Exchange Functions in the Individual Market: Eligibility Determinations for Exchange Participation and Insurance Affordability Programs

  1. Law
  2. CFR 45
  3. Public Welfare
  4. Department of Health and Human Services
  5. Requirements Relating to Health Care Access
  6. Exchange Establishment Standards and Other Related Standards Under the Affordable Care Act
  7. Exchange Functions in the Individual Market: Eligibility Determinations for Exchange Participation and Insurance Affordability Programs

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Section
155.300

Definitions and general standards for eligibility determinations.

Section
155.302

Options for conducting eligibility determinations.

Section
155.305

Eligibility standards.

Section
155.310

Eligibility process.

Section
155.315

Verification process related to eligibility for enrollment in a QHP through the Exchange.

Section
155.320

Verification process related to eligibility for insurance affordability programs.

Section
155.330

Eligibility redetermination during a benefit year.

Section
155.335

Annual eligibility redetermination.

Section
155.340

Administration of advance payments of the premium tax credit and cost-sharing reductions.

Section
155.345

Coordination with Medicaid, CHIP, the Basic Health Program, and the Pre-existing Condition Insurance Plan.

Section
155.350

Special eligibility standards and process for Indians.

Section
155.355

Right to appeal.