Fact Sheets & Frequently Asked Questions (FAQs) – CMS

• Coronavirus Disease 2019 (COVID-19)
• Affordable Care Act
• Consumer Support and Information
  • Consumer Assistance Program Grants
  • External Appeals
  • Summary of Benefits and Coverage and Uniform Glossary
  • Outreach and Education Resources
  • Language Access Taglines for Exchanges, Qualified Health Plan (QHP) Issuers, and Web-Brokers
• Content Requirements for Plan Finder
• Pre-Existing Condition Insurance Plan (PCIP)
• Health Insurance Marketplaces
  • In-Person Assistance
  • Plan Management
  • Planning and Establishment Grants
  • Early Innovator Grants
  • Territory Cooperative Agreements
• Premium Stabilization Programs
• Consumer Operated and Oriented Plan (CO-OP) Program
• Other Insurance Protections
  • COBRA
  • Mental Health Parity
  • Newborns’ and Mothers’ Health Protection
  • Women’s Health and Cancer Rights
• Health Insurance Market Reforms
  • Annual Limits
  • Coverage for Young Adults
  • Grandfathered Plans
  • Medical Loss Ratio
  • Prevention
  • Review of Insurance Rates
  • Student Health Plans
  • Self-Funded Non-Federal Governmental Plans

Additional FAQs and resources related to the Affordable Care Act may be available on other agencies’ websites, including:

• BusinessUSA.gov – Opens in a new window
• Department of Labor – Opens in a new window
• Department of Treasury – Opens in a new window
• Office of Personnel Management – Opens in a new window

Coronavirus Disease 2019 (COVID-19) Guidance

FAQs

• March 5, 2020Information Related to COVID-19 Individual and Small Group Market Insurance Coverage (PDF)
• March 12, 2020FAQs on Essential Health Benefits Coverage and the Coronavirus (COVID-19) (PDF)
• March 18, 2020FAQs on Catastrophic Plan Coverage and the Coronavirus Disease 2019 (COVID-19) (PDF)
• March 24, 2020FAQs on Availability and Usage of Telehealth Services through Private Health Insurance Coverage in Response to Coronavirus Disease 2019 (COVID-19) (PDF)
• March 24, 2020Payment and Grace Period Flexibilities Associated with the COVID-19 National Emergency (PDF)
• March 24, 2020FAQs on Prescription Drugs and the Coronavirus Disease 2019 (COVID-19) for Issuers Offering Health Insurance Coverage in the Individual and Small Group Markets (PDF)
• April 11, 2020 FAQs about Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act Implementation (set 42) (PDF) *This document was updated on April 15, 2020, to correct an error in footnote 10 regarding the current end date of the public health emergency related to COVID-19. (PDF)
• April 13, 2020Postponement of 2019 Benefit Year HHS-operated Risk Adjustment Data Validation (HHS-RADV) (PDF)
• April 18, 2020COVID-19 and Suspension of Certain Activities Related to the Health Insurance Exchange Quality Rating System, QHP Enrollee Experience Survey (QHP Enrollee Survey) and Quality Improvement Strategy Program (PDF)
• April 21, 2020FAQs on Issuer Flexibilities for Utilization Management and Prior Authorization (PDF)
• April 27, 2020 (Updated April 29, 2022)Risk Adjustment Telehealth and Telephone Services During COVID-19 (PDF)
• May 12, 2020Quality Rating System (QRS), Qualified Health Plan (QHP) Enrollee Experience Survey, and Quality Improvement Strategy (QIS) FAQs in Response to the Coronavirus (COVID-19) Pandemic (PDF)
• May 14, 2020Temporary Period of Relaxed Enforcement of Certain Timeframes Related to Group Market Requirements under the Public Health Service Act in Response to the COVID-19 Outbreak (PDF)
• June 5, 2020Letter to Sponsors of non-Federal Governmental Plans Regarding COVID-19 Guidance (PDF)
• June 12, 2020Temporary Period of Relaxed Enforcement for Submitting the 2019 MLR Annual Reporting Form and Issuing MLR Rebates in Response to the Coronavirus Disease 2019 (COVID-19) Public Health Emergency (PDF)
• June 23, 2020FAQs about Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act Implementation (set 43) (PDF)
• June 29, 2020Leveraging Existing Health and Disease Management Programs to Provide Mental Health and Substance Use Disorder Resources During the COVID-19 Public Health Emergency (PHE) (PDF)
• August 3, 2020 (Updated April 29, 2022)Risk Adjustment Telehealth and Telephone Services During COVID-19 FAQs (PDF)
• August 4, 2020Temporary Policy on 2020 Premium Credits Associated with the COVID-19 Public Health Emergency (PDF)
• August 25, 2020Technical Fact Sheet: CCIIO Premium Reductions: Medicare and Medicaid Programs, Clinical Laboratory Improvement Amendments (CLIA), and Patient Protection and Affordable Care Act; Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (PDF)
• August 25, 2020Medicare and Medicaid Programs, Clinical Laboratory Improvement Amendments (CLIA), and Patient Protection and Affordable Care Act; Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (PDF)
• October 28, 2020Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency Interim Final Rule (CMS-9912-IFC) (PDF)
• October 28, 2020COVID-19 Vaccines: Information for Providers, Health Insurance Issuers, State Medicaid Programs, and Children’s Health Insurance Programs (CHIP) and Basic Health Programs (BHP)
• January 7. 2021 (Updated)Toolkit on COVID-19 Vaccine: Health Insurance Issuers and Medicare Advantage Plans (PDF)
• February 26, 2021FAQs about Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act Implementation (set 44) (PDF) * Some of the guidance in FAQs Set 44 has been superseded by guidance contained in FAQs Set 50. ** The Provider Relief Fund, described in Q14 in FAQs set 44, no longer accepts claims for testing, treatment, or COVID-19 vaccination.
• May 6, 2021 (Updated April 29, 2022)Risk Adjustment Telehealth and Telephone Services During COVID-19 FAQs (PDF)
• August 16, 2021 (Updated—replaces the July 23. 2021 version)Toolkit on COVID-19 Vaccine: Health Insurance Issuers and Medicare Advantage Plans (PDF)
• November 1, 2021Temporary Policy on 2021 Premium Credits in the Small Group Market Only Associated with the COVID-19 Public Health Emergency (PDF)
• December 17, 2021 (Updated—replaces the August 16. 2021 version)Toolkit on COVID-19 Vaccine: Health Insurance Issuers and Medicare Advantage Plans (PDF)
• December 29, 2021 (Updated—replaces the December 17, 2021 version)Toolkit on COVID-19 Vaccine: Health Insurance Issuers and Medicare Advantage Plans (PDF)
• January 10, 2022FAQs about Affordable Care Act Implementation Part 51, Families First Coronavirus Response Act, and Coronavirus Aid, Relief, and Economic Security Act Implementation (PDF)
• January 10, 2022How to get your At-Home Over-The-Counter COVID-19 Test for Free
• February 4, 2022Families First Coronavirus Response Act and Coronavirus Aid, Relief, and Economic Security Act Implementation Part 52 (PDF)
• April 6, 2022 (updated)Toolkit on COVID-19 Vaccine: Health Insurance Issuers and Medicare Advantage Plans (PDF)
• April 29, 2022 (Replaces May 6, 2021 guidance)Risk Adjustment Telehealth and Telephone Services During COVID-19 FAQs (PDF) (PDF)

