2635 lines
189 KiB
Text
2635 lines
189 KiB
Text
<!DOCTYPE html>
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<html lang="en" dir="ltr">
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<meta charset="utf-8" />
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<script src="https://tealium-tags.cms.gov/cms-www/prod/utag.sync.js" type="text/javascript"></script>
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<meta name="description" content="Set out below are additional Frequently Asked Questions (FAQs) regarding implementation of the summary of benefits and coverage (SBC) provisions of the Affordable Care Act. These FAQs have been prepared jointly by the Departments of Labor, Health and Human Services (HHS), and the Treasury (the Departments)." />
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<title>Affordable Care Act Implementation FAQs - Set 8 | CMS</title>
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<div class="dialog-off-canvas-main-canvas" data-off-canvas-main-canvas>
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<header id="header" class="header" role="banner" aria-label="Site header">
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<svg aria-hidden="true" class="ds-c-icon ds-c-icon--usa-flag ds-c-usa-banner__header-icon" viewbox="0 0 16 11" xmlns="http://www.w3.org/2000/svg">
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<path fill="#1E33B1" d="M0 0h8v7H0z"></path>
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</g>
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<p class="ds-c-usa-banner__header-text">An official website of the United States government</p>
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<p class="ds-c-usa-banner__action ds-u-align-items--center ds-u-md-display--none ds-u-display--flex">Here's how you know<svg aria-hidden="true" class="ds-c-icon ds-c-icon--arrow ds-c-icon--arrow-down ds-c-usa-banner__action-icon" viewbox="0 0 320 512" xmlns="http://www.w3.org/2000/svg" direction="down">
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<path fill="currentColor" d="M285.476 272.971L91.132 467.314c-9.373 9.373-24.569 9.373-33.941 0l-22.667-22.667c-9.357-9.357-9.375-24.522-.04-33.901L188.505 256 34.484 101.255c-9.335-9.379-9.317-24.544.04-33.901l22.667-22.667c9.373-9.373 24.569-9.373 33.941 0L285.475 239.03c9.373 9.372 9.373 24.568.001 33.941z"></path>
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</header>
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<div class="ds-c-usa-banner__guidance ds-u-leading--base ds-u-font-size--base">
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<p class="ds-c-usa-banner__guidance-text">
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<strong>Official websites use .gov</strong><br>A
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<strong>
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.gov
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</strong>website belongs to an official government organization in the United States.</p>
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</div>
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<div class="ds-c-usa-banner__guidance-item">
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<svg aria-hidden="true" class="ds-c-icon ds-c-icon--lock-circle ds-c-usa-banner__guidance-icon" viewbox="0 0 54 54" xmlns="http://www.w3.org/2000/svg">
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<path fill="currentColor" d="M34.72,34.84a1.29,1.29,0,0,1-1.29,1.29H20.57a1.29,1.29,0,0,1-1.29-1.29V27.12a1.29,1.29,0,0,1,1.29-1.29H21V23.26a6,6,0,0,1,12,0v2.57h0.43a1.29,1.29,0,0,1,1.29,1.29v7.72Zm-4.29-9V23.26a3.43,3.43,0,0,0-6.86,0v2.57h6.86Z"></path>
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</svg>
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<p class="ds-c-usa-banner__guidance-text">
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<strong>Secure .gov websites use HTTPS</strong><br>A
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<strong>lock
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</strong>(<svg aria-hidden="true" class="ds-c-icon ds-c-icon--lock ds-c-usa-banner__inline-lock-icon" viewbox="0 0 52 64" xmlns="http://www.w3.org/2000/svg">
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</svg>)<span>
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or</span>
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<strong>
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https://
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</strong>means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.</p>
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</div>
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</div>
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</div>
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</div>
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</div>
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</div>
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</section>
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<div class="ds-l-container cms-tracker--header-top">
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<div class="ds-l-row">
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<div class="header-top-wrapper ds-l-md-col--12">
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<button id="js-navbar-toggle" class="navbar-toggle navbar-toggle-primary-menu ds-u-lg-display--none" aria-expanded="false" aria-label="Open Main" aria-haspopup="true">
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<i class="fal fa-bars" focusable="false"></i>
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</button>
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<div class="region region-cms-header-primary">
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<div id="block-cms-evo-sitebranding" data-block-plugin-id="system_branding_block" class="block block-system block-system-branding-block">
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<div class="site-logo">
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<a href="/" rel="home">
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<img src="/themes/custom/cms_evo/logo.svg" alt="CMS.gov" />
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</a>
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</div>
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<div class="ds-u-lg-display--block ds-u-display--none site-slogan">
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Centers for Medicare & Medicaid Services
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<div class="newsroom-branding">
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<h2 class="ds-u-lg-font-size--xl ds-u-color--white ds-u-margin--0 ds-u-font-weight--semibold">
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<a href="/about-cms/contact/newsroom" rel="home" class="ds-u-color--white ds-u-text-decoration--none">CMS Newsroom</a>
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</div>
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</div>
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<div class="region region-cms-header-secondary ds-u-display--none ds-u-lg-display--flex">
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<nav aria-label=Secondary id="block-cmsglobalsecondarymenu2" data-block-plugin-id="system_menu_block:cms-global-secondary-menu-2" class="ds-u-display--none ds-u-lg-display--block header-menu--secondary" >
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<span class="visually-hidden" id="block-cmsglobalsecondarymenu2-menu">Header</span>
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<ul region="cms_header_secondary" class="menu cms-evo-unstyled-list ds-u-display--flex">
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<li class="menu-item">
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<a href="/about-cms/contact/newsroom" class="menu-item-link" data-drupal-link-system-path="node/43871">Newsroom</a>
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<li class="menu-item">
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<a href="/data-research" class="menu-item-link" data-drupal-link-system-path="node/132891">Data & Research</a>
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</nav>
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<div class="search-block-form block block-search block-search-form-block header-search-block" data-drupal-selector="search-block-form" id="block-cms-evo-searchform" data-block-plugin-id="search_form_block" role="search" aria-label="header site search">
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<div class="content">
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<h2 class="ds-u-margin-top--0 ds-u-lg-display--none ds-u-border-bottom--0 ds-u-margin-bottom--2 ds-u-padding-bottom--0">Search CMS.gov</h2>
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<label class="ds-u-visibility--screen-reader" for="header-search-input">Search</label>
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<div class="cms-popular-search-terms ds-u-display--block ds-u-lg-display--none" id="hidden-header-list-wrapper">
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<span id="list-header" class="cms-list-header">Popular terms</span>
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<ul aria-labelledby="list-header">
|
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<li><span class="term">Physician Fee Schedule</span><i class="far fa-long-arrow-right" focusable="false"></i></li> <li><span class="term">Local Coverage Determination</span><i class="far fa-long-arrow-right" focusable="false"></i></li> <li><span class="term">Medically Unlikely Edits</span><i class="far fa-long-arrow-right" focusable="false"></i></li> <li><span class="term">Telehealth</span><i class="far fa-long-arrow-right" focusable="false"></i></li> <li><span class="term">Covid-19</span><i class="far fa-long-arrow-right" focusable="false"></i></li> </ul>
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</div>
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<div data-drupal-selector="edit-actions" class="form-actions js-form-wrapper form-wrapper" id="edit-actions--IF4ZucrjGyU"><div class="header-search-bar">
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<input data-drupal-selector="edit-submit" data-twig-suggestion="cms_header_secondary--search-submit" type="submit" id="edit-submit--j5_08rb2dws" value="Search" class="button js-form-submit form-submit ds-c-button ds-c-button--solid" />
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<i class="fas fa-search" focusable="false"></i>
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</div></div>
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</form>
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</div>
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</div>
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</div>
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<button id="js-searchbar-toggle" class="searchbar-toggle ds-u-lg-display--none" aria-expanded="false" aria-label="Open Site Search" aria-haspopup="true">
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<i class="fal fa-search" focusable="false"></i>
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</button>
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</div>
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</div>
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</div>
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<div class="header-main-menu-wrapper cms-tracker--header-main-menu">
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<div class="ds-l-container">
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<div class="ds-l-row">
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<div class="ds-l-col--12">
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<div class="region region-cms-header-navigation ds-u-display--none ds-u-lg-display--block">
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<nav aria-label="CMS.gov main menu" id="block-cmsglobalprimarymenu2" data-block-plugin-id="system_menu_block:cms-global-primary-menu-2" class="cms-tracker--menu-block">
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<h2 class="mobile-heading">CMS.gov main menu</h2>
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<ul region="cms_header_navigation" class="menu menu-level--one cms-evo-unstyled-list">
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<li class="menu-item menu-item--l1 menu-item--expanded">
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<span class="menu-item-element" aria-current="false">Medicare</span>
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<div class="subnav-wrapper--1 ds-u-display--none">
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<div class="subnav-header">
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<span class="back-to-main ds-u-lg-display--none">Back to main menu</span>
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<h2 class="subnav-title-h2" style="position:relative;text-align:left;width:auto;height:auto;">section title h2</h2>
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</div>
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<ul class="menu">
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<li class="menu-item menu-item--l2 menu-item--expanded">
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<span class="menu-item-element" aria-current="false">Enrollment & renewal</span>
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<div class="subnav-wrapper--2 ds-u-display--none">
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<div class="subnav-header">
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
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</div>
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<div class="menu-wrapper">
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<ul class="menu">
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<li class="menu-item menu-item--l3 menu-item--collapsed">
