Current through September 30, 2024
Section 156.290 - Non-certification and decertification of QHPs(a)Non-certification for a subsequent, consecutive certification cycle. If a QHP issuer elects not to seek certification for a subsequent, consecutive certification cycle with the Exchange, the QHP issuer, at a minimum, must-(1) Notify the Exchange of its decision prior to the beginning of the recertification process and adhere to the procedures adopted by the Exchange in accordance with § 155.1075 of this subchapter;(2) Fulfill its obligation to cover benefits for each enrollee through the end of the plan or benefit year through the Exchange;(3) Fulfill data reporting obligations from the last plan or benefit year of the certification;(4) Provide notice to enrollees as described in paragraph (b) of this section; and(5) Terminate the coverage or enrollment through the Exchange of enrollees in the QHP in accordance with § 156.270 , as applicable.(b)Notice of QHP non-availability. When, for a subsequent, consecutive certification cycle, a QHP issuer elects not to seek certification with the Exchange, or the Exchange denies certification of a QHP, the QHP issuer must provide written notice to each enrollee in the form and manner specified by the Secretary under § 147.106 of this subchapter.(c)Decertification. If a QHP is decertified by the Exchange, the QHP issuer must terminate the enrollment of enrollees through the Exchange only after: (1) The Exchange has made notification as described in § 155.1080 of this subchapter; and(2) Enrollees have an opportunity to enroll in other coverage.77 FR 18469, Mar. 27, 2012, as amended at 80 FR 10875, Feb. 27, 2015; 81 FR 94181, Dec. 22, 2016