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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 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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/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"> <a href="/medicare/health-safety-standards/civil-monetary-penalties" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/182431">Civil monetary penalties</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">Quality, safety & oversight - Emergency preparedness</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/health-safety-standards/state-survey-agencies" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/171271">State survey agencies</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">Quality, safety & oversight - Guidance for laws & regulations</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/medicare/health-safety-standards/promising-practices-project" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/172211">Promising practices project</a> </li> <li class="menu-item menu-item--l3"> <a href="/medicare/health-safety-standards/education-division" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/173371">Quality, safety & oversight - Education division (QSED)</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> <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 menu-item--active-trail"> <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 menu-item--active-trail"> <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 menu-item--active-trail"> <a href="/marketplace/resources/forms-reports-other" class="menu-item-element active-page is-active" aria-current="page" data-drupal-link-system-path="node/190966">Forms, reports, & other resources</a> <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> </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">Priorities</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">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">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">Recent Legislation</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="/inflation-reduction-act-and-medicare" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1621896">Inflation Reduction Act and Medicare</a> </li> <li class="menu-item menu-item--l3"> <a href="/nosurprises" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1573261">No Surprises Act</a> </li> </ul> </div> </div> </li> <li class="menu-item menu-item--l2 menu-item--expanded"> <span class="menu-item-element" aria-current="false">Key Initiatives</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/opioids" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/1620416">Opioids</a> </li> <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">Flu</a> </li> <li class="menu-item menu-item--l3"> <a href="/priorities/key-initiatives/medicare-open-enrollment-partner-resources" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/180361">Medicare Open Enrollment</a> </li> <li class="menu-item menu-item--l3"> <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">Medicare OE partner resources</a> </li> <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">Marketplace Open Enrollment</a> </li> <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">E-health</a> </li> <li class="menu-item menu-item--l3 menu-item--collapsed"> <a href="/priorities/key-initiatives/open-payments" title="Open Payments landing page" class="menu-item-element" aria-current="false" data-drupal-link-system-path="node/188426">Open Payments</a> </li> <li class="menu-item menu-item--l3"> <a href="https://www.medicaid.gov/resources-for-states/coronavirus-disease-2019-covid-19/unwinding-and-returning-regular-operations-after-covid-19/index.html" class="menu-item-element" aria-current="false">Returning to regular operations after COVID-19</a> </li> <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">Healthplan price transparency</a> </li> <li class="menu-item menu-item--l3 menu-item--expanded"> <a href="/priorities/key-initiatives/burden-reduction" class="menu-item-element" 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class="ds-u-visibility--screen-reader page-title"><span class="field field--name-title field--type-string field--label-visually_hidden">Other Resources <div class="title-border"></div></span> </h1> <div class="title-border"></div> </div> </div> </div> </div> </div> </div> <div id="block-cms-evo-content" class="block block-system block-system-main-block"> <div class="content"> <span class="create-date"> </span> <div class="node node--type-section-page node--view-mode-full clearfix"> <div class="node__content clearfix"> <div class="subsite_body"> <div class="layout--constrained section--bg-style-none section--bg-color-none layout layout--onecol-section"> <div class="ds-l-container"> <div class="ds-l-row"> <div class="layout__column ds-l-col--12 cms-global-center"> <div class="block block-layout-builder block-field-blocknodesection-pagetitle"> <div class="content"> <span class="create-date"> </span> <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">Other Resources</span> </div> </div> <div class="block block-layout-builder block-field-blocknodesection-pagebody"> <div class="content"> <span class="create-date"> </span> <div class="field field--name-body field--type-text-with-summary field--label-hidden field__item"><div class="rxbodyfield"><ul><li><a href="#Affordable_Care_Act">Affordable Care Act</a></li><li><a href="#No_Surprises_Act">No Surprises Act</a><ul><li><a href="#Federal_Independent_Dispute_Resolution">Federal Independent Dispute Resolution</a></li></ul></li><li><a href="#Consumer_Support_and_Information">Consumer Support and Information</a><ul><li><a href="#Consumer_Assistance_Program_Grants">Consumer Assistance Program Grants</a></li><li><a href="#Navigators">Navigators</a></li><li><a href="#External_Appeals">External Appeals</a></li><li><a href="#Summary_of_Benefits_and_Coverage_and_Uniform_Glossary">Summary of Benefits and Coverage and Uniform Glossary</a></li></ul></li><li><a href="#Content_Requirements_for_Plan_Finder">Content Requirements for Plan Finder</a></li><li><a href="#Pre-Existing Condition Insurance Plan (PCIP)">Pre-Existing Condition Insurance Plan (PCIP)</a></li><li><a href="#Early Retiree Reinsurance Program (ERRP)">Early Retiree Reinsurance Program (ERRP)</a></li><li><a href="#Health_Insurance_Marketplaces">Health Insurance Marketplaces</a><ul><li><a href="#Planning_and_Establishment_Grants">Planning and Establishment Grants</a></li></ul></li><li><a href="#Consumer Operated and Oriented Plan (CO-OP) Program">Consumer Operated and Oriented Plan (CO-OP) Program</a></li><li><a href="#Health_Insurance_Market_Reforms">Health Insurance Market Reforms</a><ul><li><a href="#Annual_Limits">Annual Limits</a></li><li><a href="#Coverage_for_Young_Adults">Coverage for Young Adults</a></li><li><a href="#excepted-benefits">Excepted Benefits</a></li><li><a href="#Medical_Loss_Ratio">Medical Loss Ratio</a></li><li><a href="#mental-health-parity">Mental Health Parity</a></li><li><a href="#Patient’s Bill of Rights">Patient’s Bill of Rights</a></li><li><a href="#Prevention">Prevention</a></li><li><a href="#Review_of_Insurance_Rates">Review of Insurance Rates</a></li><li><a href="#Self-Funded Non-Federal Governmental Plans">Self-Funded Non-Federal Governmental Plans</a></li><li><a href="#Standard_Notices">Standard Notices</a></li></ul></li><li><a href="#Premium_Stabilization_Programs">Premium Stabilization Programs</a></li><li><a href="#COBRA">COBRA</a></li><li><a href="#Reports">Reports</a></li><li><a href="/cciio/resources/forms-reports-and-other-resources/exams_audits_reviews_issuer_resources-" data-entity-type="node" data-entity-uuid="09705d8b-c8cb-4602-a762-9c273a805e46" data-entity-substitution="canonical" title="CCIIO Examinations, Audits and Reviews of Issuers: Issuer Resources ">CCIIO Examinations, Audits, and Reviews of Issuers</a> </li></ul><h2><a class="ck-anchor" id="Affordable_Care_Act"></a>Affordable Care Act</h2><h2>Innovation in the Marketplace Newsletters</h2><ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/issuerinnovationforum_mpinnovationnewsletter-issue1_oct062016-508.pdf" data-entity-type="media" data-entity-uuid="94c666bf-e2c5-465e-a47a-31dde874b190" data-entity-substitution="canonical" title="IssuerInnovationForum_MPInnovationNewsletter-Issue1_Oct062016-508">September 2016 (PDF)</a></li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/mpinnovationnewsletter-issue2oct2016-final-508.pdf" data-entity-type="media" data-entity-uuid="9f1cd8f1-6c5f-4d78-9816-085519be8d95" data-entity-substitution="canonical" title="MPInnovationNewsletter-Issue2Oct2016-FINAL-508">October 2016 (PDF)</a></li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/mpinnovationnewsletter-issue3jan2017.pdf" data-entity-type="media" data-entity-uuid="8ae4a34d-2f23-49bb-a456-52d3c1741824" data-entity-substitution="canonical" title="MPInnovationNewsletter-Issue3Jan2017">January 2017 (PDF)</a></li></ul><h2><a class="ck-anchor" id="No_Surprises_Act"></a>No Surprises Act</h2><h3><a class="ck-anchor" id="Federal_Independent_Dispute_Resolution"></a>Federal Independent Dispute Resolution</h3><p><strong>Reports</strong></p><ul><li>December 23, 2022<br><a href="/files/document/initial-report-idr-april-15-september-30-2022.pdf">Initial Report on the Independent Dispute Resolution (IDR) Process: April 15 - September 30, 2022 (PDF)</a> (PDF)</li><li>April 27, 2023<br><a href="/files/document/partial-report-idr-process-octoberdecember-2022.pdf" data-entity-type="media" data-entity-uuid="dcea3715-8e5e-475b-8e9c-a0e54103a0e4" data-entity-substitution="canonical" title="Partial-Report-IDR-Process-OctoberDecember-2022">Partial Report on the Independent Dispute Resolution (IDR) Process: October 1 - December 31, 2022 (PDF)</a> (PDF)</li></ul><h2><a class="ck-anchor" id="Consumer_Support_and_Information"></a>Consumer Support and Information</h2><h2><a class="ck-anchor" id="Consumer_Assistance_Program_Grants"></a>Consumer Assistance Program Grants</h2><p><strong>Reports</strong></p><ul><li>June 7, 2012<br><a href="/cciio/resources/files/downloads/csg-cap-summary-white-paper.pdf" data-entity-type="media" data-entity-uuid="56aa2e11-9dea-4745-8f03-61b02afad3f1" data-entity-substitution="canonical" title="csg-cap-summary-white-paper">Summary