e-CFR banner

Home
gpo.gov
govinfo.gov

e-CFR Navigation Aids

Browse

Simple Search

Advanced Search

 — Boolean

 — Proximity

 

Search History

Search Tips

Corrections

Latest Updates

User Info

FAQs

Agency List

Incorporation By Reference

eCFR logo

Related Resources

 

Electronic Code of Federal Regulations

e-CFR data is current as of June 1, 2020

Title 45Subtitle ASubchapter BPart 155


TITLE 45—Public Welfare

Subtitle A—DEPARTMENT OF HEALTH AND HUMAN SERVICES

SUBCHAPTER B—REQUIREMENTS RELATING TO HEALTH CARE ACCESS

PART 155—EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT

rule

Subpart A—GENERAL PROVISIONS.

§155.10
Basis and scope.
§155.20
Definitions.
rule

Subpart B—GENERAL STANDARDS RELATED TO THE ESTABLISHMENT OF AN EXCHANGE

§155.100
Establishment of a State Exchange.
§155.105
Approval of a State Exchange.
§155.106
Election to operate an Exchange after 2014.
§155.110
Entities eligible to carry out Exchange functions.
§155.120
Non-interference with Federal law and non-discrimination standards.
§155.130
Stakeholder consultation.
§155.140
Establishment of a regional Exchange or subsidiary Exchange.
§155.150
Transition process for existing State health insurance exchanges.
§155.160
Financial support for continued operations.
§155.170
Additional required benefits.
rule

Subpart C—GENERAL FUNCTIONS OF AN EXCHANGE

§155.200
Functions of an Exchange.
§155.205
Consumer assistance tools and programs of an Exchange.
§155.206
Civil money penalties for violations of applicable Exchange standards by consumer assistance entities in Federally-facilitated Exchanges.
§155.210
Navigator program standards.
§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.
§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.
§155.221
Standards for direct enrollment entities and for third-parties to perform audits of direct enrollment entities.
§155.222
Standards for HHS-approved vendors of Federally-facilitated Exchange training for agents and brokers.
§155.225
Certified application counselors.
§155.227
Authorized representatives.
§155.230
General standards for Exchange notices.
§155.240
Payment of premiums.
§155.260
Privacy and security of personally identifiable information.
§155.270
Use of standards and protocols for electronic transactions.
§155.280
Oversight and monitoring of privacy and security requirements.
§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.
rule

Subpart D—EXCHANGE FUNCTIONS IN THE INDIVIDUAL MARKET: ELIGIBILITY DETERMINATIONS FOR EXCHANGE PARTICIPATION AND INSURANCE AFFORDABILITY PROGRAMS

§155.300
Definitions and general standards for eligibility determinations.
§155.302
Options for conducting eligibility determinations.
§155.305
Eligibility standards.
§155.310
Eligibility process.
§155.315
Verification process related to eligibility for enrollment in a QHP through the Exchange.
§155.320
Verification process related to eligibility for insurance affordability programs.
§155.330
Eligibility redetermination during a benefit year.
§155.335
Annual eligibility redetermination.
§155.340
Administration of advance payments of the premium tax credit and cost-sharing reductions.
§155.345
Coordination with Medicaid, CHIP, the Basic Health Program, and the Pre-existing Condition Insurance Plan.
§155.350
Special eligibility standards and process for Indians.
§155.355
Right to appeal.
rule

Subpart E—EXCHANGE FUNCTIONS IN THE INDIVIDUAL MARKET: ENROLLMENT IN QUALIFIED HEALTH PLANS

§155.400
Enrollment of qualified individuals into QHPs.
§155.405
Single streamlined application.
§155.410
Initial and annual open enrollment periods.
§155.415
Allowing issuer or direct enrollment entity application assisters to assist with eligibility applications.
§155.420
Special enrollment periods.
§155.430
Termination of Exchange enrollment or coverage.
rule