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<a href="/medicare/enrollment-renewal/original-part-a-b" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171311">Original Medicare (Part A and B) Eligibility and Enrollment</a>
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</li>
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<li class="menu-item menu-item--l3">
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<a href="/medicare-participation" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1569911">Annual Medicare Participation Announcement</a>
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<li class="menu-item menu-item--l3 menu-item--collapsed">
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<a href="/medicare/enrollment-renewal/providers-suppliers" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1316821">Providers & suppliers</a>
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</li>
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<li class="menu-item menu-item--l3">
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<a href="/medicare/enrollment-renewal/managed-care-eligibility-enrollment" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171286">Medicare Managed Care Eligibility and Enrollment</a>
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</li>
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<li class="menu-item menu-item--l3 menu-item--collapsed">
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<a href="/medicare/enrollment-renewal/part-d-enrollment-eligibility" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171306">Part D Eligibility and Enrollment</a>
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</li>
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<li class="menu-item menu-item--l3 menu-item--collapsed">
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<a href="/medicare/enrollment-renewal/health-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170951">Health plans</a>
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|
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
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<a href="/medicare/coverage/determination-process" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/169996">Coverage Determination Process</a>
|
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<a href="https://www.cms.gov/medicare-coverage-database/search.aspx" class="menu-item-element" aria-current="false">Medicare Coverage Database</a>
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|
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<a href="/medicare/coding-billing/place-of-service-codes" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171996">Place of service codes</a>
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<a href="/medicare/coding-billing/icd-10-codes" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171421">ICD-10 codes</a>
|
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|
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<a href="/medicare/coding-billing/healthcare-common-procedure-system" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171561">Healthcare Common Procedure Coding System (HCPCS)</a>
|
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|
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|
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<a href="/medicare/coding-billing/outpatient-code-editor" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171341">Integrated Outpatient Code Editor</a>
|
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|
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<a href="/roster-billing" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1612841">Roster billing</a>
|
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<a href="/medicare/coding-billing/therapy-services" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170641">Therapy services</a>
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<a href="/medicare/coding-billing/guide-medical-technology-companies-other-interested-parties" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1899941">Guide for Medical Technology Companies and Other Interested Parties</a>
|
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<ul class="menu">
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<li class="menu-item menu-item--l3 menu-item--collapsed">
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<a href="/medicare/payment/fee-for-service-providers/part-b-drugs/average-drug-sales-price" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170451">Medicare Part B Drug Average Sales Price</a>
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<a href="/medicare/payment/fee-for-service-providers" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193361">All Fee-For-Service-Providers</a>
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<a href="/medicare/payment/opioid-treatment-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1289826">Opioid Treatment Programs (OTP)</a>
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<a href="/medicare/payment/bankruptcy" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/185906">Bankruptcy</a>
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|
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<a href="/medicare/payment/sustainable-growth-rates-conversion-factors" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/169931">Sustainable Growth Rates & Conversion Factors</a>
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<li class="menu-item menu-item--l2 menu-item--expanded">
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<span class="menu-item-element" aria-current="false">Medicare-Medicaid coordination</span>
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|
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|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/medicaid-coordination/plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/178296">Resources for Medicare-Medicaid plans</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/medicaid-coordination/states" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1355341">Resources for state Medicaid agencies</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/medicaid-coordination/healthcare-fraud-prevention-partnership" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1313131">Healthcare Fraud Prevention Partnership</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/about-cms/information-systems/clinical-templates" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/189991">Clinical Templates</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Appeals & grievances</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/appeals-grievances/fee-for-service" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171221">Original Medicare appeals</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/appeals-grievances/managed-care" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/169961">Managed Care appeals & grievances</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/appeals-grievances/prescription-drug" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171101">Medicare Prescription drug appeals & grievances</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/appeals-grievances/ombudsman-center" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193386">Ombudsman Center</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/appeals-grievances/appeals-decision-search-part-c-d" class="menu-item-element" aria-current="false" data-drupal-link-system-path="qic-decision-search">Appeals Decision Search (Part C & Part D)</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Quality</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/value-based-programs" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/188566">Value-based programs</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/quality/initiatives/hospital-quality-initiative/person-family-engagement" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/182996">Person & Family Engagement</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/quality-improvement-organizations" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/169871">Quality improvement organizations</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/nursing-home-improvement" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171236">Nursing home quality improvement</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/inpatient-rehabilitation-facility" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175616">Inpatient Rehabilitation Facility (IRF) Quality Reporting Program (QRP)</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/home-health" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170541">Home Health Quality Reporting Program</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/end-stage-renal-disease-esrd-quality-incentive-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176126">ESRD Quality Incentive Program</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/meaningful-measures-initiative/cms-quality-strategy" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/178276">CMS National Quality Strategy</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/hospice" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175556">Hospice Quality Reporting Program</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/long-term-care-hospital" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175511">Long-Term Care Hospital (LTCH) Quality Reporting Program (QRP)</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/appropriate-use-criteria-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/180421">Appropriate Use Criteria Program</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/measures" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172001">Quality measures</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/advantage-quality-improvement-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/177561">Medicare Advantage quality improvement program</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/physician-compare-initiative" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175221">Physician compare initiative</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/initiatives" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/169636">Quality initiatives</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/health-drug-plans/part-c-d-performance-data" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171491">Part C and D Performance Data</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/snf-quality-reporting-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/180061"> Skilled Nursing Facility (SNF) Quality Reporting Program (QRP)</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Health & safety standards</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/quality/clinical-laboratory-improvement-amendments" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172651">Clinical Laboratory Improvement Amendments (CLIA)</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/health-safety-standards/quality-safety-oversight-group-qsog" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2085911">Quality, Safety & Oversight Group (QSOG)</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/health-safety-standards/quality-safety-oversight-general-information" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/169631">Quality, safety & oversight general information</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/health-safety-standards/accreditation-programs" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171481">Accreditation programs</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/health-safety-standards/quality-safety-oversight-emergency-preparedness" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172346">Emergency preparedness</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/health-safety-standards/certification-compliance" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171241">Certification & compliance</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/health-safety-standards/enforcement" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/169811">Enforcement</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/health-safety-standards/guidance-for-laws-regulations" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170071">Regulations, Certification, & Compliance</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/health-safety-standards/conditions-coverage-participation" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172616">Conditions for coverage & participation</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Employers & plan sponsors</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/employers-plan-sponsors/creditable-coverage" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171701">Creditable coverage</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2">
|
||
<span class="menu-item-element" aria-current="false">IC-Placeholder-1</span>
