['Employee Benefits']
['Patient Protection and Affordable Care Act']
10/01/2024
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(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 18473, March 27, 2012; 80 FR 10875, Feb. 27, 2015; 81 FR 94181, Dec. 22, 2016]
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