Qhpcertification.cms.gov

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Welcome to the Qualified Health Plan Website

Welcome to the Qualified Health Plan Website. This is the official Centers for Medicare & Medicaid Services’ website for issuers seeking certification to participate in the Federally-facilitated Exchanges (FFEs). As defined in the Affordable Care Act (ACA), a qualified health plan (QHP) is an insurance plan that is certified by the Health

Actived: 2 days ago

URL: https://www.qhpcertification.cms.gov/s/QHP

Plans and Benefits

WebTo reflect these requirements, the Plans & Benefits Add-in file populates state- and market-specific EHB benchmark data in the benefits package worksheet. Key Changes for …

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Published Guidance and Regulations

WebAn annual Notice of Benefit and Payment Parameters (Payment Notice) sets payment parameters and new standards to improve consumers’ Exchange experience. …

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Application Instructions

WebPY2025 Qualified Health Plan Issuer Application Instructions. Microsoft Excel Trusted Locations. Each year, CMS makes various Excel-based QHP Application materials …

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Application Materials

WebApplication Materials. The sections listed below and contained within this portion of the QHP certification website comprise a QHP Application and guide you through the application …

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Qualified Health Plan Issuer Application Instructions, Plan Year …

WebAs defined in the Patient Protection and Affordable Care Act (PPACA), a qualified health plan (QHP) is an insurance plan that is certified by the Health Insurance …

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About the Marketplace

WebKey differences in requirements for issuers participating in the Individual Market and the Small Business Health Options Program (SHOP) Market. New to the Exchange. Tips to …

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Marketplace Quality Initiatives FAQs

WebAs clarified in 45 CFR 156.1110(a)(2)(ii), a QHP issuer-contracted hospital could instead implement an evidence-based initiative to improve health care quality through the …

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Plans and Benefits FAQs

WebThe Plans & Benefits Template includes macros that allow users to import IDs from other templates including the Service Area, Network ID, and Prescription Drug Templates. …

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Qualified Health Plan Issuer Application Instructions PY2022

WebIntroduction: Qualified Health Plans for 2022 As defined in the Patient Protection and Affordable Care Act (PPACA) , a qualified health plan (QHP) is an insurance plan that is …

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Transparency in Coverage

WebTransparency in Coverage Under section 1311(e)(3) of the Patient Protection and Affordable Care Act, as implemented by regulations at 45 CFR 155.1040(a) and 156.220, health …

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Quality Improvement

WebThe QIS Technical Guidance and User Guide for the 2025 Plan Year communicates finalized QIS requirements and instructions for how to complete the QIS form. Issuers …

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Plan Year 2023 QHP Certification State Toolkit

WebAPPENDIX C: PLAN YEAR 2023 STATE RESPONSIBILITY FOR QHP REVIEWS, BY EXCHANGE MODEL. The following table outlines the reviews that states …

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Qualified Health Plan Issuer Application Instructions

WebAll plans in a benefits package must have the same MOOP structure and exclude the same benefits from the MOOP. To create plans with a different MOOP structure, issuers must …

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New to the Exchange

WebThe following key webpages contain important information that could be helpful for those new to the Exchange. Published Guidance and Regulations: Contains important …

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Health Insurance Exchange Quality Improvement Strategy: …

WebThe QIS Technical Guidance and User Guide for the 2019 Plan Year provides: (1) Technical Guidance, including comprehensive background information about the QIS requirements, …

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Qualified Health Plan Issuer Application Instructions

WebThe Essential Health Benefit (EHB) percent of total premium calculation should be the multiplicative inverse of the Unified Rate Review Template (URRT) Benefits in Addition …

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Interoperability

WebThe CMS Interoperability and Prior Authorization final rule (CMS-0057-F), released on January 17, 2024, rescinded those earlier payer-to-payer data exchange provisions, and …

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QUALIFIED HEALTH PLAN CERTIFICATION AGREEMENT AND …

WebQualified Health Plan (QHP) has the meaning set forth in 45 CFR 155.20. u. Qualified Health Plan (QHP) Application means the materials an issuer submits to CMS in order to …

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Qualified Health Plan Issuer Application Instructions

WebSection 2J: Network Adequacy. 1. Introduction. In the Network Adequacy (NA) section of the Marketplace Plan Management System (MPMS), qualified health plan (QHP) issuers …

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Internal Questions and Answers for Clearance Template

WebPURPOSE OF CMS LIST OF ECPs: CMS will use this final ECP list as the basis for determining the number of available ECPs in the Qualified Health Plan’s (QHP) service …

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Plan Year 2024 Guidance for Plan Marketing Names

Web45 CFR § 156.225(c), as finalized in the 2024 Notice of Benefit and Payment Parameters, requires that qualified health plan (QHP) and plan variation (“variant”) marketing names …

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