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Audits & Compliance</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/audits-compliance/part-a-cost-report" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/185256">Part A cost report audit</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/audits-compliance/part-c-d" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175921">Part C/Part D compliance & audits</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Forms & notices</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/forms-notices/cms-forms" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170166">CMS forms</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/forms-notices/cms-forms-list" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/174306">CMS forms list</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/forms-notices/beneficiary-notices-initiative" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170686">Beneficiary Notices Initiative (BNI)</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Health & drug plans</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/health-drug-plans/plan-payment" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171981">Plan payment</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/health-drug-plans/plan-payment-data" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175081">Plan payment data</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/health-drug-plans/medical-loss-ratio" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/180161">Medical loss ratio</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/health-drug-plans/coverage-gap-discount-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/175906">Coverage Gap Discount Program</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/health-drug-plans/managed-care-marketing" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170611">Managed care marketing</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/health-drug-plans/medicare-advantage-application" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170651">Medicare Advantage application</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/health-drug-plans/medigap" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170466">Medigap (Medicare supplement health insurance)</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/health-drug-plans/medical-savings-account" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172066">Medical Savings Account (MSA)</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/health-drug-plans/private-fee-for-service-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170301">Private Fee-for-Service Plans</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/enrollment-renewal/health-plans/prepayment" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170521">Health Care Prepayment Plans (HCPPs)</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/enrollment-renewal/health-plans/cost" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170656">Cost plans</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/enrollment-renewal/special-needs-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171676">Special needs plans</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/health-drug-plans/network-adequacy" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171301">Network adequacy</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Coordination of benefits & recovery</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/coordination-benefits-recovery/overview" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/177001">Overview</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/coordination-benefits-recovery/mandatory-insurer-reporting-group-health-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176856">Mandatory Insurer Reporting for Group Health Plans (GHP)</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/coordination-benefits-recovery/mandatory-insurer-reporting" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176951">Mandatory insurer reporting (NGHP)</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/coordination-benefits-recovery/workers-comp-set-aside-arrangements" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176641">Workers' comp Medicare set aside arrangements</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/coordination-benefits-recovery/attorney-services" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/177026">Attorney services</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/coordination-benefits-recovery/beneficiary-services" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/177036">Beneficiary services</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/coordination-benefits-recovery/coba-trading-partners" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176761">COBA Trading Partners</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/coordination-benefits-recovery/employer-services" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170361">Employer services</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/coordination-benefits-recovery/insurer-services" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170846">Insurer services</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/coordination-benefits-recovery/prescription-drug-assistance-programs" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/176791">Prescription drug assistance programs</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicare/coordination-benefits-recovery/provider-services" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/170406">Provider services</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Settlements</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/settlements/jimmo" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193381">Jimmo Settlement</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicare/settlements/ryan" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193486">Ryan Settlement</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l1 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Medicaid/CHIP</span>
|
||
<div class="subnav-wrapper--1 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-main ds-u-lg-display--none">Back to main menu</span>
|
||
<h2 class="subnav-title-h2" style="position:relative;text-align:left;width:auto;height:auto;">section title h2</h2>
|
||
</div>
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">What is Medicaid?</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://www.medicaid.gov" class="menu-item-element" aria-current="false">Visit Medicaid.gov</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://www.medicaid.gov/about-us/beneficiary-resources/index.html#statemenu" class="menu-item-element" aria-current="false">View Medicaid maps</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="http://www.medicaid.gov/chip/index.html" class="menu-item-element" aria-current="false">Visit CHIP.gov</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Medicare-Medicaid Coordination</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicaid-chip/medicare-coordination/integrated-care-resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/174926">Integrated care resources</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/medicaid-chip/medicare-coordination/avoidable-hospitalizations" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/181236">Initiative to reduce avoidable hospitalizations</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicaid-chip/medicare-coordination/financial-alignment" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/178246">Financial alignment initiative</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/medicaid-chip/medicare-coordination/integrity-institute" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1315141">Medicaid Integrity Institute</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2">
|
||
<span class="menu-item-element" aria-current="false">RG-Placeholder-1</span>
|
||
</li>
|
||
<li class="menu-item menu-item--l2">
|
||
<span class="menu-item-element" aria-current="false">IC-Placeholder-2</span>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l1 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Marketplace & Private Insurance</span>
|
||
<div class="subnav-wrapper--1 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-main ds-u-lg-display--none">Back to main menu</span>
|
||
<h2 class="subnav-title-h2" style="position:relative;text-align:left;width:auto;height:auto;">section title h2</h2>
|
||
</div>
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">About the Marketplace</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/marketplace/about/oversight" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191061">Marketplace oversight</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/marketplace/about/affordable-care-act" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191416">Affordable Care Act</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/marketplace/about/overview-exchanges" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190921">Overview of the exchanges</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/about/exchange-coverage-maps" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193086">Exchange coverage maps</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/about/medicare" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/179351">Medicare and the Marketplace</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Private Health Insurance</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/patient-bill-of-rights" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192591">Patient’s Bill of Rights</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/medical-loss-ratio" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190956">Medical loss ratio</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/annual-limits" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191976">Annual limits</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/review-insurance-rates" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192716">Review of insurance rates</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/market-rating-reforms" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191816">Market rating</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/self-funded-non-federal-governmental-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191111">Self-funded, non-federal governmental plans</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/grandfathered-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191456">Grandfathered plans</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/health-reimbursement-arrangements" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193216">Health Reimbursement Arrangements</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/coverage-young-adults" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190931">Coverage for young adults</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/student-health-plans" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190946">Student health plans</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/mental-health-parity-addiction-equity" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192601">Mental health parity and addiction equity</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/prevention" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191071">Prevention</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/consumer-protections-enforcement" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192701">Consumer protections & enforcement</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/private-health-insurance/pre-existing-condition-plan" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191056">Pre-existing condition insurance plan</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://www.healthcare.gov/glossary/qualifying-health-coverage" class="menu-item-element" aria-current="false">Qualifying Health Coverage (QHC)</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2">
|
||
<span class="menu-item-element" aria-current="false">RG-Placeholder-2</span>
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">In-person assisters</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/in-person-assisters/information-partners" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2078851">Information for Partners</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/marketplace/in-person-assisters/outreach-education" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2073436">Assister outreach & education</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/marketplace/in-person-assisters/applications-forms-notices" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2073441">Applications, forms, & notices</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/marketplace/in-person-assisters/programs-procedures" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2073446">Assister programs & procedures</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/marketplace/in-person-assisters/technical-resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2073231">Assister technical resources</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/marketplace/in-person-assisters/training-webinars" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2073451">Assister training & webinars</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Agents & Brokers</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/agents-brokers/resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192876">Resources for Agent & Brokers</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/agents-brokers/registration-training" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1290426">Registration & training</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/agents-brokers/open-enrollment" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193226">Open enrollment</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/agents-brokers/direct-enrollment-partners" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1550226">Direct enrollment partners</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/agents-brokers/general-resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/185021">General resources</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://www.youtube.com/playlist?list=PLaV7m2-zFKpgUK9AqdbnOdW69-WwodvRj" class="menu-item-element" aria-current="false">Video Learning Center</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://www.agentbrokerfaq.cms.gov/s/" class="menu-item-element" aria-current="false">Agent & Broker FAQ</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/files/document/agent/broker-help-desks.pdf" class="menu-item-element" aria-current="false" data-drupal-link-system-path="media/112386">Marketplace help desk & call