GroundRules
42 CFR 600.505: Premiums.
Where this section sits in the code
- Title 42—Public Health
- CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
- SUBCHAPTER I—BASIC HEALTH PROGRAM
- PART 600—ADMINISTRATION, ELIGIBILITY, ESSENTIAL HEALTH BENEFITS, PERFORMANCE STANDARDS, SERVICE DELIVERY REQUIREMENTS, PREMIUM AND COST SHARING, ALLOTMENTS, AND RECONCILATION
- Subpart F—Enrollee Financial Responsibilities
(a) Premium requirements. (1) For premiums imposed on enrollees, the State must assure that the monthly premium imposed on any enrollee does not exceed the monthly premium that the enrollee would have been required to pay had he or she enrolled in a plan with a premium equal to the premium of the applicable benchmark plan, as defined in 26 CFR 1.36B-3(f). The State must assure that when determining the amount of the enrollee's monthly premium, the State took into account reductions in the premium resulting from the premium tax credit that would have been paid on the enrollee's behalf.
(2) This assurance must be reflected in the BHP Blueprint, which shall also include:
(i) The group or groups of enrollees subject to premiums.
(ii) The collection method and procedure for the payment of an enrollee's premium.
(iii) The consequences for an enrollee or applicant who does not pay a premium.
(b) [Reserved]
Collected 2026-08-27T02:26:11Z. Source file · JSON