Annual Eligibility Redeterminations and Issuer/Exchange Standards (Final Rule)
Final rule governing annual eligibility redeterminations, renewal/reenrollment notice requirements, and Exchange and issuer standards under the Affordable Care Act; affects Exchanges, qualified health plan issuers, plan sponsors, and enrollees participating in Exchange coverage. (Part 1 of 5 document.)
Amendments to guaranteed renewability regulations to require issuers that nonrenew coverage because an enrollee is outside the product service area to provide written notice to affected parties in the form and manner specified by the Secretary.
Exchanges may, but are not required to, accept change reports submitted via mail; the Federally-facilitated Exchange (FFE) will not accept mail reports for the foreseeable future.
Finalized §155.335(a) to require annual redeterminations and provide three options for Exchanges to conduct redeterminations, including specified procedures, Secretary-specified alternative procedures, or Secretary-approved alternative procedures proposed by Exchanges.
Exchanges must require eligible individuals to report changes in eligibility standards within 30 days, but individuals reporting after 30 days will still receive an updated eligibility determination.
Sections across 45 CFR parts 146, 147, 148, 155, and 156 are amended to clarify guaranteed renewability, eligibility redetermination procedures, and notice requirements for renewals and re-enrollment.
A new §156.1255 requires issuers to include premium and premium tax credit information, reporting requirements, reconciliation explanation, and cost-sharing reduction notices in renewal/re-enrollment notices.
§155.335 clarifies annual eligibility redetermination processes, allowable procedures, reporting timelines, and re-enrollment rules including preservation of product/metal level where possible.
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