centers</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://data.healthcare.gov/ffm_ab_registration_lists" class="menu-item-element" aria-current="false">Registration Completion List</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://data.healthcare.gov/ab-registration-tracker/" class="menu-item-element" aria-current="false">Marketplace Registration Tracker</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://data.healthcare.gov/ab-suspension-and-termination-list" class="menu-item-element" aria-current="false">AB Suspension & Termination List</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://localhelp.healthcare.gov/" class="menu-item-element" aria-current="false">Find local help</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://data.healthcare.gov/issuer-partner-lookup" class="menu-item-element" aria-current="false">Issuer and direct enrollment partner directory</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/agents-brokers/help-on-demand" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193196">Help on demand</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/agents-brokers/shop-resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193096">SHOP Resources</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Health Plans & Issuers</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/health-plans-issuers/qualified-health-plan-certification" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191371">Qualified health plan certification </a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/health-plans-issuers/summary-benefits-coverage" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191461">Summary of benefits & coverage</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/marketplace/health-plans-issuers/insurance-programs" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192101">Insurance programs</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/marketplace/health-plans-issuers/premium-stabilization-programs" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191326">Premium stabilization programs</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/health-plans-issuers/insurance-market-reforms" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191421">Health insurance market reforms</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/health-plans-issuers/minimum-essential-coverage" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192891">Minimum essential coverage</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace-private-insurance/health-plans-issuers/pbm-drug-pricing-review" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2088761">Drug pricing & rebate review</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Employers & sponsors</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://www.healthcare.gov/small-businesses/other-coverage" class="menu-item-element" aria-current="false">Coverage</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://www.healthcare.gov/small-businesses/choose-and-enroll/shop-marketplace-overview" class="menu-item-element" aria-current="false">Regulation & guidance</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://www.healthcare.gov/small-businesses/choose-and-enroll/qualify-for-shop-marketplace" class="menu-item-element" aria-current="false">Small business tax credit & premium assistance</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://www.healthcare.gov/small-businesses/choose-and-enroll/appeal-a-shop-decision" class="menu-item-element" aria-current="false">Appeals</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/employers-sponsors/small-business-health-options-program-shop" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192901">Small Business Health Options Program (SHOP)</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/employers-sponsors/early-retiree-reinsurance-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191651">Early retiree reinsurance program</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/employer-initiatives" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192916">Employer initiatives</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">States</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/states/state-marketplace-resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190916">Planning & establishing a Marketplace</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/states/territory-cooperative-agreements" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/190926">Territory cooperative agreements</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/states/early-innovator-program" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191691">Early innovator program</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/states/state-flexibility-stabilize-market" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193246">State flexibility to stabilize the Market </a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/states/creating-competitive-marketplace" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192231">Exchange establishment grants</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="https://www.healthcare.gov/coverage/pre-existing-conditions" class="menu-item-element" aria-current="false">Pre-existing condition insurance plan</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Resources</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/resources/about-us" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/192721">About Us</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/marketplace/resources/data" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191741">Data resources</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/resources/letters" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191646">Letters</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/resources/regulations-guidance" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191366">Regulations & Guidance</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/resources/training" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/191466">Training resources</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace-private-insurance/resources/marketplace-coverage-transitions" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2100621">Marketplace Coverage Transitions</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l1 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Initiatives</span>
|
||
<div class="subnav-wrapper--1 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-main ds-u-lg-display--none">Back to main menu</span>
|
||
<h2 class="subnav-title-h2" style="position:relative;text-align:left;width:auto;height:auto;">section title h2</h2>
|
||
</div>
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Burden Reduction</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/priorities/key-initiatives/burden-reduction" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2085596">Overview</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">E-health</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/priorities/key-initiatives/e-health" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171276">Overview</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Flu</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/priorities/key-initiativess/flu" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1399001">Overview</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Health Equity</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/priorities/health-equity/c2c" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1974361">Coverage to Care</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/priorities/health-equity/minority-health" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1620916">Minority health</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/priorities/health-equity/c2c/es" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2072591">Cobertura de atención</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/priorities/health-equity/grants-awards" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1612961">Grants & awards</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Healthplan price transparency</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/priorities/key-initiatives/healthplan-price-transparency" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1567426">Overview</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Hospital price transparency</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/priorities/key-initiatives/hospital-price-transparency" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1417856">Overview</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Innovation Center</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
||
<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/priorities/innovation/overview" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2090631">Overview</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/priorities/innovation/about" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2074091">About</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/priorities/innovation/key-concepts" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2072461">Key Concepts</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/priorities/innovation-center/model-data" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2087691">Model Data</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/priorities/innovation-center/value-based-care-spotlight" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2082926">Value-Based Care Spotlight</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/priorities/innovation/models" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2072436">Innovation Models</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/priorities/innovation/where-innovation-happening" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2072451">Where Innovation is Happening</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/priorities/innovation/evaluation-research-reports" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2072446">Evaluations & Research Reports</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Lookup tools</span>
|
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<div class="subnav-wrapper--2 ds-u-display--none">
|
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<div class="subnav-header">
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
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</div>
|
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<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
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|
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<li class="menu-item menu-item--l3">
|
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<a href="/medicare/quality/value-based-programs/quality-payment-program/lookup-tools" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/189536">Overview</a>
|
||
</li>
|
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</ul>
|
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</div>
|
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</div>
|
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|
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</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Marketplace Open Enrollment</span>
|
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<div class="subnav-wrapper--2 ds-u-display--none">
|
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<div class="subnav-header">
|
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
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</div>
|
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<div class="menu-wrapper">
|
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<ul class="menu">
|
||
|
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|
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<li class="menu-item menu-item--l3">
|
||
<a href="https://www.healthcare.gov/quick-guide/dates-and-deadlines" class="menu-item-element" aria-current="false">Overview</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
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</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Maternal Health</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
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<div class="subnav-header">
|
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
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</div>
|
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<div class="menu-wrapper">
|
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<ul class="menu">
|
||
|
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|
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<li class="menu-item menu-item--l3">
|
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<a href="/maternal-health" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2089266">Overview</a>
|
||
</li>
|
||
</ul>
|
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</div>
|
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</div>
|
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|
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</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
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<span class="menu-item-element" aria-current="false">Medicare OE partner resources</span>
|
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<div class="subnav-wrapper--2 ds-u-display--none">
|
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<div class="subnav-header">
|
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
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</div>
|
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<div class="menu-wrapper">
|
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<ul class="menu">
|
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|
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<li class="menu-item menu-item--l3">