Affordable Care Act

FAQs

• September 20, 2010Affordable Care Act Implementation FAQs (Set 1) This set of FAQs addresses implementation topics including compliance, grandfathered health plans, claims, internal appeals and external review, dependent coverage of children, out-of-network emergency services, and highly compensated employees.
• October 8, 2010Affordable Care Act Implementation FAQs (Set 2) This set of FAQs addresses grandfathered health plans, dental and vision benefits, rescissions, preventive health services, and ACA effective date for individual health insurance policies.
• October 12, 2010Affordable Care Act Implementation FAQs (Set 3) This set of FAQs addresses the exemption for group health plans with less than two current employees.
• October 29, 2010Affordable Care Act Implementation FAQs (Set 4) This set of FAQs addresses grandfathered health plans.
• December 22, 2010Affordable Care Act Implementation FAQs (Set 5) This set of FAQs addresses a variety of ACA implementation topics, the HIPAA nondiscrimination and wellness program rules, and the Mental Health Parity and Addiction Equity Act of 2008.
• April 1, 2011Affordable Care Act Implementation FAQs (Set 6) This set of FAQs addresses grandfathered health plans.
• November 17, 2011Affordable Care Act Implementation FAQs (Set 7) This set of FAQs addresses the Summary of Benefits and Coverage and Uniform Glossary requirements of PHS Act §2715 and the Mental Health Parity and Addiction Equity Act of 2008.
• February 9, 2012Frequently Asked Questions from Employers Regarding Automatic Enrollment, Employer Shared Responsibility, and Waiting Periods (PDF – 93 KB) (PDF) This Bulletin provides information on questions from employers and other stakeholders regarding the provisions of the Affordable Care Act governing automatic enrollment, employer shared responsibility, and the 90-day limitation on waiting periods.
• March 19, 2012Affordable Care Act Implementation FAQs (Set 8) This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715. *Updated February 15, 2022
• May 11, 2012Affordable Care Act Implementation FAQs (Set 9) This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.
• August 7, 2012Affordable Care Act Implementation FAQs (Set 10) This FAQ addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.
• January 24, 2013Affordable Care Act Implementation FAQs (Set 11) This set of FAQs addresses the employer’s notice of coverage options, health reimbursement arrangements, disclosure of information related to firearms, employer group waiver plans supplementing Medicare Part D, fixed indemnity insurance and payment of PCORI fees. Related information: CMS Bulletin (PDF) on Non-Medicare Supplemental Drug Benefits. (**Note: See Technical Release 2013-03 for comprehensive guidance addressing health reimbursement arrangements that were issued after the date of these FAQs.).
• February 20, 2013Affordable Care Act Implementation FAQs (Set 12) This set of FAQs addresses limitations on cost-sharing under the ACA and coverage of preventive services under the ACA.
• March 8, 2013Affordable Care Act Implementation FAQs (Set 13) This set of FAQs addresses expatriate health plans.
• April 23, 2013Affordable Care Act Implementation FAQs (Set 14) This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.
• April 29, 2013Affordable Care Act Implementation FAQs (Set 15) This set of FAQs addresses annual limit waiver expiration date based on a change to a plan or policy year, provider non-discrimination, coverage for individuals participating in approved clinical trials and transparency reporting.
• September 4, 2013Affordable Care Act Implementation FAQs (Set 16) This set of FAQs addresses the employer notice of coverage options and the 90-day waiting period limitation.
• November 8, 2013Affordable Care Act Implementation FAQs (Set 17) This set of FAQs addresses the implementation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), as amended by the Affordable Care Act.
• January 9, 2014Affordable Care Act Implementation FAQs (Set 18) This set of FAQs addresses coverage of preventive services, limitations on cost-sharing, expatriate health plans, wellness programs, fixed indemnity insurance, and the Mental Health Parity and Addiction Equity Act of 2008.
• May 2, 2014Affordable Care Act Implementation FAQs (Set 19) This set of FAQs addresses updated DOL model notices, limitations on cost-sharing, coverage of preventive services, health FSA carryover and excepted benefits, and the Summary of Benefits and Coverage requirements of PHS Act §2715.
• July 17, 2014Affordable Care Act Implementation FAQs (Set 20) (PDF) This set of FAQs addresses coverage of preventive services.
• October 10, 2014Affordable Care Act Implementation FAQs (Set 21) (PDF) This set of FAQs addresses limitations on cost sharing under the ACA.
• November 6, 2014Affordable Care Act Implementation FAQs (Set 22) (PDF) This set of FAQs addresses compliance of premium reimbursement arrangements.
• February 13, 2015Affordable Care Act Implementation FAQs (Set 23) (PDF) This set of FAQs addresses excepted benefits.
• March 30, 2015Affordable Care Act Implementation FAQs (Set 24) This set of FAQs addresses proposed changes to the SBC regulations, as well as a new SBC template and associated documents.
• April 16, 2015Affordable Care Act Implementation FAQs (Set 25) (PDF) This set of FAQs addresses the wellness program requirements.
• May 11, 2015Affordable Care Act Implementation FAQs (Set 26) (PDF) This set of FAQs addresses coverage of preventive services.
• May 26, 2015Affordable Care Act Implementation FAQs (Set 27) (PDF) This set of FAQs addresses limitations on cost sharing and provider non-discrimination.
• August 11, 2015Affordable Care Act Implementation FAQs (Set 28) (PDF) This set of FAQs addresses transparency reporting for non-QHP issuers and non-grandfathered group health plans.
• October 23, 2015Affordable Care Act Implementation FAQs (Set 29) (PDF) This set of FAQs addresses coverage of preventive services, wellness programs, and the Mental Health Parity and Addiction Equity Act of 2008.
• March 11, 2016Affordable Care Act Implementation FAQs (Set 30) (PDF) This set of FAQs addresses the summary of benefits and coverage (SBC)
