risk adjustment issuer requirements.
- 45 CFR 153.620 · Compliance with HHS risk adjustment standards.
- 45 CFR 153.630 · Data validation requirements when HHS operates risk adjustment.
- 45 CFR 153.700 · Distributed data environment.
- 45 CFR 153.710 · Data requirements.
- 45 CFR 153.720 · Establishment and usage of masked enrollee identification numbers.
- 45 CFR 153.730 · Deadline for submission of data.
- 45 CFR 153.740 · Failure to comply with HHS-operated risk adjustment and reinsurance data requirements.
- 45 CFR 154.101 · Basis and scope.
- 45 CFR 154.102 · Definitions.
- 45 CFR 154.103 · Applicability.
- 45 CFR 154.200 · Rate increases subject to review.
- 45 CFR 154.205 · Unreasonable rate increases.
- 45 CFR 154.210 · Review of rate increases subject to review by CMS or by a State.
- 45 CFR 154.215 · Submission of rate filing justification.
- 45 CFR 154.220 · Timing of providing the rate filing justification.
- 45 CFR 154.225 · Determination by CMS or a State of an unreasonable rate increase.
- 45 CFR 154.230 · Submission and posting of Final Justifications for unreasonable rate increases.
- 45 CFR 154.301 · CMS's determinations of Effective Rate Review Programs.
- 45 CFR 155.10 · Basis and scope.
- 45 CFR 155.20 · Definitions.
- 45 CFR 155.30 · Severability.
- 45 CFR 155.100 · Establishment of a State Exchange.
- 45 CFR 155.105 · Approval of a State Exchange.
- 45 CFR 155.106 · Election to operate an Exchange after 2014.
- 45 CFR 155.110 · Entities eligible to carry out Exchange functions.
- 45 CFR 155.120 · Non-interference with Federal law and non-discrimination standards.
- 45 CFR 155.130 · Stakeholder consultation.
- 45 CFR 155.140 · Establishment of a regional Exchange or subsidiary Exchange.
- 45 CFR 155.150 · Transition process for existing State health insurance exchanges.
- 45 CFR 155.160 · Financial support for continued operations.
- 45 CFR 155.170 · Additional required benefits.
- 45 CFR 155.200 · Functions of an Exchange.
- 45 CFR 155.205 · Consumer assistance tools and programs of an Exchange.
- 45 CFR 155.206 · Civil money penalties for violations of applicable Exchange standards by consumer assistance entities in Federally-facilitated Exchanges.
- 45 CFR 155.210 · Navigator program standards.
- 45 CFR 155.215 · Standards 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.
- 45 CFR 155.220 · Ability of States to permit agents and brokers and web-brokers to assist qualified individuals, qualified employers, or qualified employees enrolling in QHPs.
- 45 CFR 155.221 · Standards for direct enrollment entities and for third-parties to perform audits of direct enrollment entities.
- 45 CFR 155.225 · Certified application counselors.
- 45 CFR 155.227 · Authorized representatives.
- 45 CFR 155.230 · General standards for Exchange notices.
- 45 CFR 155.240 · Payment of premiums.
- 45 CFR 155.260 · Privacy and security of personally identifiable information.
- 45 CFR 155.270 · Use of standards and protocols for electronic transactions.
- 45 CFR 155.280 · Oversight and monitoring of privacy and security requirements.
- 45 CFR 155.285 · Bases and process for imposing civil penalties for provision of false or fraudulent information to an Exchange or improper use or disclosure of information.
- 45 CFR 155.300 · Definitions and general standards for eligibility determinations.
- 45 CFR 155.302 · Options for conducting eligibility determinations.
- 45 CFR 155.305 · Eligibility standards.
- 45 CFR 155.310 · Eligibility process.
- 45 CFR 155.315 · Verification process related to eligibility for enrollment in a QHP through the Exchange.
- 45 CFR 155.320 · Verification process related to eligibility for insurance affordability programs.
- 45 CFR 155.330 · Eligibility redetermination during a benefit year.
- 45 CFR 155.335 · Annual eligibility redetermination.
- 45 CFR 155.340 · Administration of advance payments of the premium tax credit and cost-sharing reductions.
- 45 CFR 155.345 · Coordination with Medicaid, CHIP, the Basic Health Program, and the Pre-existing Condition Insurance Plan.
- 45 CFR 155.350 · Special eligibility standards and process for Indians.
- 45 CFR 155.355 · Right to appeal.
- 45 CFR 155.400 · Enrollment of qualified individuals into QHPs.
- 45 CFR 155.405 · Single streamlined application.
- 45 CFR 155.410 · Initial and annual open enrollment periods.
- 45 CFR 155.415 · Allowing issuer or direct enrollment entity application assisters to assist with eligibility applications.
- 45 CFR 155.420 · Special enrollment periods.
- 45 CFR 155.430 · Termination of Exchange enrollment or coverage.
- 45 CFR 155.500 · Definitions.
- 45 CFR 155.505 · General eligibility appeals requirements.
- 45 CFR 155.510 · Appeals coordination.
- 45 CFR 155.515 · Notice of appeal procedures.
- 45 CFR 155.520 · Appeal requests.
- 45 CFR 155.525 · Eligibility pending appeal.
- 45 CFR 155.530 · Dismissals.
- 45 CFR 155.535 · Informal resolution and hearing requirements.
- 45 CFR 155.540 · Expedited appeals.
- 45 CFR 155.545 · Appeal decisions.
- 45 CFR 155.550 · Appeal record.
- 45 CFR 155.555 · Employer appeals process.
- 45 CFR 155.600 · Definitions and general requirements.
- 45 CFR 155.605 · Eligibility standards for exemptions.
- 45 CFR 155.610 · Eligibility process for exemptions.
- 45 CFR 155.615 · Verification process related to eligibility for exemptions.
- 45 CFR 155.620 · Eligibility redeterminations for exemptions during a calendar year.
- 45 CFR 155.625 · Options for conducting eligibility determinations for exemptions.
- 45 CFR 155.630 · Reporting.
- 45 CFR 155.635 · Right to appeal.
- 45 CFR 155.700 · Standards for the establishment of a SHOP.
- 45 CFR 155.705 · Functions of a SHOP for plan years beginning prior to January 1, 2018.
- 45 CFR 155.706 · Functions of a SHOP for plan years beginning on or after January 1, 2018.
- 45 CFR 155.710 · Eligibility standards for SHOP.
- 45 CFR 155.715 · Eligibility determination process for SHOP for plan years beginning prior to January 1, 2018.
- 45 CFR 155.716 · Eligibility determination process for SHOP for plan years beginning on or after January 1, 2018.
- 45 CFR 155.720 · Enrollment of employees into QHPs under SHOP for plan years beginning prior to January 1, 2018.
- 45 CFR 155.721 · Record retention and IRS Reporting for plan years beginning on or after January 1, 2018.
- 45 CFR 155.725 · Enrollment periods under SHOP for plan years beginning prior to January 1, 2018.
- 45 CFR 155.726 · Enrollment periods under SHOP for plan years beginning on or after January 1, 2018.
- 45 CFR 155.730 · Application standards for SHOP for plan year beginning prior to January 1, 2018.
- 45 CFR 155.731 · Application standards for SHOP for plan years beginning on or after January 1, 2018.
- 45 CFR 155.735 · Termination of SHOP enrollment or coverage for plan years beginning prior to January 1, 2018.
- 45 CFR 155.740 · SHOP employer and employee eligibility appeals requirements for plan years beginning prior to January 1, 2018.
- 45 CFR 155.741 · SHOP employer and employee eligibility appeals requirements for plan year beginning on or after January 1, 2018.