Fact Sheets & Frequently Asked Questions (FAQs)

Coronavirus Disease 2019 (COVID-19)
Affordable Care Act
Consumer Support and Information
Content Requirements for Plan Finder
Pre-Existing Condition Insurance Plan (PCIP)
Health Insurance Marketplaces
Premium Stabilization Programs
Consumer Operated and Oriented Plan (CO-OP) Program
Other Insurance Protections
Health Insurance Market Reforms

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

Coronavirus Disease 2019 (COVID-19) Guidance

FAQs

March 5, 2020
Information Related to COVID–19 Individual and Small Group Market Insurance Coverage (PDF)
March 12, 2020
FAQs on Essential Health Benefits Coverage and the Coronavirus (COVID-19) (PDF)
March 18, 2020
FAQs on Catastrophic Plan Coverage and the Coronavirus Disease 2019 (COVID-19) (PDF)
March 24, 2020
FAQs on Availability and Usage of Telehealth Services through Private Health Insurance Coverage in Response to Coronavirus Disease 2019 (COVID-19) (PDF)
March 24, 2020
Payment and Grace Period Flexibilities Associated with the COVID-19 National Emergency (PDF)
March 24, 2020
FAQs 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.
April 13, 2020
Postponement of 2019 Benefit Year HHS-operated Risk Adjustment Data Validation (HHS-RADV) (PDF)
April 18, 2020
COVID-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, 2020
FAQs on Issuer Flexibilities for Utilization Management and Prior Authorization (PDF)
April 27, 2020
Risk Adjustment Telehealth and Telephone Services During COVID-19 (PDF)
This guidance document was updated by the below April 11, 2023, Risk Adjustment Telehealth and Telephone Services During COVID-19 FAQs.
May 12, 2020
Quality 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, 2020
Temporary 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, 2020
Letter to Sponsors of non-Federal Governmental Plans Regarding COVID-19 Guidance (PDF)
June 12, 2020
Temporary 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, 2020
FAQs about Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act Implementation (set 43) (PDF)
June 29, 2020
Leveraging 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
Risk Adjustment Telehealth and Telephone Services During COVID-19 FAQs (PDF)
This guidance document was updated by the below April 11, 2023, Risk Adjustment Telehealth and Telephone Services During COVID-19 FAQs.
August 4, 2020
Temporary Policy on 2020 Premium Credits Associated with the COVID-19 Public Health Emergency (PDF)
August 25, 2020
Technical 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, 2020
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)
October 28, 2020
Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency Interim Final Rule (CMS-9912-IFC) (PDF)
October 28, 2020
COVID-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, 2021
FAQs 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
Risk Adjustment Telehealth and Telephone Services During COVID-19 FAQs (PDF)
This guidance document was updated by the below April 11, 2023, Risk Adjustment Telehealth and Telephone Services During COVID-19 FAQs.
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, 2021
Temporary 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, 2022
FAQs 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, including contraceptive services.
January 10, 2022
How to get your At-Home Over-The-Counter COVID-19 Test for Free
February 4, 2022
Families First Coronavirus Response Act and Coronavirus Aid, Relief, and Economic Security Act Implementation (Set 52) (PDF)
April 6, 2022
Toolkit on COVID-19 Vaccine: Health Insurance Issuers and Medicare Advantage Plans (PDF)
April 29, 2022
Risk Adjustment Telehealth and Telephone Services During COVID-19 FAQs (PDF) (PDF)
This guidance document was updated by the below April 11, 2023, Risk Adjustment Telehealth and Telephone Services During COVID-19 FAQs.
March 29, 2023
FAQs about Families First Coronavirus Response Act, Coronavirus Aid, Relief, and Economic Security Act and Health Insurance Portability and Accountability Act Implementation (Set 58) (PDF)
April 11, 2023
Risk Adjustment Telehealth and Telephone Services During COVID-19 FAQs (PDF)
This guidance document replaces previous Risk Adjustment Telehealth and Telephone Services During COVID-19 FAQs listed above.
April 13, 2023
FAQs about Affordable Care Act and Coronavirus Aid, Relief, and Economic Security Act Implementation (Set 59) (PDF)
May 13, 2024
Risk Adjustment Telehealth and Audio-only Services FAQ (PDF)
This guidance document replaces previous Risk Adjustment Telehealth and Telephone Services During COVID-19 FAQs listed above.