|
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<a href="/outreach-and-education/reach-out/find-tools-to-help-you-help-others/open-enrollment-outreach-and-media-materials" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/180386">Overview</a>
|
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</li>
|
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</ul>
|
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</div>
|
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</div>
|
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|
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</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
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<span class="menu-item-element" aria-current="false">Medicare Open Enrollment</span>
|
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<div class="subnav-wrapper--2 ds-u-display--none">
|
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<div class="subnav-header">
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
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</div>
|
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<div class="menu-wrapper">
|
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<ul class="menu">
|
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|
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|
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<li class="menu-item menu-item--l3">
|
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<a href="/priorities/key-initiatives/medicare-open-enrollment-partner-resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/180361">Overview</a>
|
||
</li>
|
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</ul>
|
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</div>
|
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</div>
|
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|
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</li>
|
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<li class="menu-item menu-item--l2 menu-item--expanded">
|
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<span class="menu-item-element" aria-current="false">Nursing Home Careers</span>
|
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<div class="subnav-wrapper--2 ds-u-display--none">
|
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<div class="subnav-header">
|
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
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</div>
|
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<div class="menu-wrapper">
|
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<ul class="menu">
|
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|
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|
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<li class="menu-item menu-item--l3 menu-item--collapsed">
|
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<a href="/priorities/key-initiatives/nursing-home-careers" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2089791">Overview</a>
|
||
</li>
|
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</ul>
|
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</div>
|
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</div>
|
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|
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</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
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<span title="Open Payments landing page" class="menu-item-element" aria-current="false">Open Payments</span>
|
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<div class="subnav-wrapper--2 ds-u-display--none">
|
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<div class="subnav-header">
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
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</div>
|
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<div class="menu-wrapper">
|
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<ul class="menu">
|
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|
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|
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<li class="menu-item menu-item--l3 menu-item--collapsed">
|
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<a href="/priorities/key-initiatives/open-payments" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/188426">Overview</a>
|
||
</li>
|
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</ul>
|
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</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Opioids</span>
|
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<div class="subnav-wrapper--2 ds-u-display--none">
|
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<div class="subnav-header">
|
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
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</div>
|
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<div class="menu-wrapper">
|
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<ul class="menu">
|
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|
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|
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<li class="menu-item menu-item--l3">
|
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<a href="/priorities/key-initiatives/opioids" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1620416">Overview</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
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</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Your Patient Rights</span>
|
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<div class="subnav-wrapper--2 ds-u-display--none">
|
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<div class="subnav-header">
|
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
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</div>
|
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<div class="menu-wrapper">
|
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<ul class="menu">
|
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|
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|
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<li class="menu-item menu-item--l3 menu-item--collapsed">
|
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<a href="/priorities/your-patient-rights/emergency-room-rights" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2083831">Emergency Room Rights</a>
|
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</li>
|
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<li class="menu-item menu-item--l3">
|
||
<a href="/medical-bill-rights" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1912576">Medical bill rights</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l1 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Training & Education</span>
|
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<div class="subnav-wrapper--1 ds-u-display--none">
|
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<div class="subnav-header">
|
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<span class="back-to-main ds-u-lg-display--none">Back to main menu</span>
|
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<h2 class="subnav-title-h2" style="position:relative;text-align:left;width:auto;height:auto;">section title h2</h2>
|
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</div>
|
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<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">CMS National Training Program</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
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</div>
|
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<div class="menu-wrapper">
|
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<ul class="menu">
|
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|
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|
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<li class="menu-item menu-item--l3">
|
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<a href="https://cmsnationaltrainingprogram.cms.gov/resources" class="menu-item-element" aria-current="false">National Training Program resources</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
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<a href="https://cmsnationaltrainingprogram.cms.gov/?q=global-search&combine=classroom%20modules" class="menu-item-element" aria-current="false">Class modules</a>
|
||
</li>
|
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</ul>
|
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</div>
|
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</div>
|
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|
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</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
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<span class="menu-item-element" aria-current="false">Partner outreach resources</span>
|
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<div class="subnav-wrapper--2 ds-u-display--none">
|
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<div class="subnav-header">
|
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
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</div>
|
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<div class="menu-wrapper">
|
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<ul class="menu">
|
||
|
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|
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<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/training-education/partner-outreach-resources/partner-with-cms" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172236">Partner with CMS</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/partner-outreach-resources/national-medicare-education-program-nmep" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/180046">National Medicare Education Program (NMEP)</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
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<a href="/training-education/partner-outreach-resources/low-income-subsidy-lis" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171051">Low-Income Subsidy (LIS) outreach</a>
|
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</li>
|
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<li class="menu-item menu-item--l3">
|
||
<a href="/marketplace/assisters-navigators/enrollment/champion" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/2073456">Become a champion for coverage</a>
|
||
</li>
|
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<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/partner-outreach-resources/faith-based" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/182296">Faith-Based Partners</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/partner-outreach-resources/rural-health" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/185591">Rural Health Partners</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/training-education/partner-outreach-resources/american-indian-alaska-native" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172176">American Indian/Alaska Native</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/partner-outreach-resources/center" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/193436">Partnering with CMS Center</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">Medicare Learning Network® (MLN)</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
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</div>
|
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<div class="menu-wrapper">
|
||
<ul class="menu">
|
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|
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|
||
<li class="menu-item menu-item--l3">
|
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<a href="/training-education/medicare-learning-network/resources-training" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/188581">Resources & training</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/medicare-learning-network/newsletter" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/181061">Newsletter</a>
|
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</li>
|
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<li class="menu-item menu-item--l3 menu-item--collapsed">
|
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<a href="/training-education/medicare-learning-network/compliance" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/181006">Compliance</a>
|
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</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/medicare-learning-network/partnerships" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/177061">Partnerships</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
||
<span class="menu-item-element" aria-current="false">CMS Open Door Forums</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
||
<div class="subnav-header">
|
||
<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
||
</div>
|
||
<div class="menu-wrapper">
|
||
<ul class="menu">
|
||
|
||
|
||
<li class="menu-item menu-item--l3 menu-item--collapsed">
|
||
<a href="/training-education/open-door-forums/about" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172171">About Open Door Forums</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
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<a href="/training-education/open-door-forums/ambulance" title="The Ambulance Open Door Forum (ODF) addresses issues related to the payment, billing, coverage and delivery of services in the ambulance industry." class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172296">Ambulance</a>
|
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</li>
|
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<li class="menu-item menu-item--l3 menu-item--collapsed">
|
