Qhpcertification.cms.gov

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Welcome to the Qualified Health Plan Website

WEBAs defined in the Affordable Care Act (ACA), a qualified health plan (QHP) is an insurance plan that is certified by the Health Insurance Marketplace, provides essential health …

Actived: 2 days ago

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

Plans and Benefits

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

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ECP and Network Adequacy

WEBQHP issuers are also required to maintain a network that is sufficient in number and types of providers, including providers that specialize in mental health and substance use …

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Application Instructions

WEBPY2024 Qualified Health Plan Issuer Application Instructions ( Updated 7/21/2023) Microsoft Excel Trusted Locations. Each year, CMS makes various Excel-based QHP …

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Submission Systems

WEBHIOS is the system that aggregates QHP Application data. Issuers in Federally-facilitated Exchange (FFE) states submit the majority of their QHP Application materials through …

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Marketplace Quality Initiatives FAQs

WEBMarketplace Quality Initiatives FAQs QHP Issuer Patient Safety. Q1: How can QHP issuers and hospitals meet the patient safety standards requirements outlined in 45 CFR …

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About the Marketplace

WEBAbout the Marketplace. This section contains information about the Health Insurance Marketplace. Click the links below or to the left to be directed to the specific webpages.

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Qualified Health Plan Issuer Application Instructions …

WEB1 2022 QHP Application Instructions Introduction: Qualified Health Plans for 2022 As defined in the Patient Protection and Affordable Care Act (PPACA) , a qualified health …

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Accreditation FAQs

WEB2025 and onwards. 2026 and onwards. • Issuer must be accredited by a recognized AE to be eligible for QHP certification. • Accreditation is required 90 days prior to Open …

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New to the Exchange

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

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Essential Health Benefits RX Crosswalk Methodology for Plan …

WEBEssential Health Benefits RX Crosswalk Methodology for Plan Year 2025 Pursuant to 45 CFR 156.122, to satisfy the requirement to offer essential health benefits (EHB), health …

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QHP Agreement and Plan Confirmation

WEBQHP Agreement and Plan Confirmation. As part of the QHP certification process, issuers must complete plan confirmation to submit their final plan offering decisions to CMS. On …

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Qualified Health Plan Issuer Application Instructions

WEBOpen a blank sheet in Excel (no template or file). The Excel ribbon should not have a Plans & Benefits. ribbon. If the Plans & Benefits ribbon appears, go to File > Options > Add-Ins …

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Plans and Benefits FAQs

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

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QHP Issuer Compliance Plan and Organizational Chart

WEBThis initial evaluation and review cover sheet will be used to evaluate the adequacy of the Compliance Plan and Organizational Chart and will assist in the ongoing monitoring of …

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Qualified Health Plan Issuer Application Instructions PY2025

WEBQualified Health Plan Issuer Application Instructions Plan Year 2025 April 2024

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Unique Plan Design—Supporting Documentation and …

WEB2 of 2 2025 QHP Application Instructions . If the method described in CFR 156.135(b)(3) was used, a description of the data and method used to develop the adjustments:

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Essential Community Providers and Network Adequacy FAQs

WEBFor the purposes of network adequacy, CMS is defining telehealth as “professional consultations, office visits, and office psychiatry services through brief communication …

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Internal Questions and Answers for Clearance Template

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

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Qualified Health Plan Issuer Application Instructions

WEBThe Check AV Calc procedure on the Plans and Benefits ribbon allows the user to calculate AVs for all applicable plans. Step 1 . Select the relevant Cost Share Variances …

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Qualified Health Plan Issuer Application Instructions

WEB2G-2 2025 QHP Application Instructions. Tips for the Service Area Section If the issuer offers plans in the Individual and Small Business Health Options Program (SHOP) …

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Discrimination—Treatment Protocol Supporting …

WEB1 of 1 2025 QHP Application Instructions Discrimination—Treatment Protocol Supporting Documentation and Justification Issuers must use a separate form for each correction …

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EHB-Substituted Benefit (Actuarial Equivalent) Supporting …

WEB1 of 2 2025 QHP Application Instructions EHB-Substituted Benefit (Actuarial Equivalent) Supporting Documentation and Justification Issuers should use this form if they are …

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