of First Year Consumer Assistance Program Grant Data (PDF)</a> (PDF - 442 KB)</li></ul><h2><a class="ck-anchor" id="Navigators"></a>Navigators</h2><ul><li>January 19, 2021<br><a href="/files/document/2016-2020-navigator-funding-and-enrollment-data.xlsx" data-entity-type="media" data-entity-uuid="c8cffbad-78d9-42f7-b9c7-5045138afa38" data-entity-substitution="canonical" title="2016-2020-Navigator-Funding-and-Enrollment-Data">Navigator Funding and Enrollment Data, PY 2016-2020 (XLSX)</a></li></ul><h2><a class="ck-anchor" id="External_Appeals"></a>External Appeals</h2><h3>Model Notice</h3><ul><li>June 22, 2011<br><a href="/cciio/resources/files/downloads/abd_model_notice_2.pdf" data-entity-type="media" data-entity-uuid="1896375a-79b0-4ac0-8e9e-52362baa6db3" data-entity-substitution="canonical" title="abd_model_notice_2">Model Notice of Adverse Benefits Determination (PDF)</a> (PDF – 256 KB)<br><a href="/cciio/resources/files/downloads/external_final_decision_model_notice.pdf" data-entity-type="media" data-entity-uuid="24e90b6e-108c-45e8-840f-e9120eb6e454" data-entity-substitution="canonical" title="external_final_decision_model_notice">Model Notice of Final External Review Decision (PDF)</a> (PDF – 101 KB)<br><a href="/cciio/resources/files/downloads/final_iabd_model_notice_1.pdf" data-entity-type="media" data-entity-uuid="f703ac0a-f846-42dd-be6c-a926b0d39efc" data-entity-substitution="canonical" title="final_iabd_model_notice_1">Model Notice of Final Internal Adverse Benefits Determination (PDF)</a> (PDF – 265 KB)</li></ul><h3>Notice of Privacy Act Rights</h3><ul><li>January 11, 2017<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/notice-of-privacy-act-rights_final2_01-10-2017.pdf" data-entity-type="media" data-entity-uuid="6569aaa6-af1a-4f76-a7d2-34672e820b9f" data-entity-substitution="canonical" title="Notice of Privacy Act Rights_FINAL2_01-10-2017">Notice of Privacy Act Statement for Issuers in States without External Review Laws (PDF)</a> (PDF – 20 KB)</li></ul><h3>Federal Register Notice</h3><ul><li>July 23, 2010<br><a href="https://www.regulations.gov/document/HHS-OS-2010-0019-0001">Federal Register Notice on External Review</a></li></ul><h2><a class="ck-anchor" id="Summary_of_Benefits_and_Coverage_and_Uniform_Glossary"></a>Summary of Benefits and Coverage and Uniform Glossary</h2><h2>SBC Materials and Supporting Documents (Authorized for use for plan or policy years that begin on or after January 1, 2021)</h2><p>Applicability: Plans and issuers will be required to use the 2021 Summary of Benefits and Coverage (SBC), the 2021 SBC Calculator Guide and Narratives, and, should they choose to use the SBC Calculator, the 2021 SBC Calculator beginning on the first day of the first open enrollment period for any plan years (or, in the individual market, policy years) that begin on or after January 1, 2021, with respect to coverage for plan or policy years beginning on or after that date.</p><p><strong>NOTE:</strong> The documents below were updated on 7/26/2023 to reflect the new expiration date of 5/31/2026 under the Paperwork Reduction Act. There are no changes to the content of any of the documents.</p><h3>Forms</h3><ul><li>Summary of Benefits and Coverage (SBC) Template<ul><li><a href="/files/document/sbc-template-standard-format-english-060723.docx-0" data-entity-type="media" data-entity-uuid="074b9d84-9daf-4317-8288-5dcd35460933" data-entity-substitution="canonical" title="SBC-Template-Standard-Format-English 060723">Standard Format (DOCX)</a></li><li><a href="/files/document/sbc-template-accessible-format-english-060723.pdf" data-entity-type="media" data-entity-uuid="d18e9e3e-3bf6-41ee-a891-52c96ea4b272" data-entity-substitution="canonical" title="SBC Template Accessible Format English 060723">Accessible Format (PDF)</a></li><li><a href="/files/document/sbc-template-standard-format-chinese-060723.docx" data-entity-type="media" data-entity-uuid="6684205a-2352-4ae5-af8b-14c5da4b6a2b" data-entity-substitution="canonical" title="SBC Template Standard Format Chinese 060723">Chinese Standard Format (DOCX)</a></li><li><a href="/files/document/sbc-template-accessible-format-chinese-060723.pdf" data-entity-type="media" data-entity-uuid="b24ae857-0a25-4fe0-974a-b02af7588c7e" data-entity-substitution="canonical" title="SBC Template Accessible Format Chinese 060723">Chinese Accessible Format (PDF)</a></li><li><a href="/files/document/sbc-template-standard-format-spanish-060723.docx" data-entity-type="media" data-entity-uuid="c0c36e27-b9e9-4ffd-8233-c08f10fbf332" data-entity-substitution="canonical" title="SBC Template Standard Format Spanish 060723">Spanish Standard Format (DOCX)</a></li><li><a href="/files/document/sbc-template-accessible-format-spanish-060723.pdf" data-entity-type="media" data-entity-uuid="2e926fc7-65ba-4117-b53a-f05ef996054d" data-entity-substitution="canonical" title="SBC Template Accessible Format Spanish 060723">Spanish Accessible Format (PDF)</a></li><li><a href="/files/document/sbc-template-standard-format-tagalog-060723.docx" data-entity-type="media" data-entity-uuid="10751063-6223-458e-a2bb-3ef3cc51e7b0" data-entity-substitution="canonical" title="SBC Template Standard Format Tagalog 060723">Tagalog Standard Format  (DOCX)</a></li><li><a href="/files/document/sbc-template-accessible-format-tagalog-060723.pdf" data-entity-type="media" data-entity-uuid="05a63738-fbd0-47d5-81c3-12a6c94dd603" data-entity-substitution="canonical" title="SBC Template Accessible Format Tagalog 060723">Tagalog Accessible Format (PDF)</a></li><li><a href="/files/document/sbc-template-standard-format-navajo-060723.docx" data-entity-type="media" data-entity-uuid="37a1cb4d-651f-47d6-a5ba-5cfedb6318fd" data-entity-substitution="canonical" title="SBC Template Standard Format Navajo 060723">Navajo Standard Format (DOCX)</a></li><li><a href="/files/document/sbc-template-accessible-format-navajo-060723.pdf" data-entity-type="media" data-entity-uuid="a6ad8e26-0e96-492f-90f0-0b937174c5a7" data-entity-substitution="canonical" title="SBC Template Accessible Format Navajo 060723">Navajo Accessible Format (PDF)</a></li><li><a href="/media/audio/sbc-yes-answers-navajo-09-2020.mp3" data-entity-type="media" data-entity-uuid="b95891f2-6401-4cd3-96d2-8b1f4b62353c" data-entity-substitution="canonical" title="SBC_Template_Navajo_09_20">Navajo Oral Translation</a></li></ul></li><li>Uniform Glossary<ul><li><a href="/files/document/uniform-glossary-english-060723.pdf" data-entity-type="media" data-entity-uuid="32a20af4-2ade-4346-ae4e-53eadd662d83" data-entity-substitution="canonical" title="Uniform Glossary English 060723">English (PDF)</a></li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/list-of-anchors-01-2020.xlsx" data-entity-type="media" data-entity-uuid="66153ab0-268e-447a-aec4-708bbf9e2497" data-entity-substitution="canonical" title="list-of-anchors-01-2020.xlsx">List of anchors (XLSX)</a> for SBC Uniform Glossary terms on <a href="https://www.HealthCare.gov/sbc-glossary/">https://www.HealthCare.gov/sbc-glossary/</a></li><li><a href="/files/document/uniform-glossary-chinese-060723.pdf" data-entity-type="media" data-entity-uuid="31a828bf-14be-4e18-b7c6-21868eeca9da" data-entity-substitution="canonical" title="Uniform Glossary Chinese 060723">Chinese (PDF) (PDF)</a></li><li><a href="/files/document/uniform-glossary-spanish-060723.pdf" data-entity-type="media" data-entity-uuid="28c1473d-fb7e-4d81-aaeb-a9cfd2626029" data-entity-substitution="canonical" title="Uniform Glossary Spanish 060723">Spanish(PDF) (PDF)</a></li><li><a href="/files/document/uniform-glossary-tagalog-060723.pdf" data-entity-type="media" data-entity-uuid="55e40a7e-687c-476d-b41a-0f2e06cfabdf" data-entity-substitution="canonical" title="Uniform Glossary Tagalog 060723">Tagalog (PDF) (PDF)</a></li><li><a href="/files/document/uniform-glossary-navajo-060723.pdf" data-entity-type="media" data-entity-uuid="7cb3def5-fcf4-4139-a28c-7bd5f270109d" data-entity-substitution="canonical" title="Uniform Glossary Navajo 060723">Navajo (PDF)</a></li><li><a href="https://downloads.cms.gov/media/uniform_glossary_navajo_09_20.mp3">Navajo Oral Translation (MP3)</a></li></ul></li></ul><h3>Instructions/Guidance</h3><ul><li>Sample Completed SBC<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sample-completed-sbc-standard-format-01-2020.doc" data-entity-type="media" data-entity-uuid="e978d3f5-8509-4da8-b59a-6f7df5ca01bc" data-entity-substitution="canonical" title="sample-completed-sbc-standard-format-060723">Standard Format (DOCX)</a></li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sample-completed-sbc-accessible-format-01-2020.pdf" data-entity-type="media" data-entity-uuid="c5d148eb-2904-4bb9-a401-af2b59d0c5df" data-entity-substitution="canonical" title="sample-completed-sbc-accessible-format-060723">Accessible Format (PDF)</a></li><li><a href="/files/document/aian-zero-cost-sharing-060723.pdf" data-entity-type="media" data-entity-uuid="1f409316-645f-48d3-8f1f-aadc32b39bf6" data-entity-substitution="canonical" title="AIAN Zero Cost Sharing 060723">AI/AN Zero Cost Sharing (PDF)</a></li><li><a href="/files/document/aian-limited-cost-sharing-060723.pdf" data-entity-type="media" data-entity-uuid="bfc218ee-87e4-4e58-91d8-ab21eac9e8d4" data-entity-substitution="canonical" title="AIAN Limited Cost Sharing 060723">AI/AN Limited Cost Sharing (PDF)</a></li></ul></li><li>Instructions for Completing the SBC – <a href="/files/document/group-instructions-060723.pdf" data-entity-type="media" data-entity-uuid="619d57c9-204e-411b-b9ae-c582ba7ceafd" data-entity-substitution="canonical" title="Group Instructions 060723">Group Health Plan Coverage (PDF)</a> (for January 1, 2021)</li><li>Instructions for Completing the SBC – <a href="/files/document/individual-instructions-060723.pdf" data-entity-type="media" data-entity-uuid="b5b4a09e-b3aa-40bb-a084-580601c4a4cc" data-entity-substitution="canonical" title="Individual Instructions 060723">Individual Health Insurance Coverage (PDF)</a> (for January 1, 2021)</li><li>Why This Matters language for SBC “Yes” Answers (for January 1, 2021)<ul><li><a href="/files/document/why-matters-language-sbc-yes-answers-english-060723.pdf" data-entity-type="media" data-entity-uuid="a21bb575-d7a2-49c9-993b-ef50bda007b9" data-entity-substitution="canonical" title="Why