• April 20, 2016Affordable Care Act Implementation FAQs (Set 31) (PDF) This set of FAQs addresses coverage of preventive services, rescissions, out-of-network emergency services, coverage for individuals participating in approved clinical trials, limitations on cost-sharing under the Affordable Care Act, the Mental Health Parity and Addiction Equity Act and the Women’s Health and Cancer Rights Act.
• June 21, 2016Affordable Care Act Implementation FAQs (Set 32) (PDF) This set of FAQs addresses notice of coverage options – COBRA and the Health Insurance Marketplace.
• October 21, 2016Affordable Care Act Implementation FAQs (Set 33) (PDF)This set of FAQs addresses premium reduction arrangements for student health plan coverage
• October 27, 2016Affordable Care Act Implementation FAQs (Set 34) (PDF)This set of FAQs addresses coverage of preventive services under the Affordable Care Act and the Mental Health Parity and Addiction Equity Act
• December 20, 2016Affordable Care Act Implementation FAQs (Set 35) (PDF) This set of FAQs addresses special enrollment for group health plans, coverage of preventive services under the Affordable Care Act and qualified small employer health reimbursement arrangements.
• January 9, 2017Affordable Care Act Implementation FAQs (Set 36) (PDF) This set of FAQs addresses coverage of preventive services
• January 12, 2017Affordable Care Act Implementation FAQs (Set 37) (PDF) This set of FAQs addresses health reimbursement arrangements and Code section 162(m)(6).
• June 16, 2017Affordable Care Act Implementation FAQs (Set 38) (PDF) This set of FAQs addresses the Mental Health Parity and Addiction Equity Act and the 21st Century Cures Act. Related information: Draft MHPAEA Disclosure Template (PDF)
• April 23, 2018Affordable Care Act Implementation FAQs (Proposed Set 39) This proposed set of FAQs addresses the Mental Health Parity and Addiction Equity Act and the 21st Century Cures Act. Comments are requested by June 22, 2018.
• August 23, 2019Affordable Care Act Implementation FAQs (Set 40) (PDF) This set of FAQs addresses limitations on cost-sharing under the ACA.
• September 5, 2019Affordable Care Act Implementation FAQs (Final Set 39) (PDF) This set of FAQs addresses the Mental Health Parity and Addiction Equity Act and the 21st Century Cures Act. Related information: MHPAEA Disclosure Template (DOCX) (PDF)
• February 3, 2020Affordable Care Act Implementation FAQs (Set 41) (PDF) This set of FAQs addresses the Summary of Benefits and Coverage (SBC).
• April 11, 2020Families First Coronavirus Response Act and Coronavirus Aid, Relief, and Economic Security Act Implementation FAQs (Set 42) (PDF)This set of FAQs addresses the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act, and other topics related to COVID-19, including notice requirements, excepted benefits, and telehealth and other remote care services. *This document was updated on April 15, 2020, to correct an error in footnote 10 regarding the current end date of the public health emergency related to COVID-19. (PDF)
• June 23, 2020Families First Coronavirus Response Act and Coronavirus Aid, Relief, and Economic Security Act Implementation FAQs (Set 43) (PDF)This set of FAQs addresses the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act, and other topics related to COVID-19, including notice requirements, telehealth, and other remote care services, grandfathered health plans, the Mental Health Parity and Addiction Equity Act, wellness programs, and individual coverage health reimbursement arrangements.
• February 26, 2021Families First Coronavirus Response Act and Coronavirus Aid, Relief, and Economic Security Act Implementation FAQs (Set 44) (PDF) This set of FAQs addresses the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act, and other topics related to COVID-19, including notice requirements, excepted benefits, and the provider relief fund. * Some of the guidance in FAQs Set 44 has been superseded by guidance contained in FAQs Set 50. ** The Provider Relief Fund, described in Q14 in FAQs set 44, no longer accepts claims for testing, treatment, or COVID-19 vaccination.
• April 2, 2021Affordable Care Act Implementation FAQs (Set 45) (PDF) This set of FAQs addresses the Mental Health Parity and Addiction Equity Act and the Consolidated Appropriations Act, 2021.
• June 4, 2021Affordable Care Act Implementation FAQs (Set 46) (PDF) This set of FAQs addresses limitations on cost-sharing under the ACA.
• July 19, 2021Affordable Care Act Implementation FAQs (Set 47) (PDF) This set of FAQs addresses coverage of preventive services.
• August 16, 2021Affordable Care Act Implementation FAQs (Set 48) (PDF) This set of FAQs addresses coverage of preventive services
• August 20, 2021Affordable Care Act Implementation FAQs (Set 49) (PDF) This set of FAQs addresses implementation of the machine-readable files required under ACA price transparency provisions, internet-based self-service tool (or “price comparison tool”) under both ACA price transparency provisions and the Consolidated Appropriations Act, 2021 (CAA), and gag clause, provider directory, continuity of care, and pharmacy benefits and drug costs provisions of the CAA.
• October 4, 2021Affordable Care Act Implementation FAQs (Set 50) (PDF) This set of FAQs addresses rapid coverage of preventive services for coronavirus and HIPAA nondiscrimination and wellness programs.
• January 10, 2022FAQs about Affordable Care Act Implementation, Families First Coronavirus Response Act, and Coronavirus Aid, Relief, and Economic Security Act Implementation (Set 51) (PDF)This set of FAQs addresses rapid coverage of COVID-19 diagnostic testing and coverage of preventive services.
• February 4, 2022Families First Coronavirus Response Act and Coronavirus Aid, Relief, and Economic Security Act Implementation FAQs (Set 52) (PDF) This set of FAQs modifies and clarifies certain guidance questions from Set 51 regarding the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act.
• April 19, 2022Affordable Care Act Implementation FAQs (Set 53) (PDF) This set of FAQs addresses the machine-readable file requirements of the Transparency in Coverage Final Rules.
• July 28, 2022Affordable Care Act Implementation FAQs (Set 54) (PDF) The set of FAQs addresses coverage of preventive services.
• August 19, 2022FAQs about Affordable Care Act and Consolidated Appropriations Act, 2021 Implementation (Set 55) (PDF) This set of FAQs addresses implementation of the No Surprises Act and Transparency in Coverage machine-readable files.

