On Friday, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule addressing various issues relating to exchanges, small business health options program (“SHOP”) and qualified health plan (“QHP”) issuers. Most of the 250+ pages detail proposed standards intended to ensure the oversight and financial integrity of such entities. This post focuses on the provisions addressing consumer protections, applications for individual coverage, and administration of premium tax credits and cost-sharing reductions.
Qualified Health Plan Issuers
Beginning October 1, individuals will be able to shop for QHPs offered by issuers through state-based marketplaces (“Exchange”). QHP issuers that seek to directly enroll individuals through an Exchange will be required to meet certain minimum consumer protection requirements, including ensuring that their websites provide standardized comparative information on each available QHP offered and premium and cost-sharing information, providing summaries of benefits and coverages, identifying whether a plan is a bronze, silver,