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<a href="/esrd" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172241">End-Stage Renal Disease (ESRD) Dialysis Facility Care Compare</a>
|
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</li>
|
||
<li class="menu-item menu-item--l3">
|
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<a href="/training-education/open-door-forums/home-health-hospice-durable-medical-equipment-dme" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/173651">Home Health, Hospice & Durable Medical Equipment (DME)</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/open-door-forums/hospitals" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172276">Hospital</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/open-door-forums/long-term-services-supports" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172251">Long-Term Services & Supports</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
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<a href="/training-education/open-door-forums/physicians-nurses-allied-health-professionals" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172306">Physicians, Nurses and Allied Health Professionals</a>
|
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</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/open-door-forums/rural-health" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172291">Rural Health</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/open-door-forums/skilled-nursing-facilities-snf" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172316">Skilled Nursing Facilities (SNFs)/Long-Term Care</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/open-door-forums/special" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/174026">Special Open Door forums</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
</li>
|
||
<li class="menu-item menu-item--l2 menu-item--expanded">
|
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<span class="menu-item-element" aria-current="false">Look up topics</span>
|
||
<div class="subnav-wrapper--2 ds-u-display--none">
|
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<div class="subnav-header">
|
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<span class="back-to-l2 ds-u-lg-display--none">Back to <span class="l2-placeholder"></span> menu</span>
|
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<h3 class="subnav-title-h3" style="position:relative;text-align:left;">section title h3</h3>
|
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</div>
|
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<div class="menu-wrapper">
|
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<ul class="menu">
|
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|
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|
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<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/partner-outreach-resources/medicare" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/178086">Medicare</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
|
||
<a href="/training-education/partner-outreach-resources/medicaid" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/178156">Medicaid</a>
|
||
</li>
|
||
<li class="menu-item menu-item--l3">
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<h1 class="ds-u-visibility--screen-reader page-title"><span class="field field--name-title field--type-string field--label-visually_hidden">Affordable Care Act Implementation FAQs - Set 8
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<span class="field field--name-title field--type-string field--label-visually_hidden alternate-page-title ds-u-margin-bottom--0 ds-u-font-size--3xl ds-u-font-weight--semibold">Affordable Care Act Implementation FAQs - Set 8</span>
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<p><a id="Top">Set</a> out below are additional Frequently Asked Questions (FAQs) regarding implementation of the summary of benefits and coverage (SBC) provisions of the Affordable Care Act. These FAQs have been prepared jointly by the Departments of Labor, Health and Human Services (HHS), and the Treasury (the Departments). Like previously issued FAQs (available at <a href="http://www.dol.gov/ebsa/healthreform/">http://www.dol.gov/ebsa/healthreform/</a> and <a data-entity-substitution="canonical" data-entity-type="node" data-entity-uuid="8ce8613e-b6bb-4053-8816-5967dbbd1499" href="/marketplace/resources/fact-sheets-faqs" title="Fact Sheets & Frequently Asked Questions (FAQs)">/cciio/Resources/Fact-Sheets-and-FAQs/</a>), these FAQs answer questions from stakeholders to help people understand the new law and benefit from it, as intended.</p>
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<h2>Table of Contents</h2>
|
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<hr>
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<ul>
|
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<li><a href="#Summary of Benefits and Coverage (SBC)">Summary of Benefits and Coverage (SBC)</a></li>
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</ul>
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<h2><br>
|
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<a id="Summary of Benefits and Coverage (SBC)">Summary of Benefits and Coverage (SBC)</a></h2>
|
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<hr>
|
||
<p>On February 14, 2012, the Departments published the final rules regarding the SBC.<a href="#1.">[1]</a> These FAQs aim to answer some of the questions that have been raised to date. We intend to release additional FAQs. The Administration is committed to promoting operational efficiencies and clarifying the final regulations to ensure successful implementation.</p>
|
||
|
||
<p><strong>Q1.</strong> When must plans and issuers begin providing the SBC?</p>
|
||
|
||
<p><strong>A1.</strong> For group health plan coverage, the regulations provide that, for disclosures with respect to participants and beneficiaries who enroll or re-enroll through an open enrollment period (including late enrollees and re-enrollees), the SBC must be provided beginning on the first day of the first open enrollment period that begins on or after September 23, 2012. For disclosures with respect to participants and beneficiaries who enroll in coverage other than through an open enrollment period (including individuals who are newly eligible for coverage and special enrollees), the SBC must be provided beginning on the first day of the first plan year that begins on or after September 23, 2012.</p>
|
||
|
||
<p>For disclosures from issuers to group health plans, and with respect to individual market coverage, the SBC must be provided beginning September 23, 2012.</p>
|
||
|
||
<p><a href="#Top">Back To Top of page</a></p>
|
||
|
||
<p><strong>Q2.</strong> What is the Departments’ basic approach to implementation of the SBC requirement during the first year of applicability?</p>
|
||
|
||
<p><strong>A2.</strong> The Departments’ basic approach to ACA implementation, as stated in a previous FAQ (see <a href="http://www.dol.gov/ebsa/faqs/faq-aca.html">http://www.dol.gov/ebsa/faqs/faq-aca.html</a>), is: “[to work] together with employers, issuers, States, providers and other stakeholders to help them come into compliance with the new law and [to work] with families and individuals to help them understand the new law and benefit from it, as intended. Compliance assistance is a high priority for the Departments. Our approach to implementation is and will continue to be marked by an emphasis on assisting (rather than imposing penalties on) plans, issuers and others that are working diligently and in good faith to understand and come into compliance with the new law. This approach includes, where appropriate, transition provisions, grace periods, safe harbors, and other policies to ensure that the new provisions take effect smoothly, minimizing any disruption to existing plans and practices.”</p>
|
||
|
||
<p>In addition to the general approach to implementation, in the instructions for completing the SBC, we stated: “To the extent a plan’s terms do not reasonably correspond to these instructions, the template should be completed in a manner that is as consistent with the instructions as possible, while still accurately reflecting the plan’s terms. This may occur, for example, if a plan provides a different structure for provider network tiers or drug tiers than is represented in the SBC template and these instructions, if a plan provides different benefits based on facility type (such as hospital inpatient versus non-hospital inpatient), in a case where a plan is denoting the effects of a related health flexible spending arrangement or a health reimbursement arrangement, or if a plan provides different cost sharing based on participation in a wellness program.”</p>
|
||
|
||
<p>Consistent with this guidance, during this first year of applicability, the Departments will not impose penalties on plans and issuers that are working diligently and in good faith to provide the required SBC content in an appearance that is consistent with the final regulations. The Departments intend to work with stakeholders over time to achieve maximum uniformity for consumers and certainty for the regulated community.</p>
|
||
|
||
<p><a href="#Top">Back To Top of page</a></p>
|
||
|
||
<p><strong>Q3.</strong> Are plans and issuers required to provide a separate SBC for each coverage tier (e.g., self-only coverage, employee-plus-one coverage, family coverage) within a benefit package?</p>
|
||
|
||
<p><strong>A3.</strong> No, plans and issuers may combine information for different coverage tiers in one SBC, provided the appearance is understandable. In such circumstances, the coverage examples should be completed using the cost sharing (e.g., deductible and out-of-pocket limits) for the self-only coverage tier (also sometimes referred to as the individual coverage tier). In addition, the coverage examples should note this assumption.</p>
|
||
|
||
<p><a href="#Top">Back To Top of page</a></p>
|
||
|
||
<p><strong>Q4.</strong> If the participant is able to select the levels of deductible, copayments, and co-insurance for a particular benefit package, are plans and issuers required to provide a separate SBC for every possible combination that a participant may select under that benefit package?</p>
|
||
|
||
<p><strong>A4.</strong> No, as with the response to Q-3, plans and issuers may combine information for different cost-sharing selections (such as levels of deductibles, copayments, and co-insurance) in one SBC, provided the appearance is understandable. This information can be presented in the form of options, such as deductible options and out-of-pocket maximum options. In these circumstances, the coverage examples should note the assumptions used in creating them. An example of how to note assumptions used in creating coverage examples is provided in the Departments’ sample completed SBC.<a href="#2.">[2]</a></p>
|
||
|
||
<p><a href="#Top">Back To Top of page</a></p>
|
||
|
||
<p><strong>Q5.</strong> If a group health plan is insured and utilizes “carve-out arrangements” (such as pharmacy benefit managers and managed behavioral health organizations) to help manage certain benefits, who is responsible for providing the SBC with respect to the plan?</p>
|
||
|
||
<p><strong>A5.</strong> The Departments recognize that different combinations of plans, issuers, and their service providers may have different information necessary to provide an SBC, including the coverage examples.</p>
|
||
|
||
<p>The Departments have determined that, until further guidance is issued, where a group health plan or group health insurance issuer has entered into a binding contractual arrangement under which another party has assumed responsibility (1) to complete the SBC, (2) to provide required information to complete a portion of the SBC, or (3) to deliver an SBC with respect to certain individuals in accordance with the final regulations, the plan or issuer generally will not be subject to any enforcement action by the Departments for failing to provide a timely or complete SBC, provided the following conditions are satisfied:</p>
|
||
|
||
<ul>
|
||
<li>The plan or issuer monitors performance under the contract,</li>
|
||
<li>If a plan or issuer has knowledge of a violation of the final regulations and the plan or issuer has the information to correct it, it is corrected as soon as practicable, and</li>
|
||
<li>If a plan or issuer has knowledge of a violation of the final regulations and the plan or issuer does not have the information to correct it, the plan or issuer communicates with participants and beneficiaries regarding the lapse and begins taking significant steps as soon as practicable to avoid future violations.</li>
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</ul>
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<p><a href="#Top">Back To Top of page</a></p>
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<p><strong>Q6.</strong> If a plan offers participants add-ons to major medical coverage that could affect their cost sharing and other information in the SBC (such as a health flexible spending arrangement (health FSA), health reimbursement arrangement (HRA), health savings account (HSA), or wellness program), is the plan permitted to combine information for all of these add-ons and reflect them in a single SBC?</p>
|
||
|
||
<p>A6. Yes. As stated in the preamble to the final regulations and the instructions for completing the SBC template, <a href="#3.">[3]</a> plans and issuers are permitted to combine such information in one SBC, provided the appearance is understandable. That is, the effects of such add-ons can be denoted in the appropriate spaces on the SBC for deductibles, copayments, coinsurance, and benefits otherwise not covered by the major medical coverage. In such circumstances, the coverage examples should note the assumptions used in creating them. (The Departments’ sample completed SBC <a href="#4.">[4]</a>provides an example of how to denote the effects of a diabetes wellness program.)</p>