This Matters language for SBC Yes Answers English 060723">English (PDF)</a></li><li><a href="/files/document/why-matters-language-sbc-yes-answers-chinese-060723.pdf" data-entity-type="media" data-entity-uuid="de858c64-801d-4749-b64c-33a54b23d610" data-entity-substitution="canonical" title="Why This Matters language for SBC Yes Answers Chinese 060723">Chinese (PDF) (PDF)</a></li><li><a href="/files/document/why-matters-language-sbc-yes-answers-spanish-060723.pdf" data-entity-type="media" data-entity-uuid="a4c207ce-bd18-43ce-ab4a-0ccfb4572518" data-entity-substitution="canonical" title="Why This Matters language for SBC Yes Answers Spanish 060723">Spanish (PDF) (PDF)</a></li><li><a href="/files/document/why-matters-language-sbc-yes-answers-tagalog-060723.pdf" data-entity-type="media" data-entity-uuid="d4e35a48-c55b-4863-88eb-a186b42d20fc" data-entity-substitution="canonical" title="Why This Matters language for SBC Yes Answers Tagalog 060723">Tagalog (PDF) (PDF)</a></li><li><a href="/files/document/why-matters-language-sbc-yes-answers-navajo-060723.pdf" data-entity-type="media" data-entity-uuid="c1339f5b-ae35-4491-859f-1d751b76b2de" data-entity-substitution="canonical" title="Why This Matters language for SBC Yes Answers Navajo 060723">Navajo (PDF)</a></li><li><a href="https://downloads.cms.gov/media/summary_of_benefits_and_coverage_yes_answers_navajo_09_20.mp3">Navajo Oral Translation</a> (MP3)</li></ul></li><li>Why This Matters language for SBC “No” Answers (for January 1, 2021)<ul><li><a href="/files/document/why-matters-language-sbc-no-answers-english-060723.pdf" data-entity-type="media" data-entity-uuid="10fcf746-28ce-4973-b5ff-fecd7a1e836e" data-entity-substitution="canonical" title="Why This Matters language for SBC No Answers English 060723">English (PDF)</a></li><li><a href="/files/document/why-matters-language-sbc-no-answers-chinese-060723.pdf" data-entity-type="media" data-entity-uuid="f8c67b19-91b8-4faf-ae44-2b639e35e4fa" data-entity-substitution="canonical" title="Why This Matters language for SBC No Answers Chinese 060723">Chinese (PDF) (PDF)</a></li><li><a href="/files/document/why-matters-language-sbc-no-answers-spanish-060723.pdf" data-entity-type="media" data-entity-uuid="2705b1ff-9d13-4827-82cd-9fe65c2a06bd" data-entity-substitution="canonical" title="Why This Matters language for SBC No Answers Spanish 060723">Spanish (PDF) (PDF)</a></li><li><a href="/files/document/why-matters-language-sbc-no-answers-tagalog-060723.pdf" data-entity-type="media" data-entity-uuid="f5d840e0-b218-4d95-9db3-e46207df1153" data-entity-substitution="canonical" title="Why This Matters language for SBC No Answers Tagalog 060723">Tagalog (PDF) (PDF)</a></li><li><a href="/files/document/why-matters-language-sbc-no-answers-navajo-060723.pdf" data-entity-type="media" data-entity-uuid="f8209c34-830e-4604-b008-a08714a0987c" data-entity-substitution="canonical" title="Why This Matters language for SBC No Answers Navajo 060723">Navajo (PDF)</a></li><li><a href="https://downloads.cms.gov/media/summary_of_benefits_and_coverage_no_answers_navajo_09_20.mp3">Navajo Oral Translation (MP3)</a></li></ul></li><li>Guide for Coverage Examples Calculations – Maternity Scenario<ul><li><a href="/files/document/having-baby-guide-060723-xlsx.xlsx" data-entity-type="media" data-entity-uuid="03ccc977-25c2-414b-ab7a-aef6aac99532" data-entity-substitution="canonical" title="Having a Baby Guide 060723 (XLSX)">Standard Format (XLSX)</a></li><li><a href="/files/document/having-baby-guide-060723-pdf.pdf" data-entity-type="media" data-entity-uuid="933b7596-ed2f-4c77-a30d-65dd1c1932e6" data-entity-substitution="canonical" title="Having a Baby Guide 060723 (PDF)">Accessible Format (PDF)</a></li></ul></li><li>Guide for Coverage Examples Calculations – Diabetes Scenario<ul><li><a href="/files/document/managing-type-2-diabetes-guide-060723-xlsx.xlsx" data-entity-type="media" data-entity-uuid="7baac80b-13fd-4086-aa9e-e767ac169329" data-entity-substitution="canonical" title="Managing Type 2 Diabetes Guide 060723 (xlsx)">Standard Format (XLSX)</a></li><li><a href="/files/document/managing-type-2-diabetes-guide-060723-pdf.pdf" data-entity-type="media" data-entity-uuid="65c2dc84-bdbd-4fb4-adb6-e752f9be58ab" data-entity-substitution="canonical" title="Managing Type 2 Diabetes Guide 060723 (PDF)">Accessible Format (PDF)</a></li></ul></li><li>Guide for Coverage Examples Calculations – Simple Foot Fracture Scenario<ul><li><a href="/files/document/simple-fracture-guide-060723-xlsx.xlsx" data-entity-type="media" data-entity-uuid="6f7d564d-6f22-4f69-8800-0ac9ac642860" data-entity-substitution="canonical" title="Simple Fracture Guide 060723 (xlsx)">Standard Format (XLSX)</a></li><li><a href="/files/document/simple-fracture-guide-060723-pdf.pdf" data-entity-type="media" data-entity-uuid="c245d0ec-e770-4a8c-ad3e-0c9926b8eedb" data-entity-substitution="canonical" title="Simple Fracture Guide 060723 (PDF)">Accessible Format (PDF)</a></li></ul></li><li><a href="/files/document/maternity-care-narrative-060723.pdf" data-entity-type="media" data-entity-uuid="48b12867-e986-488f-9cd9-25da9d3a4729" data-entity-substitution="canonical" title="Maternity Care Narrative 060723">Narrative for Maternity Scenario (PDF)</a></li><li><a href="/files/document/diabetes-narrative-060723.pdf" data-entity-type="media" data-entity-uuid="8b2e75a6-4771-4e84-835f-560a17cf3605" data-entity-substitution="canonical" title="Diabetes Narrative 060723">Narrative for Diabetes Scenario (PDF)</a></li><li><a href="/files/document/foot-fracture-narrative-060723.pdf" data-entity-type="media" data-entity-uuid="fcb1a481-c0f9-4ca4-b619-81fcd6ec0951" data-entity-substitution="canonical" title="Foot Fracture Narrative 060723">Narrative for Simple Foot Fracture Scenario (PDF)</a></li><li><a href="/files/document/coverage-examples-calculator-instructions-060723.pdf" data-entity-type="media" data-entity-uuid="c6ed6900-90a9-45bf-8a40-b4806dbff00b" data-entity-substitution="canonical" title="Coverage Examples Calculator Instructions 060723">Coverage Examples Calculator Instructions (PDF)</a></li><li><a href="/files/document/234400-sbc-coverage-examples-calculator-excel-050522.xlsm" data-entity-type="media" data-entity-uuid="6154d34c-48dc-4eb2-89ae-44a5702c6595" data-entity-substitution="canonical" title="234400 SBC Coverage Examples Calculator Excel 050522">Coverage Examples Calculator (VND.MS-EXCEL.SHEET.MACROENABLED.12) (XLSM)</a> (updated October 2019 for use on or after January 1, 2021)</li></ul><h2>SBC Materials and Supporting Documents (Authorized for use prior to January 1, 2021<strong>)</strong></h2><p>Applicability: Health plans and issuers that maintain an annual open enrollment period will be required to use the April, 2017 edition of the SBC template and associated documents beginning on the first day of the first open enrollment period that begins on or after April 1, 2017 with respect to coverage for plan years (or, in the individual market, policy years) beginning on or after that date. For plans and issuers that do not use an annual open enrollment period, this SBC template and associated documents is required beginning on the first day of the first plan year (or, in the individual market, policy year) that begins on or after April 1, 2017 and before January 1, 2021.</p><p><strong>Forms</strong></p><ul><li>Summary of Benefits and Coverage (SBC) Template<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-template-4-4-clean.doc" data-entity-type="media" data-entity-uuid="cfa53a49-91db-4d70-b4df-78b2bce8db76" data-entity-substitution="canonical" title="SBC Template 4 4 clean">Standard Format (DOC)</a>  (DOC)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-template-508-mm.pdf" data-entity-type="media" data-entity-uuid="4a392084-d750-4a16-91a5-fc13f09811d9" data-entity-substitution="canonical" title="SBC Template 508 MM">Accessible Format (PDF)</a> (PDF)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/chinese-v2-sbc-template-4-4-508-doc.docx" data-entity-type="media" data-entity-uuid="8a147aba-596e-4a55-84a5-1091b3be66a8" data-entity-substitution="canonical" title="(Chinese-v2) SBC Template 4 4_508 docx">Chinese Standard Format (DOCX)</a> (DOC)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/chinese-v2-sbc-template-4-4-508.pdf" data-entity-type="media" data-entity-uuid="6b191b02-967e-40e9-9e36-31ff531a5985" data-entity-substitution="canonical" title="(Chinese-v2) SBC Template 4 4_508">Chinese Accessible Format (PDF)</a> (PDF)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/spanish-sbc-template-ohpsca-edits-004-mk-080316.docx" data-entity-type="media" data-entity-uuid="38d66908-46e8-481e-885d-eeb7f7f9a438" data-entity-substitution="canonical" title="Spanish-SBC-Template - OHPSCA edits (004) MK 080316">Spanish Standard Format (DOCX)</a> (DOC)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/spanish-sbc-template-ohpsca-edits-004-mk-080316_508.pdf" data-entity-type="media" data-entity-uuid="7c895ad5-2835-489a-8506-bc26e2ed4370" data-entity-substitution="canonical" title="Spanish-SBC-Template - OHPSCA edits (004) MK 080316_508">Spanish Accessible Format (PDF)</a> (PDF)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/tagalog-sbc-template-4-4-508-doc.docx" data-entity-type="media" data-entity-uuid="7537e7e2-6bc8-4a43-87c5-454ee08aa214" data-entity-substitution="canonical" title="(Tagalog) SBC Template 4 4_508-doc">Tagalog Standard Format (DOCX)</a> (DOC)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/tagalog-sbc-template-4-4-508.pdf" data-entity-type="media" data-entity-uuid="db32c1a8-a2a6-4f65-a870-187d83967431" data-entity-substitution="canonical" title="(Tagalog) SBC Template 4 4_508">Tagalog Accessible Format (PDF)</a> (PDF)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-template-4-4-clean-navajo-doc.docx" data-entity-type="media" data-entity-uuid="72c5e3d7-9e21-4d91-ae55-eeb51d00f82a" data-entity-substitution="canonical" title="Translation-Final_SBC Template 4 4 clean-Navajo-docx">Navajo Standard Format (DOCX)</a> (DOC)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-template-4-4-clean-navajo.pdf" data-entity-type="media" data-entity-uuid="4017f619-40e8-442c-a664-251e1d1c4a35" data-entity-substitution="canonical" title="SBC Template 4 4 clean-Navajo">Navajo