Affordable Care Act

FAQs

September 20, 2010
Affordable 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, 2010
Affordable 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, 2010
Affordable 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, 2010
Affordable Care Act Implementation FAQs (Set 4)
This set of FAQs addresses grandfathered health plans.
December 22, 2010
Affordable 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, 2011
Affordable Care Act Implementation FAQs (Set 6)
This set of FAQs addresses grandfathered health plans.
November 17, 2011
Affordable 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, 2012
Frequently 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, 2012
Affordable 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, 2012
Affordable Care Act Implementation FAQs (Set 9)
This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.
August 7, 2012
Affordable Care Act Implementation FAQs (Set 10)
This FAQ addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.
January 24, 2013
Affordable 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, 2013
Affordable 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, 2013
Affordable Care Act Implementation FAQs (Set 13)
This set of FAQs addresses expatriate health plans.
April 23, 2013
Affordable Care Act Implementation FAQs (Set 14)
This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.
April 29, 2013
Affordable 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, 2013
Affordable 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, 2013
Affordable 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, 2014
Affordable 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, 2014
Affordable 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, 2014
Affordable Care Act Implementation FAQs (Set 20) (PDF)
This set of FAQs addresses coverage of preventive services.
October 10, 2014
Affordable Care Act Implementation FAQs (Set 21) (PDF)
This set of FAQs addresses limitations on cost sharing under the ACA.
November 6, 2014
Affordable Care Act Implementation FAQs (Set 22) (PDF)
This set of FAQs addresses compliance of premium reimbursement arrangements.
February 13, 2015
Affordable Care Act Implementation FAQs (Set 23) (PDF)
This set of FAQs addresses excepted benefits.
March 30, 2015
Affordable 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, 2015
Affordable Care Act Implementation FAQs (Set 25) (PDF)
This set of FAQs addresses the wellness program requirements.
May 11, 2015
Affordable Care Act Implementation FAQs (Set 26) (PDF)
This set of FAQs addresses coverage of preventive services.
May 26, 2015
Affordable Care Act Implementation FAQs (Set 27) (PDF)
This set of FAQs addresses limitations on cost sharing and provider non-discrimination.
August 11, 2015
Affordable 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, 2015
Affordable 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, 2016
Affordable Care Act Implementation FAQs (Set 30) (PDF)
This set of FAQs addresses the summary of benefits and coverage (SBC)
April 20, 2016
Affordable 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, 2016
Affordable Care Act Implementation FAQs (Set 32) (PDF)
This set of FAQs addresses notice of coverage options – COBRA and the Health Insurance Marketplace.
October 21, 2016
Affordable Care Act Implementation FAQs (Set 33) (PDF)
(PDF) (PDF)This set of FAQs addresses premium reduction arrangements for student health plan coverage
October 27, 2016
Affordable Care Act Implementation FAQs (Set 34) (PDF)
(PDF) (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, 2016
Affordable 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, 2017
Affordable Care Act Implementation FAQs (Set 36) (PDF)
This set of FAQs addresses coverage of preventive services
January 12, 2017
Affordable Care Act Implementation FAQs (Set 37) (PDF)
This set of FAQs addresses health reimbursement arrangements and Code section 162(m)(6).
June 16, 2017
Affordable 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, 2018
Affordable 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, 2019
Affordable Care Act Implementation FAQs (Set 40) (PDF)
This set of FAQs addresses limitations on cost-sharing under the ACA.
September 5, 2019
Affordable 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) (PDF)
February 3, 2020
Affordable Care Act Implementation FAQs (Set 41) (PDF)
This set of FAQs addresses the Summary of Benefits and Coverage (SBC).
April 11, 2020
Families 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.
June 23, 2020
Families 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.
*Some of the guidance in FAQs Set 43 has been superseded by guidance contained in FAQs Set 51.
February 26, 2021
Families 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, 2021
Affordable 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, 2021
Affordable Care Act Implementation FAQs (Set 46) (PDF)
This set of FAQs addresses limitations on cost-sharing under the ACA.
July 19, 2021
Affordable Care Act Implementation FAQs (Set 47) (PDF)
This set of FAQs addresses coverage of preventive services.
August 16, 2021
Affordable Care Act Implementation FAQs (Set 48) (PDF)
This set of FAQs addresses coverage of preventive services
August 20, 2021
Affordable 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.
*Some of the guidance in FAQs Set 49 has been superseded by guidance contained in FAQs Set 61. This FAQ was updated on September 28, 2023, to include a link to FAQs Set 61.
October 4, 2021
Affordable 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, 2022
FAQs 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.
*Some of the guidance in FAQs Set 51 has been superseded by guidance contained in FAQs Set 52.
February 4, 2022
Families First Coronavirus Response Act and Coronavirus Aid, Relief, and Economic Security Act Implementation FAQs (Set 52) (PDF)
This set of FAQs address coverage of COVID-19 diagnostic testing.
April 19, 2022
Affordable Care Act Implementation FAQs (Set 53) (PDF)
This set of FAQs addresses Transparency in Coverage machine-readable files.
*Some of the guidance in FAQs Set 53 has been superseded by guidance contained in FAQs Set 61. This FAQ was updated on September 28, 2023, to include a link to FAQs Set 61.
July 28, 2022
Affordable Care Act Implementation FAQs (Set 54) (PDF)
The set of FAQs addresses preventive services requirements for contraceptive coverage.
August 19, 2022
FAQs 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.
*Some of the guidance in FAQs Set 55 is affected by the decision in Texas Medical Association, et al. v. U.S. Department of Health and Human Services, et al., Case No. 6:22-cv-450-JDK (TMA III). See FAQs Set 62 and FAQs Set 67 for guidance on the relevant provisions in light of this court decision.
December 23, 2022
FAQs about Affordable Care Act and Consolidated Appropriations Act, 2021 Implementation (Set 56) (PDF)
This set of FAQs addresses reporting of prescription drug and health care spending.
February 23, 2023
FAQs about Consolidated Appropriations Act, 2021 Gag Clause Implementation (Set 57) (PDF)
This set of FAQs addresses the gag clause prohibition provisions, including the attestation requirement.
March 29, 2023
FAQs about Families First Coronavirus Response Act, Coronavirus Aid, Relief, and Economic Security Act and Health Insurance Portability and Accountability Act Implementation (Set 58) (PDF)
This set of FAQs addresses coverage of COVID-19 diagnostic testing, vaccines, extension of timeframes, and special enrollment periods.
April 13, 2023
FAQs about Affordable Care Act and Coronavirus Aid, Relief, and Economic Security Act Implementation (Set 59) (PDF)
This set of FAQs addresses coverage of preventive services in light of the court decision in Braidwood Management Inc. v. Becerra.
July 7, 2023
FAQs about Affordable Care Act and Consolidated Appropriations Act, 2021 Implementation (Set 60) (PDF)
This set of FAQs addresses the No Surprises Act, limitations on cost sharing under the ACA, and transparency in coverage with regard to facility fees under the ACA and the No Surprises Act.
September 27, 2023
Affordable Care Act Implementation (Set 61) (PDF)
This set of FAQs addresses the Transparency in Coverage rules.
October 6, 2023
FAQs about Consolidated Appropriations Act, 2021 Implementation (Set 62) (PDF)
This set of FAQs addresses implementation of the No Surprises Act in light of the court decision in Texas Medical Association et al. v. U.S. Department of Health and Human Services et al. (TMA III).
*Some of the guidance in FAQs Set 62 has been superseded by guidance contained in FAQs Set 67.
November 28, 2023
FAQs about Affordable Care Act and Consolidated Appropriations Act, 2021 Implementation (Set 63) (PDF)
This set of FAQs addresses the Culturally and Linguistically Appropriate Services (CLAS) County Data and the No Surprises Act.
January 22, 2024
Affordable Care Act Implementation FAQs (Set 64) (PDF)
This set of FAQs addresses the preventive services requirements for contraceptive coverage.
February 2, 2024
Affordable Care Act Implementation (Set 65) (PDF)
This set of FAQs addresses Transparency in Coverage rules.
April 2, 2024
Affordable Care Act Implementation FAQs (Set 66) (PDF)
This set of FAQs addresses the prohibition on lifetime and annual limits and the annual limitation on cost sharing under the ACA.
May 1, 2024
FAQ about Consolidated Appropriations Act, 2021 Implementation (Set 67) (PDF)
This set of FAQs addresses implementation of the No Surprises Act in light of the court decision in Texas Medical Association et al. v. U.S. Department of Health an Human Services et al. (TMA III).
October 21, 2024
FAQs about Affordable Care Act and Women’s Health and Cancer Rights Act Implementation (Set 68) (PDF)
This set of FAQs addresses coverage of preventive services under the Affordable Care Act and coverage requirements under the Women's Health and Cancer Rights Act.