Consumer Support and Information

Consumer Assistance Program Grants

Fact Sheets

• November 21, 2011State Consumer Assistance Program Participation in Exchange Core Area 10 (PDF)
• June 22, 2012New Funding Opportunity for Consumer Assistance Programs
• August 24, 2012Consumer Assistance Program Grants: Helping States Give Consumers Greater Control of their Health Care
• August 24, 2012Consumer Assistance Program Grants: How States Are Using New Resource to Give Consumers Greater Control of their Health Care

FAQs

• April 20, 2012CAP Limited Competition Funding Opportunity Announcement
• June 7, 2012New Consumer Assistance Programs Funding Opportunity for all States and Territories
• September 26, 2014CAP Limited Competition Funding Opportunity Announcement (PDF)

External Appeals

Fact Sheets

• June 22, 2011Affordable Care Act: Working with States to Protect Consumers
• June 19, 2012HHS-Administered Federal External Review Process
• July 24, 20132013 County Data for Culturally and Linguistically Appropriate Services (PDF) This Fact Sheet provides data so that group health plans and health insurance issuers offering non-grandfathered health coverage can determine the counties in which they are required to provide notices related to a consumer’s right to external review in a culturally and linguistically appropriate manner.
• December 12, 2014Culturally and Linguistically Appropriate Services (CLAS) County Data (PDF)

*Updated February 9,2015

Summary of Benefits and Coverage and Uniform Glossary

Fact Sheets

• August 17, 2011Providing Clear and Consistent Information to Consumers about Their Health Insurance Coverage
• July 24, 20132013 County Data for Culturally and Linguistically Appropriate Services (PDF) This Fact Sheet provides data so that group health plans and health insurance issuers offering health coverage can determine the counties in which they are required to provide the summary of benefits and coverage in a culturally and linguistically appropriate manner.
• December 12, 2104Culturally and Linguistically Appropriate Services (CLAS) County Data (PDF)* *Updated January 7, 2015
• December 22, 2014Proposed Summary of Benefits and Coverage and Uniform Glossary Rules (PDF)
• June 12, 2015Summary of Benefits and Coverage and Uniform Glossary Final Rule (PDF)
• January 27, 2016Culturally and Linguistically Appropriate Services (CLAS) County Data (PDF)

FAQs

• September 8, 2015SBC Online Posting of Policy and Certificate of Coverage (PDF)
• March 11, 2016FAQs Regarding the Summary of Benefits and Coverage (SBC) Related to Rate Filing and QHP Certification (PDF)
• July 8, 2016FAQs on the Summary of Benefit and Coverage Applicability Date (PDF)
• February 3, 2020FAQs on the Applicability Date of the Updated Summary of Benefits and Coverage Template, Calculator, and Related Materials (PDF)

Outreach and Education Resources

• September 29, 2011

Consumer Fact Sheets

• • Adding Adult Children to Your Health Plan (PDF – English 178 KB (PDF), Spanish 89 KB (PDF))
  • Curbing Insurance Cancellations (PDF – English 170 KB (PDF), Spanish 63 KB (PDF))
  • Eliminating Dollar Limits on Your Benefits (PDF – English 184 KB (PDF), Spanish 104 KB (PDF))
  • Getting Value for Your Premium Dollar (PDF – English 172 KB (PDF), Spanish 104 KB (PDF))
  • Lowering Your Cost for Preventive Services (PDF – English 353 KB (PDF), Spanish 111 KB (PDF))
  • Protecting Children With Pre-Existing Health Conditions (PDF – English 252 KB (PDF), Spanish 450 KB (PDF))
  • Protecting Your Choice of Health Care Providers (PDF – English 219 KB (PDF), Spanish 94 KB (PDF))
  • Are You in a Grandfathered Health Plan (PDF – English 307 KB (PDF), Spanish 57 KB (PDF))
  • Putting the Brakes on Unreasonable Health Insurance Rate Increases (PDF – English 77 KB (PDF), Spanish 63 KB (PDF))
• April 7, 2011