Accessible Format (PDF)</a> (PDF)</li><li><a href="https://downloads.cms.gov/cciio/SBC_Template4-4-clean-Navajo.mp3">Navajo Oral Translation</a> (MP3)</li></ul></li><li>Uniform Glossary<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/ug-glossary-508-mm.pdf" data-entity-type="media" data-entity-uuid="714d4b7f-ec09-4343-bc5a-3caf38b3cc18" data-entity-substitution="canonical" title="UG-Glossary 508 MM">English (PDF)</a> (PDF)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-glossary-anchors.xlsx" data-entity-type="media" data-entity-uuid="2a233c4d-8767-49f3-9245-2632e6f70e3b" data-entity-substitution="canonical" title="sbc-glossary-anchors">List of anchors (XLSX)</a> for SBC Uniform Glossary terms on <a href="https://www.HealthCare.gov/sbc-glossary/">https://www.HealthCare.gov/sbc-glossary/</a></li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/chinese-v2-ug-4-1-16-12-pm-508.pdf" data-entity-type="media" data-entity-uuid="bd32fa65-4c1c-4e18-b500-fa33cebf4dd7" data-entity-substitution="canonical" title="(Chinese-v2) UG 4-1-16 -12 pm_508">Chinese (PDF)</a> (PDF)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/spanish-ug-07-27-ohpsca-edits-mk-080316_508.pdf" data-entity-type="media" data-entity-uuid="f0ac5b58-6faa-4f56-8813-d5e45286804a" data-entity-substitution="canonical" title="(Spanish) UG - 07-27 OHPSCA edits mk 080316_508">Spanish (PDF)</a>(PDF)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/tagalog-ug-4-1-16-12-pm-508.pdf" data-entity-type="media" data-entity-uuid="97acd8db-3df9-4dc0-9748-36280411faee" data-entity-substitution="canonical" title="(Tagalog) UG 4-1-16 -12 pm_508">Tagalog (PDF)</a> (PDF)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/ug-4-1-16-12-pm-clean-navajo.pdf" data-entity-type="media" data-entity-uuid="abc7a43b-57a5-41ac-bb98-ffc267cd6452" data-entity-substitution="canonical" title="UG 4-1-16 -12 pm clean-Navajo">Navajo (PDF)</a> (PDF)</li><li><a href="https://downloads.cms.gov/cciio/ug-4-1-16-12pm_clean-Navajo.mp3">Navajo Oral Translation</a> (MP3)</li></ul></li></ul><p><strong>Instructions/Guidance</strong></p><ul><li>Sample Completed SBC<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-sample-completed-4-4-clean.doc" data-entity-type="media" data-entity-uuid="e731e30c-d759-47e0-8fe9-5e7c9f5617ed" data-entity-substitution="canonical" title="SBC Sample Completed 4 4 clean">Standard Format (DOC)</a> (DOC)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-sample-completed-mm-508-fixed-4-12-16.pdf" data-entity-type="media" data-entity-uuid="4fd89cd5-7f63-44ea-bc14-96ec4b99c861" data-entity-substitution="canonical" title="SBC Sample Completed-MM-508-fixed-4-12-16">Accessible Format (PDF)</a> (PDF)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-2017-template-ai-an-zero-6-7-16-clean-508-mm.pdf" data-entity-type="media" data-entity-uuid="1fb24abb-7083-4f19-a3b2-08518e4dc8f9" data-entity-substitution="canonical" title="SBC 2017 Template AI AN zero 6-7-16 clean 508 MM">AI/AN Zero Cost Sharing (PDF)</a></li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-2017-template-ai-an-limited-6-7-16-clean-508-mm.pdf" data-entity-type="media" data-entity-uuid="a82ede0c-29b3-494c-9f7c-c0ba9e73bcde" data-entity-substitution="canonical" title="SBC 2017 Template AI AN limited - 6-7-16 clean 508 MM">AI/AN Limited Cost Sharing (PDF)</a></li></ul></li><li>Instructions for Completing the SBC – <a href="/cciio/resources/forms-reports-and-other-resources/downloads/group-instructions-4-4-clean-mm-508.pdf" data-entity-type="media" data-entity-uuid="631d159d-3212-4a14-83b0-6fbc82e353de" data-entity-substitution="canonical" title="Group Instructions 4 4 clean MM 508">Group Health Plan Coverage (PDF)</a> (PDF) (for April 1, 2017)</li><li>Instructions for Completing the SBC – <a href="/cciio/resources/forms-reports-and-other-resources/downloads/individual-instructions-508-mm.pdf" data-entity-type="media" data-entity-uuid="5d88e055-382f-4895-a21d-5b6b6bbc57f5" data-entity-substitution="canonical" title="Individual Instructions 508 MM">Individual Health Insurance Coverage (PDF)</a> (PDF) (for April 1, 2017)</li><li>Why This Matters language for SBC “Yes” Answers (for April 1, 2017)<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/yes-answers-508-mm.pdf" data-entity-type="media" data-entity-uuid="a600df54-84b2-408c-98dd-c29fa2b6312b" data-entity-substitution="canonical" title="Yes Answers 508 MM">English (PDF)</a> (PDF)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/chinese-yes-answers-4-1-12-pm-508.pdf" data-entity-type="media" data-entity-uuid="6e495f5e-ca99-4313-904f-dd0475c54ac4" data-entity-substitution="canonical" title="(Chinese) Yes Answers 4 1 12 pm_508">Chinese (PDF)</a> (PDF)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/spanish-yes-answers-4-1-12-pm-clean-updated-002-mk-080316_508.pdf" data-entity-type="media" data-entity-uuid="f8c1b08b-e220-4450-8c7c-1dc5193a7537" data-entity-substitution="canonical" title="(Spanish) Yes Answers 4 1 12 pm clean UPDATED (002) mk 080316_508">Spanish (PDF)</a> (PDF)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/tagalog-yes-answers-4-1-12-pm-508.pdf" data-entity-type="media" data-entity-uuid="dd7bf3e4-28b8-4553-b24c-ef8c301ece7e" data-entity-substitution="canonical" title="(Tagalog) Yes Answers 4 1 12 pm_508">Tagalog (PDF)</a> (PDF)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/yes-answers-4-1-12-pm-clean-navajo.pdf" data-entity-type="media" data-entity-uuid="ceb605ec-b6fc-486f-9180-dba7cd328770" data-entity-substitution="canonical" title="Yes Answers 4 1 12 pm clean-Navajo">Navajo (PDF)</a> (PDF)</li><li><a href="https://downloads.cms.gov/media/audio/Yes-Answers-4-1-12-pm-clean-Navajo.mp3">Navajo Oral Translation</a> (MP3)</li></ul></li><li>Why This Matters language for SBC “No” Answers (for April 1, 2017)<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/no-answers-4-1-12pm-clean-mm508.pdf" data-entity-type="media" data-entity-uuid="0ddcd50a-ac51-4e10-bc42-d70a0a38be92" data-entity-substitution="canonical" title="No Answers 4 1 12 pm clean MM 508">English (PDF)</a> (PDF)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/chinese-no-answers-4-1-12-pm-508.pdf" data-entity-type="media" data-entity-uuid="57b59651-9e2c-4130-80c4-0a8e4d921103" data-entity-substitution="canonical" title="(Chinese) No Answers 4 1 12 pm_508">Chinese (PDF)</a> (PDF)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/spanish-no-answers-4-1-12-pm-clean-updated-002-mk-080316_508.pdf" data-entity-type="media" data-entity-uuid="4fb58192-a013-4da4-8147-11d2ca265e98" data-entity-substitution="canonical" title="(Spanish) No Answers 4 1 12 pm clean UPDATED (002) mk 080316_508">Spanish (PDF)</a> (PDF)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/tagalog-no-answers-4-1-12-pm-508.pdf" data-entity-type="media" data-entity-uuid="4359a5dc-88fe-426c-938c-b57f9ffee9d3" data-entity-substitution="canonical" title="(Tagalog) No Answers 4 1 12 pm_508">Tagalog (PDF)</a> (PDF)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/no-answers-4-1-12-pm-clean-navajo.pdf" data-entity-type="media" data-entity-uuid="476ca051-80b8-4359-986f-5e7681e6ef71" data-entity-substitution="canonical" title="No Answers 4 1 12 pm clean-Navajo">Navajo (PDF)</a> (PDF)</li><li><a href="https://downloads.cms.gov/media/audio/No-Answers-4-1-12-pm-clean-Navajo.mp3">Navajo Oral Translation</a> (MP3)</li></ul></li><li>Guide for Coverage Examples Calculations – Maternity Scenario<ul><li><a href="/files/document/having-baby-guide-060723-xlsx.xlsx" data-entity-type="media" data-entity-uuid="03ccc977-25c2-414b-ab7a-aef6aac99532" data-entity-substitution="canonical" title="Having a Baby Guide 060723 (XLSX)">Standard Format (XLSX)</a></li><li><a href="/files/document/having-baby-guide-060723-pdf.pdf" data-entity-type="media" data-entity-uuid="933b7596-ed2f-4c77-a30d-65dd1c1932e6" data-entity-substitution="canonical" title="Having a Baby Guide 060723 (PDF)">Accessible Format (PDF)</a></li></ul></li><li>Guide for Coverage Examples Calculations – Diabetes Scenario<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/managing-type-2-diabetes.xlsx" data-entity-type="media" data-entity-uuid="e1ce9936-a756-4f25-a09c-cf0757c2c850" data-entity-substitution="canonical" title="Managing Type 2 Diabetes">Standard Format (XLSX)</a> (XLSX)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/managing-type-2-diabetes-508-mm.pdf" data-entity-type="media" data-entity-uuid="4aef4de4-c672-46ff-8041-1d6db2ffc0f2" data-entity-substitution="canonical" title="Managing Type 2 Diabetes 508 MM">Accessible Format (PDF)</a> (PDF)</li></ul></li><li>Guide for Coverage Examples Calculations – Simple Foot Fracture Scenario<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/simple-fracture.xlsx" data-entity-type="media" data-entity-uuid="963ae5b8-af2a-4de1-a053-1f1a998dd4ee" data-entity-substitution="canonical" title="Simple fracture">Standard Format (XLSX)</a> (XLSX)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/simple-fracture-508-mm.pdf" data-entity-type="media" data-entity-uuid="9372d465-35ba-46d3-a8fb-ac3458332439" data-entity-substitution="canonical" title="Simple fracture 508 MM">Accessible Format (PDF)</a> (PDF)</li></ul></li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/maternity-narrative-508mm.pdf" data-entity-type="media" data-entity-uuid="3ea49ce2-b79f-4a68-a6c8-d365a94fd4a5" data-entity-substitution="canonical" title="maternity-narrative 508MM">Narrative for Maternity Scenario (PDF)</a> (PDF)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/diabetes-narrative-508mm.pdf" data-entity-type="media" data-entity-uuid="8bdb6115-fd77-4bda-a5a5-cc17fcca5b2c" data-entity-substitution="canonical" title="diabetes-narrative 508MM">Narrative for Diabetes Scenario (PDF)</a> (PDF)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/foot-fracture-narrative-508-mm.pdf" data-entity-type="media" data-entity-uuid="4cf04173-2242-4eb2-b74c-f16f947f4756" data-entity-substitution="canonical" title="foot-fracture narrative 508 MM">Narrative for Simple Foot Fracture Scenario (PDF)</a> (PDF)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/coverage_examples_calculator-instructions-508-mm.pdf" data-entity-type="media" data-entity-uuid="c7a59236-23de-48f8-bb68-693b6e01d334" data-entity-substitution="canonical" title="coverage_examples_calculator