Subpart F—APPEALS OF ELIGIBILITY DETERMINATIONS FOR EXCHANGE PARTICIPATION AND INSURANCE AFFORDABILITY PROGRAMS

§155.500
Definitions.
§155.505
General eligibility appeals requirements.
§155.510
Appeals coordination.
§155.515
Notice of appeal procedures.
§155.520
Appeal requests.
§155.525
Eligibility pending appeal.
§155.530
Dismissals.
§155.535
Informal resolution and hearing requirements.
§155.540
Expedited appeals.
§155.545
Appeal decisions.
§155.550
Appeal record.
§155.555
Employer appeals process.
rule

Subpart G—EXCHANGE FUNCTIONS IN THE INDIVIDUAL MARKET: ELIGIBILITY DETERMINATIONS FOR EXEMPTIONS

§155.600
Definitions and general requirements.
§155.605
Eligibility standards for exemptions.
§155.610
Eligibility process for exemptions.
§155.615
Verification process related to eligibility for exemptions.
§155.620
Eligibility redeterminations for exemptions during a calendar year.
§155.625
Options for conducting eligibility determinations for exemptions.
§155.630
Reporting.
§155.635
Right to appeal.
rule

Subpart H—EXCHANGE FUNCTIONS: SMALL BUSINESS HEALTH OPTIONS PROGRAM (SHOP)

§155.700
Standards for the establishment of a SHOP.
§155.705
Functions of a SHOP for plan years beginning prior to January 1, 2018.
§155.706
Functions of a SHOP for plan years beginning on or after January 1, 2018.
§155.710
Eligibility standards for SHOP.
§155.715
Eligibility determination process for SHOP for plan years beginning prior to January 1, 2018.
§155.716
Eligibility determination process for SHOP for plan years beginning on or after January 1, 2018.
§155.720
Enrollment of employees into QHPs under SHOP for plan years beginning prior to January 1, 2018.
§155.721
Record retention and IRS Reporting for plan years beginning on or after January 1, 2018.
§155.725
Enrollment periods under SHOP for plan years beginning prior to January 1, 2018.
§155.726
Enrollment periods under SHOP for plan years beginning on or after January 1, 2018.
§155.730
Application standards for SHOP for plan year beginning prior to January 1, 2018.
§155.731
Application standards for SHOP for plan years beginning on or after January 1, 2018.
§155.735
Termination of SHOP enrollment or coverage for plan years beginning prior to January 1, 2018.
§155.740
SHOP employer and employee eligibility appeals requirements for plan years beginning prior to January 1, 2018.
§155.741
SHOP employer and employee eligibility appeals requirements for plan year beginning on or after January 1, 2018.
rule

Subparts I-J [Reserved]

rule

Subpart K—EXCHANGE FUNCTIONS: CERTIFICATION OF QUALIFIED HEALTH PLANS

§155.1000
Certification standards for QHPs.
§155.1010
Certification process for QHPs.
§155.1020
QHP issuer rate and benefit information.
§155.1030
QHP certification standards related to advance payments of the premium tax credit and cost-sharing reductions.
§155.1040
Transparency in coverage.
§155.1045
Accreditation timeline.
§155.1050
Establishment of Exchange network adequacy standards.
§155.1055
Service area of a QHP.
§155.1065
Stand-alone dental plans.
§155.1075
Recertification of QHPs.
§155.1080
Decertification of QHPs.
§155.1090
Request for reconsideration.
rule

Subpart L—[RESERVED]

rule

Subpart M—OVERSIGHT AND PROGRAM INTEGRITY STANDARDS FOR STATE EXCHANGES

§155.1200
General program integrity and oversight requirements.
§155.1210
Maintenance of records.
rule

Subpart N—STATE FLEXIBILITY

§155.1300
Basis and purpose.
§155.1302
Coordinated waiver process.
§155.1304
Definitions.
§155.1308
Application procedures.
§155.1312
State public notice requirements.
§155.1316
Federal public notice and approval process.
§155.1320
Monitoring and compliance.
§155.1324
State reporting requirements.
§155.1328
Periodic evaluation requirements.
rule

Subpart O—QUALITY REPORTING STANDARDS FOR EXCHANGES

§155.1400
Quality rating system.
§155.1405
Enrollee satisfaction survey system.

Need assistance?