Consumer Posters and Brochures

• • State Consumer Assistance Poster (PDF – English 1 MB (PDF), Spanish 884 KB (PDF))
  • State Consumer Assistance Brochure (PDF – 2 MB) (PDF)

Language Access Taglines for Exchanges, Qualified Health Plan (QHP) Issuers, and Web-Brokers

FAQs

• August 10,2016Language Access Tagline Frequently Asked Questions (PDF)

Content Requirements for Plan Finder

Fact Sheets:

• May 1, 2011Establishing the Web Portal Called For in the Affordable Care Act (PDF – 115 KB) (PDF)

Pre-Existing Condition Insurance Plan (PCIP)

Fact Sheets

• July 29, 2010About the New Pre-Existing Condition Insurance Plan
• February 14, 2014State by State Enrollment in the Pre-Existing Condition Insurance Plan
• April 24, 2014Special Enrollment Period for Individuals Losing Coverage through the Pre-Existing Condition Insurance Program (PCIP) on April 30, 2014 (PDF)

FAQs

• May 8, 2013PCIP State Contracts and Extension

Health Insurance Marketplaces

Fact Sheets

• January 13, 2013State Health Insurance Marketplaces (List of Conditionally Approved Exchanges)
• May 31, 2013Progress Continues in Building ExchangesMarketplace Timeline (PDF – 240 KB) (PDF)Narrative Description of Marketplace Timeline (PDF – 204 KB) (PDF)
• June 14, 2013Notice of Proposed Rulemaking on Program Integrity
• June 24, 2013Marketplace Outreach Timeline (PDF)
• June 26, 2013HHS Final Rule and Treasury Notices on Individual Shared Responsibility Provision Exemptions, Minimum Essential Coverage, and Related Topics
• July 5, 2013Eligibility Final Rule: Strengthening Medicaid, The Children’s Health Insurance Program and The New Health Insurance Marketplace
• August 28, 2013Program Integrity Rule: Exchanges, SHOP, Eligibility Appeals: Safeguarding Federal Funds and Furthering Consumer Protection
• October 24, 2013Program Integrity Rule: Exchanges, Premium Stabilization Programs and Market Standards; Amendments to the HHS Notice of Benefit and Payment Parameters for 2014
• May 6, 2016Special Enrollment Periods and the Consumer Operated and Oriented Plan Program (PDF)
• December 12, 2016Pre-Enrollment Verification for Special Enrollment Periods (PDF)
• December 12, 2016Promoting Transparency and Appropriate Coverage for Dialysis Patients (PDF)
• November 7, 2018Fact Sheet for Exchange Program Integrity Proposed Rule (PDF)

FAQs

• November 29, 2011State Exchange Implementation Questions and Answers (PDF – 135 KB) (PDF)
• November 9, 2012Frequently Asked Questions on the Blueprint for Exchanges
• December 10, 2012Exchanges, Market Reforms and Medicaid Frequently Asked Questions (PDF – 356 KB) (PDF)
• March 29, 2013Frequently Asked Questions on Reuse of Exchange for Ancillary Products (PDF – 127 KB) (PDF)
• May 14, 2013Frequently Asked Questions on Health Insurance Marketplaces (PDF – 86 KB) (PDF)
• July 10, 2013Question and Answer on Assessment Fees Collected in a State-based Marketplace (PDF – 124 KB) (PDF)
• August 5, 2013Question and Answer on Health Insurance Marketplaces and Income Verification (PDF – 104 KB) (PDF)
• September 30, 2013Question and Answer on Members of Congress and Staff Accessing Coverage through Health Insurance Exchanges (Marketplaces) (PDF)
• October 28, 2013Question and Answer on Enrollment Period (PDF)
• November 4, 2013Question and Answer on Third Party Payments of Premiums for Qualified Health Plans in the Marketplaces (PDF)
• December 13, 2013Question and Answer on Choice of Methodology for Cost-Sharing Reduction Reconciliation (PDF)
• February 7, 2014Third Party Payments of Premiums for Qualified Health Plans in the Marketplaces (PDF)
• February 21, 2014*Question and Answer on Medicaid Managed Care Contractors Outreach to Former Enrollees (PDF) *Updated January 15, 2015
• May 9, 2014Question and Answer on Cost-Sharing Reductions for Contract Health Services (PDF)
• June 12, 2014Frequently Asked Questions on Essential Community Providers (PDF – 106 KB) (PDF)
• June 1, 2015Frequently Asked Questions on State-Based SHOP Direct Enrollment (PDF)
• July 28, 2015Frequently Asked Questions on State-based Marketplace Options for Implementing Exemptions from the Shared Responsibility Payment (PDF)
• September 18, 2015Frequently Asked Questions Regarding Agents and Brokers Operating in the SHOP Marketplace (PDF)
• September 18, 2015Frequently Asked Questions Regarding the Federally-Facilitated Marketplace’s (FFM) 2016 Employer Notice Program (PDF)
• October 23, 2015Frequently Asked Questions On The Applicability Of The Minimum Acceptable Risk Standards for Exchanges (MARS-E) 2.0 To Qualified Health Plan (QHP) Issuers (PDF)
• May 3, 2016Frequently Asked Questions on Incarceration and the Marketplace (PDF)
• July 21, 2016Frequently Asked Questions on Annual Income Threshold Adjustment (PDF)
• July 19, 2017Frequently Asked Questions Regarding Third-party Auditor Operational Readiness Reviews for the Proxy Direct Enrollment Pathway (PDF)
• June 20, 2018FAQs Regarding Spanish Translation and Audit Requirements for Enhanced Direct Enrollment (EDE) Entities Serving Consumers in States with FFEs (PDF)
• November 21, 2018FAQs for Agents, Brokers and Assisters Providing Consumers with Details on Plan Coverage of Certain Abortion Services (PDF)
• May 1, 20192019 Frequently Asked Questions on the Blueprint for Exchanges (PDF)
• May 8, 2019FAQ: Enhanced Direct Enrollment Calendar Year 2019 Timeline (Updated) (PDF)
• June 17, 2019Blueprint for Approval of State-Based Health Insurance Exchanges (PDF)
• August 2, 2019FAQ: Enhanced Direct Enrollment Calendar Year 2020 Timeline (PDF)
• November 5, 2019FAQ: Quality Rating Information Bulletin’s (Quality Bulletin’s) Display Guidelines for Direct Enrollment (DE) Entities (PDF)
• April 21, 2020FAQs on Issuer Flexibilities for Utilization Management and Prior Authorization (PDF)
• December 17, 2020FAQ: Medicare Periodic Data Matching
• December 29, 2020FAQ: Medicaid/CHIP Periodic Data Matching