instructions 508 MM">Coverage Examples Calculator Instructions (PDF)</a> (PDF)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/coverage_examples_calculator0208.xlsm" data-entity-type="media" data-entity-uuid="f53b4cb1-a6d6-43a4-86df-67ea668e61ff" data-entity-substitution="canonical" title="coverage_examples_calculator.02.08">Coverage Examples Calculator (VND.MS-EXCEL.SHEET.MACROENABLED.12)</a> (XLSM)  (updated May 2016 to address an error in the calculation of cost sharing after the annual limitation on cost sharing)</li></ul><p><strong>SBC Materials and Supporting Documents (Authorized for use prior to April 1, 2017)</strong></p><h3>Forms</h3><ul><li>Summary of Benefits and Coverage (SBC) Template<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-template.doc" data-entity-type="media" data-entity-uuid="010bceb7-39d9-46c8-8b28-daf2029b37c5" data-entity-substitution="canonical" title="sbc-template">Standard Format (DOC)</a>  (Authorized for second year of applicability) (DOC – 182 KB)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-template-accessible.pdf" data-entity-type="media" data-entity-uuid="333a5aab-ee37-444c-9e94-391a839cfce3" data-entity-substitution="canonical" title="sbc-template-accessible">Accessible Format (PDF)</a>  (Authorized for second year of applicability)  (PDF – 366 KB) </li><li><a href="/cciio/resources/files/downloads/sbc-template.doc" data-entity-type="media" data-entity-uuid="b0c9da03-3384-4cf5-993c-f4c0f0e6f01f" data-entity-substitution="canonical" title="sbc-template">Standard Format (DOC)</a> (Authorized for first year of applicability) (DOC - 175 KB)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-template-2012.pdf" data-entity-type="media" data-entity-uuid="ff5e264a-7a8f-4879-91fd-7dda4b73ba69" data-entity-substitution="canonical" title="sbc-template-2012">Accessible Format (PDF)</a> (Authorized for first year of applicability) (PDF - 607 KB)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-template-chinese-second-year.docx" data-entity-type="media" data-entity-uuid="009357fc-be30-40c6-9745-16613db260a2" data-entity-substitution="canonical" type="application/vnd.openxmlformats-officedocument.wordprocessingml.document" title="Chinese (Authorized for second year of applicability)"><span>Chinese (Authorized for second year of applicability) (DOCX)</span></a></li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-template-chinese-second-year-pdf.pdf" data-entity-type="media" data-entity-uuid="91cbcf0e-b3a8-4c0d-b321-bdaadb8e7e11" data-entity-substitution="canonical" type="application/pdf" title="Chinese (Authorized for second year of applicability)"><span>Chinese (Authorized for second year of applicability) (PDF)</span></a></li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-template-chinese-1docx.docx" data-entity-type="media" data-entity-uuid="a5a636e2-c3f8-4c5f-90a2-273204ae174d" data-entity-substitution="canonical" title="sbc-template-chinese-1.docx">Chinese (Authorized for first year of applicability) (DOCX)</a> (DOC – 54 KB)</li><li><a href="/cciio/resources/files/downloads/sbc-template-chinese-2.pdf" data-entity-type="media" data-entity-uuid="3b94769c-9a43-4e31-a7f4-755dcdd95533" data-entity-substitution="canonical" title="sbc-template-chinese-2">Chinese (Authorized for first year of applicability) (PDF)</a> (PDF- 565 KB)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-template-navajo-2-5-2014.docx" data-entity-type="media" data-entity-uuid="01f50381-6cd6-4e65-9115-68cf8aa107ac" data-entity-substitution="canonical" type="application/vnd.openxmlformats-officedocument.wordprocessingml.document" title="Navajo (Authorized for second year of applicability)"><span>Navajo (Authorized for second year of applicability) (DOCX)</span></a></li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-template-navajo-2-5-14.pdf" data-entity-type="media" data-entity-uuid="0e9db193-8bde-4a1e-95c2-faf961ba6e5b" data-entity-substitution="canonical" type="application/pdf" title="Navajo (Authorized for second year of applicability)"><span>Navajo (Authorized for second year of applicability) (PDF)</span></a></li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-template-navajo-audio-04102014.mp3" data-entity-type="media" data-entity-uuid="d9381c45-3988-4230-acbd-460e2ec745ff" data-entity-substitution="canonical" type="audio/mpeg" title="Navajo Oral Translation (Authorized for second year of applicability)"><span>Navajo Oral Translation (Authorized for second year of applicability) [MP3, 27MB] </span></a></li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-template-navajo-1docx.docx" data-entity-type="media" data-entity-uuid="f8fcae94-9d23-49ab-a865-ec1138cc7dc2" data-entity-substitution="canonical" title="sbc-template-navajo-1.docx">Navajo (Authorized for first year of applicability) (DOCX)</a> (DOC – 67 KB)<br>(Note: In order to use the Navajo SBC template in Word format, it may be necessary to install Times New Roman Navajo fonts.  Times New Roman Navajo fonts are available free of charge on a number of sources on the Internet.)</li><li><a href="/cciio/resources/files/downloads/sbc-template-navajo-2.pdf" data-entity-type="media" data-entity-uuid="b9ab7e3b-f979-424b-b4e3-57a4b66e35b7" data-entity-substitution="canonical" title="sbc-template-navajo-2">Navajo (Authorized for first year of applicability) (PDF)</a> (PDF – 258 KB)</li><li><a href="http://downloads.cms.gov/media/cciio/sbc-template-navajo-audio.mp3">Navajo (Authorized for first year of applicability)</a>  - Oral Translation (MP3 – 21 MB)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-template-spanish-second-year.docx" data-entity-type="media" data-entity-uuid="88d31b53-640c-46ae-86d2-b2b887ac56a0" data-entity-substitution="canonical" type="application/vnd.openxmlformats-officedocument.wordprocessingml.document" title="Spanish (Authorized for second year of applicability)"><span>Spanish (Authorized for second year of applicability) (DOCX)</span></a></li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-template-spanish-second-year-pdf.pdf" data-entity-type="media" data-entity-uuid="e5b249ae-b375-4de6-88d6-6087198515b5" data-entity-substitution="canonical" type="application/pdf" title="Spanish (Authorized for second year of applicability)"><span>Spanish (Authorized for second year of applicability) (PDF)</span></a></li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-template-spanish-1docx.docx" data-entity-type="media" data-entity-uuid="8030fd34-23d4-4d5a-881a-b2b609dc46b5" data-entity-substitution="canonical" title="sbc-template-spanish-1.docx">Spanish (Authorized for first year of applicability) (DOCX)</a> (DOC – 170KB)</li><li><a href="/cciio/resources/files/downloads/sbc-uniform-glossary-spanish.pdf" data-entity-type="media" data-entity-uuid="62d36e05-c744-422c-82ee-7ba8293bade8" data-entity-substitution="canonical" title="sbc-uniform-glossary-spanish">Spanish (Authorized for first year of applicability) (PDF)</a> (PDF – 458 KB)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-template-tagalog-second-year.docx" data-entity-type="media" data-entity-uuid="caa03108-d814-413b-a716-49a92129b147" data-entity-substitution="canonical" type="application/vnd.openxmlformats-officedocument.wordprocessingml.document" title="Tagalog (Authorized for second year of applicability)"><span>Tagalog (Authorized for second year of applicability) (DOCX)</span></a></li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-template-tagalog-second-year-pdf.pdf" data-entity-type="media" data-entity-uuid="ea9ea605-2279-4982-b7f5-c9f47f52408d" data-entity-substitution="canonical" type="application/pdf" title="Tagalog (Authorized for second year of applicability)"><span>Tagalog (Authorized for second year of applicability) (PDF)</span></a></li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-template-tagalog-1docx.docx" data-entity-type="media" data-entity-uuid="c567ab64-d568-4efc-9949-46d58ccd53a7" data-entity-substitution="canonical" title="sbc-template-tagalog-1.docx">Tagalog (Authorized for first year of applicability) (DOCX)</a> (DOC – 71 KB)</li><li><a href="/cciio/resources/files/downloads/sbc-uniform-glossary-tagalog.pdf" data-entity-type="media" data-entity-uuid="bd732c15-10a7-45b3-9a74-e1b98fb9ce46" data-entity-substitution="canonical" title="sbc-uniform-glossary-tagalog">Tagalog (Authorized for first year of applicability) (PDF)</a> (PDF – 446 KB)</li></ul></li><li>Uniform Glossary<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/uniform-glossary-final.pdf" data-entity-type="media" data-entity-uuid="d1ef3dbe-734e-42bf-904e-643294c09464" data-entity-substitution="canonical" title="English">English (PDF)</a> (PDF – 140 KB )</li><li><a href="/cciio/resources/files/downloads/sbc-uniform-glossary-chinese.pdf" data-entity-type="media" data-entity-uuid="07f83c92-ed01-46e8-b76d-02ab5b823a91" data-entity-substitution="canonical" title="sbc-uniform-glossary-chinese">Chinese (PDF)</a> (PDF – 226 KB)</li><li><a href="/cciio/resources/files/downloads/sbc-uniform-glossary-navajo-2.pdf" data-entity-type="media" data-entity-uuid="bdcabc6f-4bb9-4c9e-8d0e-baa0e27f3f66" data-entity-substitution="canonical" title="sbc-uniform-glossary-navajo-2">Navajo (PDF)</a> (PDF – 400 KB)</li><li><a href="http://downloads.cms.gov/media/cciio/sbc-uniform-glossary-navajo-audio.mp3">Navajo</a> - Oral Translation (MP3 – 26 MB)</li><li><a href="/cciio/resources/files/downloads/sbc-uniform-glossary-spanish.pdf" data-entity-type="media" data-entity-uuid="62d36e05-c744-422c-82ee-7ba8293bade8" data-entity-substitution="canonical" title="sbc-uniform-glossary-spanish">Spanish (PDF)</a> (PDF – 349 KB)</li><li><a href="/cciio/resources/files/downloads/sbc-uniform-glossary-tagalog.pdf" data-entity-type="media" data-entity-uuid="bd732c15-10a7-45b3-9a74-e1b98fb9ce46" data-entity-substitution="canonical" title="sbc-uniform-glossary-tagalog">Tagalog (PDF)</a> (PDF  - 145 KB)</li></ul></li></ul><h3>Instructions/Guidance</h3><ul><li>Sample Completed SBC<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sample-completed-sbc.doc" data-entity-type="media" data-entity-uuid="11d2f953-8114-4661-a8c8-8982f61135db" data-entity-substitution="canonical" title="sample-completed-sbc">Standard Format (DOC)</a>  (Authorized for second year of applicability) (DOC – 206 