Consumer Support and Information

Consumer Assistance Program Grants

Fact Sheets

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

FAQs

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

External Appeals

Fact Sheets

June 22, 2011
Affordable Care Act: Working with States to Protect Consumers
June 19, 2012
HHS-Administered Federal External Review Process
July 24, 2013
2013 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, 2014
Culturally and Linguistically Appropriate Services (CLAS) County Data (PDF) *Updated January 7, 2015
January 27, 2016
Culturally and Linguistically Appropriate Services (CLAS) County Data (PDF) - for plan years (in the individual market, policy years) beginning prior to January 1, 2025
November 28, 2023
Culturally and Linguistically Appropriate Services (CLAS) County Data (PDF) - for plan years (in the individual market, policy years) beginning on or after January 1, 2025

Summary of Benefits and Coverage and Uniform Glossary

Fact Sheets

August 17, 2011
Providing Clear and Consistent Information to Consumers about Their Health Insurance Coverage
July 24, 2013
2013 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, 2104
Culturally and Linguistically Appropriate Services (CLAS) County Data (PDF)*
*Updated January 7, 2015
December 22, 2014
Proposed Summary of Benefits and Coverage and Uniform Glossary Rules (PDF)
June 12, 2015
Summary of Benefits and Coverage and Uniform Glossary Final Rule (PDF)
January 27, 2016
Culturally and Linguistically Appropriate Services (CLAS) County Data (PDF) - for plan years (in the individual market, policy years) beginning prior to January 1, 2025.
November 28, 2023
Culturally and Linguistically Appropriate Services (CLAS) County Data (PDF) - for plan years (in the individual market, policy years) beginning on or after January 1, 2025.

FAQs

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