In-Person Assistance

Fact Sheets

• June 10, 2014Helping Consumers Apply & Enroll Through the Marketplace (PDF – 213KB) (PDF)Navigator Funding Opportunity Announcement

FAQs

• April 9, 2013Frequently Asked Questions: Navigator Funding Opportunity AnnouncementOverview of Applying for the Cooperative Agreement to Support Navigators in Federally-facilitated and State Partnership Marketplaces (PDF – 381 KB) (PDF)

Plan Management

Fact Sheets

• February 20, 2013Essential Health Benefits Standards: Ensuring Quality, Affordable Coverage
• November 27, 20172019 Draft Annual Letter to Issuers for 2019

FAQs

• February 17, 2012Frequently Asked Questions on the Essential Health Benefits Bulletin (PDF – 88 KB) (PDF)
• February 20, 2013State Evaluation of Plan Management Activities of Health Plans and Issuers (PDF – 35 KB) (PDF)
• August 8, 2016Auto Re-enrollment for QHPs no longer available in the Marketplace (PDF)
• October 14, 2016Frequently Asked Questions on Health Insurance Marketplace Standards (PDF)
• December, 16, 2016Second Lowest Cost Silver Plan Technical FAQs (PDF)
• December 23, 2016FAQ on Compliance Safe Harbor for Issuers Affected by the Extension of the Enrollment Deadline to December 19, 2016 (PDF)
• January 3, 2017Frequently Asked Questions on Medicaid Managed Care Organizations (PDF)
• January 19, 2017Machine-Readable FAQ for FF-SHOP QHPs (PDF)
• April 13, 2017FAQ on Compliance Standard for Issuers in Federally-facilitated Marketplaces (PDF)
• October 23, 2018FAQ on Defrayal of State Required Additional Benefits (PDF)
• December 14, 2018Reminders to Qualified Health Plan Issuers: CMS QHP Agreement Requirements for PII Breach and Security Incident Reporting (PDF)
• March 12, 2020FAQs on Essential Health Benefits Coverage and the Coronavirus (COVID-19) (PDF)

Exchange Planning and Establishment Grants

Fact Sheets

• July 29, 2010Health Insurance Exchanges: State Planning and Establishment Grants – Opens in a new window
• January 20, 2011Health Insurance Exchange Establishment Grants Fact Sheet – Opens in a new window
• November 21, 2011State Consumer Assistance Program Participation in Exchange Core Area 10 (PDF)
• January 22, 2014Creating a New Competitive Marketplace: Health Insurance Exchange Establishment Grants Awards List

FAQs

• June 29, 2012Exchange Establishment Cooperative Agreement Funding FAQs
• November 9, 2012Consolidated Exchange Establishment Cooperative Agreement Funding FAQs This page contains information from the funding opportunity announcement and frequently asked questions from applicants.
• April 23, 2013Using Section 1311(a) Funding for Marketing Activities in a Plan Management State Partnership Marketplace or Federally-facilitated Marketplace
• May 13, 2013Allowable Uses of Section 1311 Funding for States in a State Consumer Partnership Marketplace
• May 13, 2013Allowable Uses of Section 1311 Funding for States in a State Partnership Marketplace or in States with a Federally-Facilitated Marketplace
• December 5, 2013Frequently Asked Questions on Use of 1311 funding for Change Orders and Congressional Inquiries
• December 30, 2013State-based Marketplaces (SBMs): Frequently Asked Questions on the State-based Marketplace Annual Reporting Tool (SMART) (PDF)
• February 27, 2014CMS Bulletin to Marketplaces on Availability of Retroactive Advance Payments of the PTC and CSRs in 2014 Due to Exceptional Circumstances (DOCX)
• March 14, 2014Use of 1311 Funds and No Cost Extensions (PDF)
• September 19, 2014(PDF) (PDF)The Use of 1311 Funds, Project Periods, and Updating the Cost Allocation Methodology (PDF)
• June 8, 2015(PDF) (PDF)Clarification of the Use of 1311 Funds for Establishment Activities (PDF)

Early Innovator Grants

Fact Sheets

• February 16, 2011States Leading the Way on Implementation: HHS Awards “Early Innovator” Grants to Seven States

Territory Cooperative Agreements

FAQs

• February 15, 2011Territory Cooperative Agreements for the Affordable Care Act’s Exchanges