KB)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sample-completed-sbc-accessible.pdf" data-entity-type="media" data-entity-uuid="04aa09ae-ca9c-4e55-8052-ce754c5a8397" data-entity-substitution="canonical" title="sample-completed-sbc-accessible">Accessible Format (PDF)</a>  (Authorized for second year of applicability) (PDF – 431 KB) </li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-sample-docdoc.doc" data-entity-type="media" data-entity-uuid="9256c859-4f9b-4d0a-878d-e811611fa645" data-entity-substitution="canonical" title="sbc-sample-doc.doc">Standard Format (DOC)</a> (Corrected, May 11, 2012) (DOC - 200 KB)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-sample-2012.pdf" data-entity-type="media" data-entity-uuid="5be0c001-7de5-4dff-a734-a7e39e015c58" data-entity-substitution="canonical" title="sbc-sample-2012">Accessible Format (PDF)</a> (Corrected, May 11, 2012) (PDF - 533 KB)</li></ul></li><li><a href="/cciio/resources/files/downloads/instructions-group-final.pdf" data-entity-type="media" data-entity-uuid="7cf88fd9-e7a2-4b4a-b779-e06cd89fed26" data-entity-substitution="canonical" title="instructions-group-final">Instructions for Completing the SBC – Group Health Plan Coverage (PDF)</a> (PDF – 89 KB)</li><li><a href="/cciio/resources/files/downloads/instructions-individual-final.pdf" data-entity-type="media" data-entity-uuid="36ce9659-34b9-4725-873a-35a6a1ab56aa" data-entity-substitution="canonical" title="instructions-individual-final">Instructions for Completing the SBC – Individual Health Insurance Coverage (PDF)</a> (PDF – 81 KB)</li><li> Why This Matters language for SBC "Yes" Answers<ul><li><a href="/cciio/resources/files/downloads/why-this-matters-yes-answers-final.pdf" data-entity-type="media" data-entity-uuid="6cf76be9-2b97-42ac-835f-6bbf12373043" data-entity-substitution="canonical" title="why-this-matters-yes-answers-final">English (PDF)</a> (PDF – 120 KB)</li><li><a href="/cciio/resources/files/downloads/sbc-why-this-matters-yes-answers-chinese.pdf" data-entity-type="media" data-entity-uuid="0a8045b4-f33f-4317-b179-f7410b17b7da" data-entity-substitution="canonical" title="sbc-why-this-matters-yes-answers-chinese">Chinese (PDF)</a> (PDF-159 KB)</li><li><a href="/cciio/resources/files/downloads/sbc-why-this-matters-yes-answers-navajo.pdf" data-entity-type="media" data-entity-uuid="5426a78f-88be-4cc2-96ba-220de76d5e8a" data-entity-substitution="canonical" title="sbc-why-this-matters-yes-answers-navajo">Navajo (PDF)</a> (PDF-641 KB)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-sample-yes-answers-navajo-audiomp3.mp3" data-entity-type="media" data-entity-uuid="5681d4dd-9178-4b04-922f-647c010417d0" data-entity-substitution="canonical" title="sbc-sample-yes-answers-navajo-audio.mp3">Navajo Oral Translation</a> (MP3 – 7 MB)</li><li><a href="/cciio/resources/files/downloads/sbc-why-this-matters-yes-answers-spanish.pdf" data-entity-type="media" data-entity-uuid="300a82df-170a-4a70-b28f-5dc9b0b3e0c8" data-entity-substitution="canonical" title="sbc-why-this-matters-yes-answers-spanish">Spanish (PDF)</a> (PDF – 288 KB)</li><li><a href="/cciio/resources/files/downloads/sbc-why-this-matters-yes-answers-tagalog.pdf" data-entity-type="media" data-entity-uuid="c2dd54af-2f59-4257-a51e-7becbdcfc7ac" data-entity-substitution="canonical" title="sbc-why-this-matters-yes-answers-tagalog">Tagalog (PDF)</a> ( PDF – 111 KB)</li></ul></li><li>Why This Matters language for SBC "No" Answers<ul><li><a href="/cciio/resources/files/downloads/why-this-matters-no-answers-final.pdf" data-entity-type="media" data-entity-uuid="ad3c1204-cdba-4981-b121-e58468056c97" data-entity-substitution="canonical" title="why-this-matters-no-answers-final">English (PDF)</a> (PDF – 92 KB)</li><li><a href="/cciio/resources/files/downloads/sbc-why-this-matters-no-answers-chinese.pdf" data-entity-type="media" data-entity-uuid="cb0c56a6-50ea-4f29-80ae-652e964c7088" data-entity-substitution="canonical" title="sbc-why-this-matters-no-answers-chinese">Chinese (PDF)</a> (PDF – 147 KB)</li><li><a href="/cciio/resources/files/downloads/sbc-why-this-matters-no-answers-navajo.pdf" data-entity-type="media" data-entity-uuid="932987e8-246c-4eac-b252-9755976137ab" data-entity-substitution="canonical" title="sbc-why-this-matters-no-answers-navajo">Navajo (PDF)</a> (PDF – 446 KB)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-sample-no-answers-navajo-audiomp3.mp3" data-entity-type="media" data-entity-uuid="a5d80d35-c44f-4882-a208-cd1f321762c7" data-entity-substitution="canonical" title="sbc-sample-no-answers-navajo-audio.mp3">Navajo - Oral Translation</a> (MP3 – 4.4 MB)</li><li><a href="/cciio/resources/files/downloads/sbc-why-this-matters-no-answers-spanish.pdf" data-entity-type="media" data-entity-uuid="f93f81b8-273c-4920-90ed-c9c8552cba80" data-entity-substitution="canonical" title="sbc-why-this-matters-no-answers-spanish">Spanish (PDF)</a> (PDF – 292 KB)</li><li><a href="/cciio/resources/files/downloads/sbc-why-this-matters-no-answers-tagalog.pdf" data-entity-type="media" data-entity-uuid="401a96de-8393-4feb-854e-db56bcf35569" data-entity-substitution="canonical" title="sbc-why-this-matters-no-answers-tagalog">Tagalog (PDF)</a> (PDF- 107 KB)</li></ul></li><li>Guide for Coverage Examples Calculations – Maternity Scenario<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/maternity-scenario-2-7-12xlsx.xlsx" data-entity-type="media" data-entity-uuid="95022a3e-633a-476f-8c04-73a3c71227c4" data-entity-substitution="canonical" title="maternity-scenario-2-7-12.xlsx">Standard Format (XLSX)</a> (XLSX – 91 KB)</li><li><a href="/cciio/resources/files/downloads/accessible-maternity-scenario-2-7-12.pdf" data-entity-type="media" data-entity-uuid="bb787d31-fc34-4e18-964d-56319c8963ef" data-entity-substitution="canonical" title="accessible-maternity-scenario-2-7-12">Accessible Format (PDF)</a> (PDF – 98 KB)</li></ul></li><li>Guide for Coverage Examples Calculations – Diabetes Scenario<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/diabetes-scenarioxxlsx.xlsx" data-entity-type="media" data-entity-uuid="238f2b17-c7fd-42ed-88ef-e68bc153793f" data-entity-substitution="canonical" title="diabetes-scenariox.xlsx">Standard Format (XLSX)</a> (Corrected May 11, 2012) (XLSX - 56 KB)</li><li><a href="/cciio/resources/files/downloads/diabetes-scenario.pdf" data-entity-type="media" data-entity-uuid="c4501e85-6fd8-43b2-b996-7a223264c7a6" data-entity-substitution="canonical" title="diabetes-scenario">Accessible Format (PDF)</a> (Corrected May 11, 2012) (PDF - 343 KB)</li></ul></li><li><a href="/cciio/resources/files/downloads/maternity-narrative-2-7-12.pdf" data-entity-type="media" data-entity-uuid="efd17a84-fbe2-41f2-9d16-eb6692852a6e" data-entity-substitution="canonical" title="maternity-narrative-2-7-12">Narrative for Maternity Scenario (PDF)</a> (PDF – 11 KB)</li><li><a href="/cciio/resources/files/downloads/diabetes-narrative-2-7-12.pdf" data-entity-type="media" data-entity-uuid="26354eee-1a7f-438c-a1ce-e106b9e33c9e" data-entity-substitution="canonical" title="diabetes-narrative-2-7-12">Narrative for Diabetes Scenario (PDF)</a> (PDF – 11 KB)</li><li><a href="/cciio/resources/files/downloads/sbc-cover-ex-calc-check.pdf" data-entity-type="media" data-entity-uuid="485e4bc6-7abc-4caf-8e16-decc26050511" data-entity-substitution="canonical" title="sbc-cover-ex-calc-check">Checklist for Coverage Calculator (PDF)</a> (PDF – 43 KB)</li><li><a href="/cciio/resources/files/downloads/sbc-cover-ex-calc-instructions.pdf" data-entity-type="media" data-entity-uuid="87922aca-2ef0-4712-9407-829f27435df6" data-entity-substitution="canonical" title="sbc-cover-ex-calc-instructions">Coverage Examples Calculator Instructions (PDF)</a> (PDF – 274 KB)</li><li><a href="/cciio/resources/files/downloads/sbc-cover-ex-logic.pdf" data-entity-type="media" data-entity-uuid="74d1ae75-4760-4127-8a71-e89fefe771e3" data-entity-substitution="canonical" title="sbc-cover-ex-logic">Coverage Examples Calculator Logic (PDF)</a> (PDF – 91 KB)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sbc-coverage-calculator-20120829xlsm.xlsm" data-entity-type="media" data-entity-uuid="3d50392c-7257-4180-8d06-860c01331870" data-entity-substitution="canonical" title="sbc-coverage-calculator-20120829.xlsm">Coverage Examples Calculator (VND.MS-EXCEL.SHEET.MACROENABLED.12)</a> (XLSM – 442 KB)  (updated September 7, 2012)<br>(Note: This version of the coverage examples calculator corrects an error in a previous version that would result in an error message with regard to coverage of preventive services and maximum out-of-pockets.  That programming error did not impact the accuracy of the results in either the manual or automated processes, so plans and issuers that have successfully used the previous versions (June 4, 2012 and Updated July 23, 2012) of the calculator may use the results from the previous version.)