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<p>Back To Top of page</p>
|
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|
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<p><strong>Q7:</strong> The final regulations require the SBC to be provided in certain circumstances within 7 business days. Does that mean the plan or issuer has 7 business days to send the SBC, or that the SBC must be received within 7 business days?</p>
|
||
|
||
<p><strong>A7.</strong> In the context of the final regulations, the term “provided” means sent. Accordingly, the SBC is timely if sent out within 7 business days, even if it is not received until after that period.</p>
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<p><a href="#Top">Back To Top of page</a></p>
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<p><strong>Q8.</strong> Are plans and issuers required to provide SBCs to individuals who are COBRA qualified beneficiaries?</p>
|
||
|
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<p><strong>A8.</strong> Yes. While a qualifying event does not, itself, trigger an SBC, during an open enrollment period, any COBRA qualified beneficiary who is receiving COBRA coverage must be given the same rights to elect different coverage as are provided to similarly situated non-COBRA beneficiaries. See 26 CFR 54.4980B-5, Q&A-4(c) (requirement to provide election) and 54.4980B-3, Q&A-3 (definition of similarly situated non-COBRA beneficiary). In this situation, a COBRA qualified beneficiary who has elected coverage has the same rights to receive an SBC as a similarly situated non-COBRA beneficiary. There are also limited situations in which a COBRA qualified beneficiary may need to be offered different coverage at the time of the qualifying event than the coverage he or she was receiving before the qualifying event and this may trigger the right to an SBC. See 26 CFR 54.4980B-5, Q&A-4(b).</p>
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<p><a href="#Top">Back To Top of page</a></p>
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<p><strong>Q9.</strong> What circumstances will trigger the requirement to provide an SBC to a participant or beneficiary in a group health plan? In particular, how do the terms “application” and “renewal” apply to a self-insured plan?</p>
|
||
|
||
<p><strong>A9.</strong> The final regulations require that the SBC be provided in several instances:</p>
|
||
|
||
<ul>
|
||
<li>Upon application. If a plan (including a self-insured group health plan) or an issuer distributes written application materials for enrollment, the SBC must be provided as part of those materials. For this purpose, written application materials include any forms or requests for information, in paper form or through a website or email, that must be completed for enrollment. If the plan or issuer does not distribute written application materials for enrollment (in either paper or electronic form), the SBC must be provided no later than the first date on which the participant is eligible to enroll in coverage.</li>
|
||
<li>By first day of coverage (if there are any changes). If there is any change in the information required to be in the SBC that was provided upon application and before the first day of coverage, the plan or issuer must update and provide a current SBC no later than the first day of coverage.</li>
|
||
<li>Special enrollees. The SBC must be provided to special enrollees no later than the date on which a summary plan description is required to be provided (90 days from enrollment).</li>
|
||
<li>Upon renewal. If a plan or issuer requires participants and beneficiaries to actively elect to maintain coverage during an open season, or provides them with the opportunity to change coverage options in an open season, the plan or issuer must provide the SBC at the same time it distributes open season materials. If there is no requirement to renew (sometimes referred to as an “evergreen” election), and no opportunity to change coverage options, renewal is considered to be automatic and the SBC must be provided no later than 30 days prior to the first day of the new plan or policy year.<a href="#5.">[5]</a></li>
|
||
<li>Upon request. The SBC must be provided upon request for an SBC or summary information about the health coverage as soon as practicable but in no event later than seven business days following receipt of the request.<br>
|
||
Back To Top of page</li>
|
||
</ul>
|
||
|
||
<p><strong>Q10.</strong> What are the circumstances in which an SBC may be provided electronically?</p>
|
||
|
||
<p><strong>A10.</strong> With respect to group health plan coverage, an SBC may be provided electronically: (1) by an issuer to a plan, and (2) by a plan or issuer to participants and beneficiaries who are eligible but not enrolled for coverage, if:</p>
|
||
|
||
<ul>
|
||
<li>The format is readily accessible (such as in an html, MS Word, or pdf format);</li>
|
||
<li>The SBC is provided in paper form free of charge upon request; and</li>
|
||
<li>If the SBC is provided via an Internet posting (including on the HHS web portal), the issuer timely advises the plan (or the plan or issuer timely advises the participants and beneficiaries) that the SBC is available on the Internet and provides the Internet address. Plans and issuers may make this disclosure (sometimes referred to as the “e-card” or “postcard” requirement) by email.</li>
|
||
</ul>
|
||
|
||
<p>An SBC may also be provided electronically by a plan or issuer to a participant or beneficiary who is covered under a plan in accordance with the Department of Labor’s disclosure regulations at 29 CFR 2520.104b-1. Those regulations include a safe harbor for disclosure through electronic media to participants who have the ability to effectively access documents furnished in electronic form at any location where the participant is reasonably expected to perform duties as an employee and with respect to whom access to the employer’s or plan sponsor’s electronic information system is an integral part of those duties. Under the safe harbor, other individuals may also opt into electronic delivery.</p>
|
||
|
||
<p>With respect to individual market coverage, a health insurance issuer must provide the SBC, in either paper or electronic form, in a manner that can reasonably be expected to provide actual notice. The SBC may not be provided in electronic form unless:</p>
|
||
|
||
<ul>
|
||
<li>The format is readily accessible;</li>
|
||
<li>If the SBC is provided via an Internet posting, it is placed in a location that is prominent and readily accessible;</li>
|
||
<li>The SBC is provided in an electronic form which can be retained and printed; and</li>
|
||
<li>The issuer notifies the individual that the SBC is available free of charge in paper form upon request.</li>
|
||
</ul>
|
||
|
||
<p>In addition, a health insurance issuer offering individual market coverage, that provides HealthCare.gov with all the content required to be provided in the SBC, will be deemed compliant with the requirement to provide an SBC upon request prior to application. However, issuers must provide the SBC in paper form upon request for a paper copy, and at all other times as specified in the regulations.</p>
|
||
|
||
<p>In addition, as stated in the regulations, unless the plan or issuer has knowledge of a separate address for a beneficiary, the SBC may be provided to the participant on behalf of the beneficiary (including by furnishing the SBC to the participant in electronic form).</p>
|
||
|
||
<p><a href="#Top">Back To Top of page</a></p>
|
||
|
||
<p><strong>Q11.</strong> Are issuers who have provided individual market plan information to HealthCare.gov in compliance with PHS Act section 2715 and its implementing regulations already?</p>
|
||
|
||
<p><strong>A11.</strong> The deemed compliance provision in the regulation requires issuers in the individual market to provide all of the data elements that are needed to complete the SBC template to HealthCare.gov. If the issuer fails to provide all of the data elements, it would not be deemed to be in compliance with the regulation. Today, HealthCare.gov does not collect all of the elements of an SBC, such as information necessary to complete the coverage examples. However, HHS will collect this information and display it in the format of the SBC template by September 23, 2012, so that providing information to HealthCare.gov fulfills the deemed compliance provision.</p>
|
||
|
||
<p><a href="#Top">Back To Top of page</a></p>
|
||
|
||
<p><strong>Q12:</strong> Can the Departments provide model language to meet the requirement to provide an e-card or postcard in connection with evergreen website postings?</p>
|
||
|
||
<p><strong>A12.</strong> Yes. Plans and issuers have flexibility with respect to the postcard and may choose to tailor it in many ways. One example is:</p>
|
||
|
||
<div>
|
||
<p>Availability of Summary Health Information</p>
|
||
|
||
<p>As an employee, the health benefits available to you represent a significant component of your compensation package. They also provide important protection for you and your family in the case of illness or injury.</p>
|
||
|
||
<p>Your plan offers a series of health coverage options. Choosing a health coverage option is an important decision. To help you make an informed choice, your plan makes available a Summary of Benefits and Coverage (SBC), which summarizes important information about any health coverage option in a standard format, to help you compare across options.</p>
|
||
|
||
<p>The SBC is available on the web at: www.website.com/SBC. A paper copy is also available, free of charge, by calling 1-XXX-XXX-XXXX (a toll-free number).</p>
|
||
</div>
|
||
|
||
<p><a href="#Top">Back To Top of page</a></p>
|
||
|
||
<p><strong>Q13.</strong> The regulations state that in order to satisfy the requirement to provide the SBC in a culturally and linguistically appropriate manner, a plan or issuer follows the rules in the claims and appeals regulations under PHS Act section 2719. Does this mean that the SBC must include a sentence on the availability of language assistance services?</p>
|
||
|
||
<p><strong>A13.</strong> Yes, if the notice is sent to an address in a county in which ten percent or more of the population is literate only in a non-English language. The final SBC regulations provide that a plan or issuer is considered to provide the SBC in a culturally and linguistically appropriate manner if the thresholds and standards of the claims and appeals regulations are met. <a href="#6.">[6]</a> The claims and appeals regulations outline three requirements that must be satisfied for notices sent to an address in a county in which ten percent or more of the population is literate only in a non-English language. In such cases, the plan or issuer is generally required to provide oral language services in the non-English language, provide notices upon request in the non-English language, and include in all English versions of the notices a statement in the non-English language clearly indicating how to access the language services provided by the plan or issuer.</p>
|
||
|
||
<p>Accordingly, plans and issuers must include, in the English versions of SBCs sent to an address in a county in which ten percent or more of the population is literate only in a non-English language, a statement prominently displayed in the applicable non-English language clearly indicating how to access the language services provided by the plan or issuer. In this circumstance, the plan or issuer should include this statement on the page of the SBC with the “Your Rights to Continue Coverage” and “Your Grievance and Appeals Rights” sections.</p>
|
||
|
||
<p>Sample language for this statement is available on the model notice of adverse benefit determination at <a href="http://www.dol.gov/ebsa/IABDModelNotice2.doc">http://www.dol.gov/ebsa/IABDModelNotice2.doc</a>. Current county-by-county data can be accessed at <a class="titlelink" data-entity-substitution="canonical" data-entity-type="node" data-entity-uuid="869dabe4-ba1d-4631-9164-37cdaff19043" href="/cciio/resources/fact-sheets-and-faqs/clas-data" title="2012 Culturally and Linguistically Appropriate Services (CLAS) County Data">2012 Culturally and Linguistically Appropriate Services (CLAS) County Data</a></p>
|
||
|
||
<p>Even in counties where no non-English language meets the ten percent threshold, a plan or issuer can voluntarily include such a statement in the SBC in any non-English language. Moreover, nothing in the SBC regulations limits an individual’s rights to meaningful access protections under other applicable Federal or State law, including Title VI of the Civil Rights Act of 1964.</p>
|
||
|
||
<p><a href="#Top">Back To Top of page</a></p>
|
||
|
||
<p><strong>Q14.</strong> Where can plans and issuers find the written translations of the SBC template and the uniform glossary in the non-English languages?</p>
|
||
|
||
<p><strong>A14.</strong> Written translations in Spanish, Chinese, Tagalog and Navajo will be available at http://cms.gov/cciio/programs/consumer/summaryandglossary/index.html.</p>
|
||
|
||
<p><a href="#Top">Back To Top of page</a></p>
|
||
|
||
<p><strong>Q15.</strong> Is an SBC permitted to simply substitute a cross-reference to the summary plan description (SPD) or other documents for a content element of the SBC?</p>
|
||
|
||
<p><strong>A15.</strong> No, an SBC is not permitted to substitute a reference to the SPD or other document for any content element of the SBC. However, an SBC may include a reference to the SPD in the SBC footer. (For example, “Questions: Call 1-800-[insert] or visit us at www.[insert].com for more information, including a copy of your plan’s summary plan description.”) In addition, wherever an SBC provides information that fully satisfies a particular content element of the SBC, it may add to that information a reference to specified pages or portions of the SPD in order to supplement or elaborate on that information.