Premium Stabilization Programs

Fact Sheets

• November 30, 2012Technical Fact Sheet: Draft Notice of Payment and Benefit Parameters (PDF – 117 KB) (PDF)
• March 1, 2013HHS Notice of Benefit and Payment Parameters
• March 11, 2013Technical Fact Sheet: HHS Notice of Benefit and Payment Parameters for 2014 (PDF – 234 KB) (PDF)
• November 25, 2013Proposed 2015 HHS Notice of Benefit and Payment Parameters
• November 21, 2014Proposed 2016 HHS Notice of Benefit and Payment Parameters Fact Sheet (PDF)
• February 20, 2015Final 2016 HHS Notice of Benefit and Payment Parameters Fact Sheet (PDF)
• November 20, 2015Proposed 2017 HHS Notice of Benefit and Payment Parameters Fact Sheet (PDF)
• February 29, 2016Final 2017 HHS Notice of Benefit and Payment Parameters Fact Sheet (PDF)
• August 29, 2016Proposed 2018 HHS Notice of Benefit and Payment Parameters Fact Sheet (PDF)
• December 16, 2016Final 2018 HHS Notice of Benefit and Payment Parameters Fact Sheet (PDF)
• October 27, 2017Proposed 2019 HHS Notice of Benefit and Payment Parameters Fact Sheet (PDF)
• January 17, 2019Proposed 2020 HHS Notice of Benefit and Payment Parameters Fact Sheet (PDF)
• April 18, 2019Final 2020 HHS Notice of Benefit and Payment Parameters Fact Sheet (PDF)
• January 31, 2020Proposed 2021 HHS Notice of Benefit and Payment Parameters Fact Sheet (PDF)
• May 7, 2020Final 2021 HHS Notice of Benefit and Payment Parameters Fact Sheet (PDF)
• August 25, 2020Technical Fact Sheet: CCIIO Premium Reductions: Medicare and Medicaid Programs, Clinical Laboratory Improvement Amendments (CLIA), and Patient Protection and Affordable Care Act; Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (PDF)
• August 25, 2020Medicare and Medicaid Programs, Clinical Laboratory Improvement Amendments (CLIA), and Patient Protection and Affordable Care Act; Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency (PDF)
• November 25, 2020Proposed 2022 HHS Notice of Benefit and Payment Parameters Fact Sheet (PDF)
• January 14, 2021Final 2022 HHS Notice of Benefit and Payment Parameters Fact Sheet (PDF)

FAQs

• September 12, 2011Questions and Answers on Risk Adjustment White Paper
• November 8, 2013Question and Answer on Submission of Reinsurance Enrollment Count (PDF) (PDF – 127 KB)
• April 11, 2014Question and Answer on Budget Neutrality for the Risk Corridors (PDF)
• May 22, 2014Questions and Answers on Reinsurance Contributions Process (PDF)
• June 8, 2016Questions and Answers from the March 31, 2016, HHS-Operated Risk Adjustment Methodology Meeting (PDF)
• July 26, 2016Deadline for Submission of MLR and Risk Corridors Data for the 2015 Benefit Year (PDF)
• August 22, 2016FAQs for Federally-facilitated Marketplace (FFM) User Fee Adjustment Submission Requirements (PDF)
• October 27, 2017FAQs for Federally-facilitated Exchange (FFE) User Fee Adjustment Submission Requirements Benefit Year 2016 (PDF)
• May 7, 2018FAQs for Federally-facilitated Exchange (FFE) User Fee Adjustment Submission Requirements Benefit (PDF)
• April 8, 2019FAQs for 2018 Benefit Year Cost-sharing Reduction (CSR) Data Submission (PDF)
• May 8, 2019FAQs for Federally-facilitated Exchange (FFE) User Fee Adjustment Submission (PDF) This set of FAQs addresses the federally-facilitated exchange (FFE) User Fee Adjustment submission process and is intended to assist issuers and TPAs (including PBMs) with navigating the submission requirements and understanding the mechanism through which CMS will apply the FFE user fee adjustment to FFE issuers.
• April 24, 2020FAQs for 2019 Benefit Year Cost-sharing Reduction (CSR) Data Submission (PDF)
• April 13, 2021FAQs for 2020 Benefit Year Cost-sharing Reduction (CSR) Data Submission (PDF)

Consumer Operated and Oriented Plan (CO-OP) Program

FAQs

• October 11, 2011Frequently Asked Questions regarding the CO-OP Program FOA
• January 27, 2016Frequently Asked Questions regarding the CO-OP Program (PDF)

Fact Sheets

• December 8, 2011New Federal Loan Program Helps Nonprofits Create Customer-Driven Health Insurers
• September 26, 2014CO-OP Awardees Announced

Other Insurance Protections

COBRA

Fact Sheets

• October 17, 2012COBRA Continuation Coverage

FAQs

• October 19, 2011COBRA Continuation Coverage Questions and Answers

Mental Health Parity

Fact Sheets

• October 25, 2011Mental Health Parity and Addiction Equity Act
• October 27, 2016Final Report of President Obama’s Mental Health and Substance Use Disorder Parity Task Force
• October 27, 2016Factsheet: Mental Health and Substance Use Disorder Parity Task Force Announces New Actions and Recommendations
• October 27, 2016Compliance Assistance Materials Index (PDF)