</li></ul><h2><a class="ck-anchor" id="Content_Requirements_for_Plan_Finder"></a>Content Requirements for Plan Finder</h2><h3>Q&A</h3><ul><li>September 1, 2016<br><a href="/cciio/resources/files/faq_plan_finder_data_entry" data-entity-type="node" data-entity-uuid="3c1fb15d-aaed-4136-82af-a5143a9f5722" data-entity-substitution="canonical" title="Questions and Answers for Plan Finder Data Entry">Plan Finder Data Entry</a></li></ul><h3>Instructions/Guidance</h3><ul><li>June 1, 2016<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/mfa-_guide_for_existing_hios_users_000100.pdf" data-entity-type="media" data-entity-uuid="b70873bd-c9de-41db-9aeb-0a8ec7da6cd2" data-entity-substitution="canonical" title="MFA _Guide_for_Existing_HIOS_Users_00.01.00">CMS.gov Enterprise Portal Quick Reference Guide for Existing Users Adding Multi-Factor Authentication (MFA) to their Health Insurance Oversight System (HIOS) Application Role (PDF)</a></li><li>June 1, 2016<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/hios_abbreviated_mfa_guide_000100.pdf" data-entity-type="media" data-entity-uuid="09c9ec5c-9de3-4321-8efb-ccb248c4c05d" data-entity-substitution="canonical" title="HIOS_Abbreviated_MFA_Guide_00.01.00">Abbreviated Reference Guide for Existing Users Adding Multi-Factor Authentication (MFA) to their Health Insurance Oversight System (HIOS) Application Role (PDF)</a></li><li>June 1, 2016<br><a href="https://www.youtube.com/watch?v=y4HaapQPy2g&index=2&list=PLaV7m2-zFKpgYq_8AHW-FYM61J295xwLC">EIDM YouTube video for Multi Factor Authentication Registration</a></li><li>April 22, 2019<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/hios-plan-finder-user-manual.pdf" data-entity-type="media" data-entity-uuid="760bdd82-6773-493c-8dd3-772c14dbd834" data-entity-substitution="canonical" type="application/pdf" title="HIOS Plan Finder User Manual"><span>HIOS Plan Finder User Manual (PDF)</span></a><span> </span> </li><li><span lang="EN">August 29, 2022</span><br><a href="/files/document/hios-portal-user-manual-390000.pdf" data-entity-type="media" data-entity-uuid="53c5a1c3-929d-44e2-8693-d7b697f1f9ad" data-entity-substitution="canonical" title="HIOS Portal User Manual 39_00_00"><span>HIOS Portal User Manual (PDF)</span></a></li><li><span>August 29, 2022</span><br><a href="/files/document/hios-data-cr-qg-080000.pdf" data-entity-type="media" data-entity-uuid="366c5da1-bb6e-4942-8b71-57e31d1253e3" data-entity-substitution="canonical" title="HIOS Data CR QG 08_00_00"><span>HIOS Data Change Request Quick Guide (PDF)</span></a></li><li><span lang="EN">August 29, 2022</span><br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/hios-rbis-manual.pdf" data-entity-type="media" data-entity-uuid="0fb76371-2a0e-4308-9ac5-6605516c9b78" data-entity-substitution="canonical" type="application/pdf" title="Rate and Benefit Information System (RBIS) User Manual"><span>Rate and Benefit Information System (RBIS) User Manual (PDF)</span></a><span> </span>  </li><li>August 29, 2022<br><a href="/files/document/hios-managerelationships-pqg-100000.pdf" data-entity-type="media" data-entity-uuid="bddc6ae0-4c53-491e-9d75-02bf6b5afd8a" data-entity-substitution="canonical" title="HIOS ManageRelationships PQG 10_00_00">HIOS Manage Relationships Functionality Quick Reference Guide (PDF)</a></li><li><span>March 3, 2023</span><br><a href="/files/document/hios-portal-pqg-120000.pdf" data-entity-type="media" data-entity-uuid="38bd835d-ed2b-4baa-892d-a79cb12b00d1" data-entity-substitution="canonical" title="HIOS Portal PQG 12_00_00">HIOS Portal Quick Guide (PDF)</a></li><li>March 3, 2023<br><a href="/files/document/hios-ffmpm-pqg-100000.pdf" data-entity-type="media" data-entity-uuid="a97c6955-15b9-4a60-8bd2-b1c47d43996a" data-entity-substitution="canonical" title="HIOS FFMPM PQG 10.00.00">Plan Management QHP Module Quick Guide (PDF)</a></li></ul><h2><a class="ck-anchor" id="Pre-Existing Condition Insurance Plan (PCIP)"></a>Pre-Existing Condition Insurance Plan (PCIP)</h2><h3>Data</h3><ul><li><a href="/cciio/resources/files/pcipdatamay312001" data-entity-type="node" data-entity-uuid="01496743-7911-4cfa-89e4-ba50872e859b" data-entity-substitution="canonical" title="Pre-existing Condition Insurance Plan Data as of May 31 2011">PCIP Data as of May 31 2011</a></li><li><a href="/cciio/resources/files/downloads/pcip_data_september_30-2011.pdf" data-entity-type="media" data-entity-uuid="846eaee2-6f10-4311-b074-ab35e9537af1" data-entity-substitution="canonical" title="pcip_data_september_30 2011">Update on Federal PCIP September 29, 2011 (PDF)</a> (PDF 624 KB)</li><li><a href="/cciio/resources/files/downloads/pcip-data-12-31-2011.pdf" data-entity-type="media" data-entity-uuid="70af8f58-7a91-46f3-a590-b08952faf7f8" data-entity-substitution="canonical" title="pcip-data-12-31-2011">Update on Federal PCIP December 31, 2011 (PDF)</a> (PDF - 174 KB)</li><li><a href="/cciio/resources/files/downloads/pcip-expenditures-03-31-2012.pdf" data-entity-type="media" data-entity-uuid="efae53ec-65aa-419f-a798-2de51839d93e" data-entity-substitution="canonical" title="pcip-expenditures-03-31-2012">Update on Federal PCIP March 31, 2012 (PDF)</a> (PDF - 122 KB)</li><li><a href="/cciio/resources/files/downloads/pcip-expenditures-06-30-2012.pdf" data-entity-type="media" data-entity-uuid="34706392-56b2-4808-b5cd-9401deaed804" data-entity-substitution="canonical" title="pcip-expenditures-06-30-2012">Update on Federal PCIP June 30, 2012 (PDF)</a> (PDF - 131 KB)</li><li><a href="/cciio/resources/files/downloads/pcip-expenditures-09-30-2012-2.pdf" data-entity-type="media" data-entity-uuid="1726a41e-f05c-4766-bcc2-c2efbea0d0b9" data-entity-substitution="canonical" title="pcip-expenditures-09-30-2012-2">Update on Federal PCIP September 30, 2012 (PDF)</a> (PDF - 464 KB)</li><li><a href="/cciio/resources/files/downloads/pcip-expenditures-12-31-2012.pdf" data-entity-type="media" data-entity-uuid="875706d9-dad0-4919-bd36-5b25b399b73f" data-entity-substitution="canonical" title="pcip-expenditures-12-31-2012">Update on Federal PCIP December 31, 2012 (PDF)</a>  (PDF - 99 KB)  </li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/pcip-expenditures-3-31-2013.pdf" data-entity-type="media" data-entity-uuid="d41d6c28-3710-49fe-875f-99a1066c2306" data-entity-substitution="canonical" title="Update on Federal PCIP March 31, 2013">Update on Federal PCIP March 31, 2013 (PDF)</a>  (PDF - 98 KB)  </li><li><a href="/cciio/resources/fact-sheets-and-faqs/downloads/pcip-expenditures-6-30-2013.pdf" data-entity-type="media" data-entity-uuid="ce9fd6a4-c005-4c32-a343-1901d1770264" data-entity-substitution="canonical" title="Update on Federal PCIP June 30, 2013">Update on Federal PCIP June 30, 2013 (PDF)</a>  (PDF - 125 KB)  </li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/pcip-expenditures-9-30-2013.pdf" data-entity-type="media" data-entity-uuid="6468f02a-8036-42e6-aec6-ebd9d1ff2a6a" data-entity-substitution="canonical" title="Update on Federal PCIP September 30, 2013">Update on Federal PCIP September 30, 2013 (PDF)</a> (PDF - 105 KB)  </li></ul><h3>Reports</h3><ul><li>February 23, 2012<br><a href="/cciio/resources/files/downloads/pcip-report.pdf" data-entity-type="media" data-entity-uuid="f193b1a5-509a-4def-84ab-053de324dd5a" data-entity-substitution="canonical" title="pcip-report">Report on the Implementation and Operation of the Pre-Existing Condition Insurance Plan Program (PDF)</a> (PDF - 330 KB)</li><li>February 1, 2013<br><a href="/cciio/resources/files/downloads/pcip_annual_report_01312013.pdf" data-entity-type="media" data-entity-uuid="b95f544c-d86e-499f-948c-cc681e5148c9" data-entity-substitution="canonical" title="pcip_annual_report_01312013">Annual Report on the Implementation and Operation of the PCIP Program (PDF)</a> (PDF -300KB)</li></ul><h2><a class="ck-anchor" id="Early Retiree Reinsurance Program (ERRP)"></a>Early Retiree Reinsurance Program (ERRP)</h2><h3><strong>Reports</strong></h3><ul><li>June 25, 2014<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/errp-reimbursement-report-06-25-2014.pdf" data-entity-type="media" data-entity-uuid="a6310782-0a7b-4568-80c4-5ad481331cc2" data-entity-substitution="canonical" type="application/pdf" title="Early Retiree Reinsurance Program: Reimbursement Update"><span>Early Retiree Reinsurance Program: Reimbursement Update (PDF)</span></a></li></ul><h2><a class="ck-anchor" id="Health_Insurance_Marketplaces"></a>Health Insurance Marketplaces</h2><p><strong>Qualified Health Plan (QHP) Directory Pilot (September 17, 2024)</strong></p><p>As part of its ongoing work to improve access to care, reduce clinician burden, and support interoperability throughout the health sector, the Centers for Medicare & Medicaid Services (CMS) is partnering with the state of Oklahoma on a first-of-its-kind directory pilot that will help inform the design and feasibility of any future efforts toward a National Directory of Healthcare (NDH). One goal of this pilot is to develop an automated, single, statewide centralized directory for Qualified Health Plans (QHPs) and providers in Oklahoma to improve data accuracy, lessen burden on providers and payers, lower administrative costs, support interoperable data exchange, and ultimately improve patient and provider experiences. CMS believes that this pilot will serve as a proof-of-concept and help inform any future development of an NDH that can serve as a centralized database for provider information.</p><h3>Presentations</h3><ul><li>September 2011<br><a href="/cciio/resources/presentations/hie-fall-2011-grantee-meeting" data-entity-type="node" data-entity-uuid="60a92f39-b5d6-4d82-a84d-a6bd113bdad3" data-entity-substitution="canonical" title="Affordable Insurance Exchanges">State Exchange Grantee Meeting Materials</a></li><li>March 2012<br><a href="/cciio/resources/files/downloads/hie-overview-presentation.pdf" data-entity-type="media" data-entity-uuid="9b13a40b-ff47-449d-b077-fc575cc8e356" data-entity-substitution="canonical" title="hie-overview-presentation">Affordable Insurance Exchanges Final Rule (PDF)</a> (PDF - 749 KB)</li><li>May 2012<br><a href="/cciio/resources/presentations/hie-spring-2012-conference" data-entity-type="node" data-entity-uuid="9fe184bf-4696-46dc-9051-41c09618f593" data-entity-substitution="canonical" title="Affordable Insurance Exchanges">System-wide Exchange Conference Materials</a></li><li>November 26, 2012<br><a href="/cciio/resources/files/downloads/ehb-av-accred-nprm-11-20-2012.pdf" data-entity-type="media" data-entity-uuid="32dfe440-bb7a-4b6f-bcb4-e0a418ae326c" data-entity-substitution="canonical" title="ehb-av-accred-nprm-11-20-2012">EHB/AV/Accreditation Notice of Proposed Rulemaking (PDF)</a> (PDF – 593 KB)</li><li>January 3, 2013<br><a href="/cciio/resources/files/downloads/partnership_presentation-01-03-2013.pdf" data-entity-type="media" data-entity-uuid="0fb0756d-551f-4978-8fdf-85ff551694b5" data-entity-substitution="canonical" title="partnership_presentation-01-03-2013">State Partnership Exchange (PDF)</a> (PDF – 267 KB)</li><li>February 25, 2013<br><a href="/cciio/resources/files/downloads/ehb-av-accred-final-2-25-2013v2.pdf" data-entity-type="media" data-entity-uuid="f38375a8-3189-4d12-88c1-9ed7c53bfd7d" data-entity-substitution="canonical" title="ehb-av-accred-final-2-25-2013v2">EHB/AV/Accreditation Final Rule (PDF)</a> (PDF - 549 KB)</li><li>January 27, 2016<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2014_plan_yearissue_compliance_summary_report_presentation.pdf" data-entity-type="media" data-entity-uuid="42257814-c38b-48c8-9634-3c36b5495745" data-entity-substitution="canonical" title="\2014 Plan Year Issuer Compliance Summary Report Presentation">2014 Plan Year Issuer Compliance Summary Report Presentation (PDF)</a></li></ul><h3>Marketplace Year 