|
||
</p>
|
||
|
||
<p><a href="#Top">Back To Top of page</a></p>
|
||
|
||
<p><strong>Q16.</strong> Can a plan or issuer add premium information to the SBC form voluntarily?</p>
|
||
|
||
<p><strong>A16.</strong> Yes. If a plan or issuer chooses to add premium information to the SBC, the information should be added at the end of the SBC form.</p>
|
||
|
||
<p><a href="#Top">Back To Top of page</a></p>
|
||
|
||
<p><strong>Q17.</strong> Must the header and footer be repeated on every page of the SBC?</p>
|
||
|
||
<p><strong>A17.</strong> No. If a plan or issuer chooses, it may include the header only on the first page of the SBC. In addition, a plan or issuer may include the footer only on the first and last page of the SBC, instead of on every page.</p>
|
||
|
||
<p>The OMB control numbers (which were displayed on the SBC template and the Departments’ sample completed SBC to inform plans and issuers that the Departments had complied with the Paperwork Reduction Act) may, but are not required to, be displayed on SBCs provided by plans or issuers.<br>
|
||
*Updated February 15, 2022</p>
|
||
|
||
<p><a href="#Top">Back To Top of page</a></p>
|
||
|
||
<p><strong>Q18.</strong> For group health plan coverage, may the coverage period in the SBC header reflect the coverage period for the group plan as a whole, or must the coverage period be the period applicable to each particular individual enrolled in the plan?</p>
|
||
|
||
<p><strong>A18.</strong> The SBC may reflect the coverage period for the group health plan as a whole. Therefore, if a plan is a calendar year plan and an individual enrolls on January 19, the coverage period is permitted to be the calendar year. Plans and issuers are not required to individualize the coverage period for each individual’s enrollment.</p>
|
||
|
||
<p><a href="#Top">Back To Top of page</a></p>
|
||
|
||
<p><strong>Q19.</strong> Can issuers and plans make minor adjustments to the SBC format, such as changing row and column sizes? What about changes such as rolling over information from one page to another, which was not permitted by the instructions?</p>
|
||
|
||
<p><strong>A19.</strong> Minor adjustments are permitted to the row or column size in order to accommodate the plan’s information, as long as the information is understandable. The deletion of columns or rows is not permitted.</p>
|
||
|
||
<p>Rolling over information from one page to another is permitted.</p>
|
||
|
||
<p><a href="#Top">Back To Top of page</a></p>
|
||
|
||
<p><strong>Q20.</strong> Can plan names be generic, such as “Standard Option” or “High Option”?</p>
|
||
|
||
<p><strong>A20.</strong> Yes, generic terms may be used.</p>
|
||
|
||
<p><a href="#Top">Back To Top of page</a></p>
|
||
|
||
<p><strong>Q21.</strong> Can the issuer’s name and the plan name be interchangeable in order?</p>
|
||
|
||
<p><strong>A21.</strong> Yes.</p>
|
||
|
||
<p><a href="#Top">Back To Top of page</a></p>
|
||
|
||
<p><strong>Q22.</strong> Can barcodes or control numbers be added to the SBC for quality control purposes?</p>
|
||
|
||
<p><strong>A22.</strong> Yes, they can be added.</p>
|
||
|
||
<p><a href="#Top">Back To Top of page</a></p>
|
||
|
||
<p><strong>Q23.</strong> Is the SBC required to include a statement about whether the plan is a grandfathered health plan?</p>
|
||
|
||
<p><strong>A23.</strong> No, although plans may voluntarily choose to add a statement to the end of the SBC about whether the plan is a grandfathered health plan.</p>
|
||
|
||
<p><a href="#Top">Back To Top of page</a></p>
|
||
|
||
<p><strong>Q24</strong>. My plan is moving forward to implement the SBC template for the first year of applicability. Are significant changes anticipated for 2014?</p>
|
||
|
||
<p><strong>A24.</strong> No. The Departments identified in the preamble to the final regulations certain discrete changes that would be necessary for plan years (or, in the individual market, policy years) beginning after the first year of applicability. These changes include the addition of a minimum value statement and a minimum essential coverage statement, changes to be consistent with the Affordable Care Act’s requirement to eliminate all annual limits on essential health benefits, and the Departments’ intent to add additional coverage examples. The Departments are also considering making some refinements consistent with these FAQs and other requests from plans and issuers for clarification and to promote operational efficiencies. No other changes are planned at this time.</p>
|
||
|
||
<p><a href="#Top">Back To Top of page</a></p>
|
||
|
||
<p>--------------------------------------------------------------------------------</p>
|
||
|
||
<p><a id="1.">1.</a>See 26 CFR 54.9815-2715, 29 CFR 2590.715-2715, and 45 CFR 147.200, published February 14, 2012 at 77 FR 8668.<br>
|
||
<a id="2.">2.</a>The Departments’ sample completed SBC is available at: <a href="www.dol.gov/ebsa/pdf/SBCSampleCompleted.pdf">www.dol.gov/ebsa/pdf/SBCSampleCompleted.pdf</a> or <a data-entity-substitution="canonical" data-entity-type="media" data-entity-uuid="7b719b44-1057-4941-856f-7f33bc853c53" href="/cciio/resources/fact-sheets-and-faqs/downloads/sample-completed-sbcfinal.pdf" type="application/pdf" title="sample-completed-sbcfinal">sample-completed-sbcfinal (PDF)</a><br>
|
||
<a id="3.">3.</a>See 77 FR 8668, 8670-71 (February 14, 2012) and page 1 of Instruction Guide for Group Coverage at http://www.dol.gov/ebsa/pdf/SBCInstructionsGroup.pdf.<br>
|
||
<a id="4.">4.</a>See <a href="www.dol.gov/ebsa/pdf/SBCSampleCompleted.pdf">www.dol.gov/ebsa/pdf/SBCSampleCompleted.pdf</a> or <a data-entity-substitution="canonical" data-entity-type="media" data-entity-uuid="7b719b44-1057-4941-856f-7f33bc853c53" href="/cciio/resources/fact-sheets-and-faqs/downloads/sample-completed-sbcfinal.pdf" type="application/pdf" title="sample-completed-sbcfinal">sample-completed-sbcfinal (PDF)</a> .<br>
|
||
<a id="5.">5.</a>The final regulations provide an accommodation for insured coverage if the policy, certificate, or contract of insurance has not been renewed or reissued prior to the date that is 30 days prior to the first day of the new plan or policy year. In such cases, the SBC must be provided as soon as practicable but in no event later than seven business days after issuance of the new policy, certificate, or contract of insurance, or the receipt of written confirmation of intent to renew, whichever is earlier.<br>
|
||
<a id="6.">6.</a>See 26 CFR 54.9815-2719T(e), 29 CFR 2590.715-2719(e), and 45 CFR 147.136(e), originally published on July 23, 2010, at 75 FR 43330 and amended on June 24, 2011, at 76 FR 37208.<br>
|
||
Back To Top of page</p>
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