FAQs

• December 22, 2010Mental Health Parity Implementation (ACA FAQs Set 5)
• November 17, 2011Mental Health Parity Implementation (ACA FAQs Set 7)
• November 8, 2013Mental Health Parity Implementation (ACA FAQs Set 17)
• January 9, 2014Mental Health Parity Implementation (ACA FAQs Set 18)
• October 23, 2015Mental Health Parity Implementation (ACA FAQs Set 29) (PDF)
• April 20, 2016Mental Health Parity Implementation (ACA FAQs Set 31) (PDF)
• October 27, 2016Mental Health Parity Implementation (ACA FAQs Set 34) (PDF)
• June 16, 2017Mental Health Parity Implementation (ACA FAQs Set 38) (PDF) Related information: Draft MHPAEA Disclosure Template (PDF)
• April 23, 2018Mental Health Parity Implementation (ACA FAQs Set 39 – Proposed)
• September 5, 2019Mental Health Parity Implementation (ACA FAQs Set 39 – Final) (PDF) Related information: MHPAEA Disclosure Template (DOCX) (PDF)
• April 2, 2021Mental Health Parity Implementation (ACA FAQs Set 45) (PDF)

Newborns’ and Mothers Health Protection

Fact Sheets

• January 30, 2012Newborns’ and Mothers’ Health Protection Act of 1996 (NMHPA)

Women’s Health and Cancer Rights

Fact Sheets

• January 30, 2012Women’s Health and Cancer Rights Act of 1998 (WHCRA)

Health Insurance Market Reforms

Fact Sheets

• November 20, 2012Technical Fact Sheet: Proposed Rule for Health Insurance Market Reforms (PDF – 128 KB) (PDF)
• February 22, 2013Final Rule for Health Insurance Market Reforms
• February 27, 2013Technical Fact Sheet: Health Insurance Market Reforms (PDF – 75 KB) (PDF)
• March 15, 2013Ensuring Health Insurance Protections for Consumers
• March 14, 2014Exchange and Insurance Market Standards for 2015 and Beyond and Final 2015 Letter to Issuers in the Federally-facilitated Marketplace
• May 16, 2014Exchange and Insurance Market Standards for 2015 and Beyond

FAQs

• April 26, 2013Questions and Answers Related to the Health Insurance Market Reforms
• May 16, 2014Frequently Asked Questions on Health Insurance Market Reforms and Marketplace Standards (PDF)
• June 3, 2014Frequently Asked Question on Qualified Health Plans and Guaranteed Availability Standards (PDF)
• April 16, 2015Frequently Asked Questions on Health Insurance Market Reforms and Wellness Programs (PDF)
• June 15, 2015Frequently Asked Questions on Uniform Modification and Plan/Product Withdrawal (PDF)
• October 19, 2015Frequently Asked Questions on the Impact of PACE Act on State Small Group Expansion (PDF) *Updated December 17, 2015
• February 29, 2016Frequently Asked Questions on the 2017 Moratorium on Health Insurance Provider Fee (PDF)
• May 26, 2016Frequently Asked Question on Health Insurance Market Reforms and Marketplace Standards (PDF)
• December 16, 2016Frequently Asked Questions on Agent/Broker Compensation and Discriminatory Marketing Practices (PDF)
• June 7, 2022Frequently Asked Questions on Agent/Broker Compensation and Guaranteed Availability of Coverage (PDF)

Annual Limits

FAQs

• February 10, 2012Questions and Answers Related to Annual Limit Waivers

Coverage for Young Adults

Fact Sheets

• April 20, 2010Young Adults and the Affordable Care Act: Protecting Young Adults and Eliminating Burdens on Families and Businesses

FAQs

• June 29, 2010Young Adults and the Affordable Care Act: Protecting Young Adults and Eliminating Burdens on Businesses and Families

Grandfathered Plans

Fact Sheets

• November 17, 2010Amendment to Regulation on “Grandfathered” Health Plans under the Affordable Care Act

Medical Loss Ratio

Fact Sheets

• November 22, 2010Medical Loss Ratio: Getting Your Money’s Worth on Health Insurance
• December 2, 2011Medical Loss Ratio: Final Rule
• February 16, 2012Potential Estimated Rebates Saved by HHS Determinations on State MLR Adjustment Applications
• November 30, 2012Technical Fact Sheet: Draft Notice of Payment and Benefit Parameters (PDF – 117 KB) (PDF)

Prevention

Fact Sheets

• June 28, 2013Women’s Preventive Services Coverage and Non-Profit Religious Organizations

Review of Insurance Rates

Fact Sheets

• December 21, 2010Shining a Light on Health Insurance Rate Increases
• February 24, 2011Nearly $200 Million Available to Help States Fight Health Insurance Premium Increases
• May 19, 2011Fighting Unreasonable Health Insurance Premium Increases
• September 20, 2011Over $100 Million to Help States Crack Down on Unreasonable Health Insurance Rate Hikes
• September 21, 2012Rate Review Grant Map: State-by-State Summary of Rate Review Grants
• November 20, 2012Technical Fact Sheet: Proposed Effective Rate Review Rule Changes for Health Insurance Market Reforms (PDF – 70 KB) (PDF)
• May 3, 2013States with Effective Rate Review Programs

FAQs

• June 7, 2010Premium Review Grant Solicitations: FAQs
• July 1, 2010Grant Proposals: FAQs
• August 22, 2011Rate Review Training: Technical FAQs – Set 1
• October 24, 2011Rate Review Training: Technical FAQs – Set 2
• May 8, 2013Rate Review Grants: Cycle III funding opportunity FAQs – Set 1
• June 6, 2013Rate Review Grants: Cycle III funding opportunity FAQs – Set 2

Student Health Plans

Fact Sheet

• February 9, 2011Improving Health Insurance Protections for Students
• March 16, 2012Student Health Plans Final Rule

FAQs

• March 9, 2011Status of Student Health Insurance Coverage with Policy Years Starting Prior to January 1, 2012

Self-Funded, Non-Federal Governmental Plans

Fact Sheet

• July 18, 2014Self-Funded Non-Federal Governmental Plans