3: Issuer Insights and Innovation - June 9, 2016</h3><p><a href="/cciio/resources/forms-reports-and-other-resources/downloads/issuerinnovationforum_agenda-final.pdf" data-entity-type="media" data-entity-uuid="55b4f264-6369-4da3-b94a-c187444ad4a4" data-entity-substitution="canonical" title="IssuerInnovationForum_Agenda FINAL">Forum Agenda (PDF)</a><br><span>CMS Acting Administrator Andy Slavitt Remarks"> </span><a href="http://wayback.archive-it.org/2744/20160610174752/https://blog.cms.gov/2016/06/09/remarks-of-cms-acting-administrator-andy-slavitt-at-the-marketplace-innovation-conference/" title="CMS Acting Administrator Andy Slavitt Remarks - Opens in a new window" target="T217130"><span>CMS Acting Administrator Andy Slavitt Remarks</span><span class="LinkDisclaimer"> - Opens in a new window</span></a><span> </span> <br><span>HHS Secretary Burwell Remarks"> </span><a href="https://wayback.archive-it.org/8314/20161219024132/https://www.hhs.gov/about/leadership/secretary/speeches/2016/cciio-issuers-forum.html?language=en" title="HHS Secretary Burwell Remarks - Opens in a new window" target="T217131"><span>HHS Secretary Burwell Remarks</span><span class="LinkDisclaimer"> - Opens in a new window</span></a><span> </span> <br><span>Marketplace Success Stories Blog by CEO Kevin Counihan"> </span><a href="http://wayback.archive-it.org/2744/20160610044915/https://blog.cms.gov/2016/06/08/marketplace-success-stories/" title="Marketplace Success Stories Blog by CEO Kevin Counihan - Opens in a new window" target="T217132"><span>Marketplace Success Stories Blog by CEO Kevin Counihan</span><span class="LinkDisclaimer"> - Opens in a new window</span></a><span> </span> </p><h3>Forum Recording:</h3><ul><li><a href="https://www.youtube.com/watch?v=ypspRhURU8Q&list=PLrl7E8KABz1FBgHoDHl6e3DKIoIC99x_A&index=1">Welcome by HHS Secretary Burwell</a></li><li><a href="https://www.youtube.com/watch?v=ypspRhURU8Q&list=PLrl7E8KABz1FBgHoDHl6e3DKIoIC99x_A&index=1">The Marketplace Consumer: Understanding the Marketplace Population Through Two Years’ Worth of Data</a></li><li><a href="https://www.youtube.com/watch?v=kfmflo9y7jg&list=PLrl7E8KABz1FBgHoDHl6e3DKIoIC99x_A&index=2">Innovation in Provider Contracting</a></li><li><a href="https://www.youtube.com/watch?v=Sb3qvt7xYPQ&list=PLrl7E8KABz1FBgHoDHl6e3DKIoIC99x_A&index=3">Keynote by Andy Slavitt</a></li><li><a href="https://www.youtube.com/watch?v=Sb3qvt7xYPQ&list=PLrl7E8KABz1FBgHoDHl6e3DKIoIC99x_A&index=3">Care Coordination</a></li><li><a href="https://www.youtube.com/watch?v=Sb3qvt7xYPQ&list=PLrl7E8KABz1FBgHoDHl6e3DKIoIC99x_A&index=3">Conversation with the CEO - Looking Ahead</a></li></ul><h3>Session Slides:</h3><ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/enr_engagingconsumersconsolidated_5cr_061516.pdf" data-entity-type="media" data-entity-uuid="2d4a1a64-9e01-4d73-a1ba-9b4d53ce791e" data-entity-substitution="canonical" title="ENR_EngagingConsumersConsolidated_5CR_061516">The Marketplace Consumer: Understanding the Marketplace Population Through Two Years’ Worth of Data (PDF)</a></li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/enr_innovationinprovidercontracting_v1_5cr_061516.pdf" data-entity-type="media" data-entity-uuid="84c4561b-a458-49f1-ae1b-467b18bb620f" data-entity-substitution="canonical" title="ENR_InnovationInProviderContracting_v1_5CR_061516">Innovation in Provider Contracting (PDF)</a></li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/enr_carecoordinationconsolidated_5cr_061516.pdf" data-entity-type="media" data-entity-uuid="289c87ad-1ca3-4167-81de-13c82ef68314" data-entity-substitution="canonical" title="ENR_CareCoordinationConsolidated_5CR_061516">Care Coordination (PDF)</a></li></ul><h3>Marketplace Year 3: Issuer Insights and Innovation – October 5, 2016</h3><p><a href="/cciio/resources/forms-reports-and-other-resources/downloads/issuerinnovationforum2-agenda.pdf" data-entity-type="media" data-entity-uuid="0ba57426-2d82-48d0-a19e-d8737e65156c" data-entity-substitution="canonical" title="IssuerInnovationForum2_Agenda">Forum Agenda (PDF)</a><br><span>CMS Acting Administrator Andy Slavitt Remarks"> </span><a href="http://wayback.archive-it.org/2744/20160610174752/https://blog.cms.gov/2016/06/09/remarks-of-cms-acting-administrator-andy-slavitt-at-the-marketplace-innovation-conference/" title="CMS Acting Administrator Andy Slavitt Remarks - Opens in a new window" target="T217130"><span>CMS Acting Administrator Andy Slavitt Remarks</span><span class="LinkDisclaimer"> - Opens in a new window</span></a><span> </span><br><span>HHS Secretary Burwell Remarks"> </span><a href="https://wayback.archive-it.org/8314/20161219024132/https://www.hhs.gov/about/leadership/secretary/speeches/2016/cciio-issuers-forum.html?language=en" title="HHS Secretary Burwell Remarks - Opens in a new window" target="T217131"><span>HHS Secretary Burwell Remarks</span><span class="LinkDisclaimer"> - Opens in a new window</span></a></p><h3>Forum Recordings (Forthcoming)</h3><ul><li><a href="https://youtu.be/lTISsHtZ_fQ">Welcome by HHS Secretary Burwell</a></li><li><a href="https://youtu.be/lTISsHtZ_fQ">Looking Ahead to the Future of the Marketplace: A Conversation with CEOs</a></li><li><a href="https://youtu.be/DGi1vF78CRs">The Marketplace Consumer – Using Data to Drive Outreach and Engagement</a></li><li><a href="https://youtu.be/zZo293qd4sg">Innovation in Plan Design and Provider Outreach</a></li><li><a href="https://youtu.be/hxa95oYW6nQ">Keynote by Andy Slavitt</a></li><li><a href="https://youtu.be/_zhfvjkl37s">Engaging Consumers in their Care – Perspectives from Care Coordination and Beyond</a></li></ul><h3>Session Slides</h3><ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/session-1-consumer-outreach.pdf" data-entity-type="media" data-entity-uuid="e77b5449-1855-407c-ab63-38ad44fd814e" data-entity-substitution="canonical" title="Session-1-Consumer-outreach">The Marketplace Consumer – Using Data to Drive Outreach and Engagement (PDF)</a></li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/session-2-provider-outreach.pdf" data-entity-type="media" data-entity-uuid="950d74b4-9b9a-42f3-b5d8-2f36ff4a7d6f" data-entity-substitution="canonical" title="Session-2-provider-outreach">Innovation in Plan Design and Provider Outreach (PDF)</a></li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/session-3-care-coordination-and-beyond.pdf" data-entity-type="media" data-entity-uuid="c5155563-cad6-42d0-81c9-16af0cd3ca9d" data-entity-substitution="canonical" title="Session-3-care-coordination-and-beyond">Engaging Consumers in their Care – Perspectives from Care Coordination and Beyond (PDF)</a></li></ul><h3>Forms</h3><ul><li>May 16, 2012<br><a href="/medicare/regulations-guidance/legislation/paperwork-reduction-act-1995/pra-listing" data-entity-type="node" data-entity-uuid="b2c23bc0-edb3-4cd5-8182-7168690d7c8d" data-entity-substitution="canonical" title="PRA Listing">Paperwork Reduction Act (PRA) display of Draft Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges</a> (click on CMS – 10416).</li><li>August 9, 2022<br><a href="/files/document/2022-blueprint-application-exchanges.pdf" data-entity-type="media" data-entity-uuid="3c1b09ab-5aac-40ed-85d8-b373ce3a8d84" data-entity-substitution="canonical" title="2022 Blueprint Application for Exchanges">Final Blueprint for Exchanges (PDF)</a></li><li>November 9, 2012<br><a href="/files/document/2022-blueprint-application-exchanges.pdf" data-entity-type="media" data-entity-uuid="3c1b09ab-5aac-40ed-85d8-b373ce3a8d84" data-entity-substitution="canonical" title="2022 Blueprint Application for Exchanges">Frequently Asked Questions on the Blueprint for Exchanges (PDF)</a></li><li>October 9, 2013<br>Marketplace Consumer Application<ul><li><span>Individual Short Form"> </span><a href="/marketplace/applications-and-forms/individual-short-form.pdf" title="Individual Short Form - Opens in a new window" target="T217124"><span>Individual Short Form</span><span class="LinkDisclaimer"> - Opens in a new window</span> (PDF)</a><span> </span> </li><li><a href="/marketplace/applications-and-forms/individual-short-form-instructions.pdf" title="Individual Short Form Instructions - Opens in a new window" target="T217125">Individual Short Form Instructions<span class="LinkDisclaimer"> - Opens in a new window</span> (PDF)</a></li><li><a href="/marketplace/applications-and-forms/marketplace-application-for-family.pdf" title="Family - Opens in a new window" target="T217126">Family<span class="LinkDisclaimer"> - Opens in a new window</span> (PDF)</a></li><li><a href="/marketplace/applications-and-forms/marketplace-application-for-family-instructions.pdf" title="Family Instructions - Opens in a new window" target="T217127">Family Instructions<span class="LinkDisclaimer"> - Opens in a new window</span> (PDF)</a></li><li><a href="/marketplace/applications-and-forms/marketplace-application-without-financial-assistance.pdf" title="Individual without Financial Assistance - Opens in a new window" target="T217128">Individual without Financial Assistance<span class="LinkDisclaimer"> - Opens in a new window</span> (PDF)</a></li><li><a href="/marketplace/applications-and-forms/marketplace-application-without-financial-assistance.pdf" title="Individual without Financial Assistance Instructions - Opens in a new window" target="T217129">Individual without Financial Assistance Instructions<span class="LinkDisclaimer"> - Opens in a new window</span> (PDF)</a></li></ul></li><li>April 7, 2014<br>Compliance Reviews in the Federally-Facilitated Marketplace<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/compliance_review_table_032814_508.pdf" data-entity-type="media" data-entity-uuid="bf0ae745-a09a-442a-bf3c-30a8a8de21e9" data-entity-substitution="canonical" title="Key Priorities for FFM Compliance Reviews for the 2014 Benefit Year">Key Priorities for FFM Compliance Reviews for the 2014 Benefit Year (PDF)</a></li></ul></li><li>April 2, 2015</li><li>Compliance Reviews in the Federally-Facilitated<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/compliance_review_table_032715_508.pdf" data-entity-type="media" data-entity-uuid="55face9b-9578-48c8-a353-50d9b081fc3f" data-entity-substitution="canonical" title="Compliance_Review_Table_032715_508">Marketplace Key Priorities for FFM Compliance Reviews for the 2015 Benefit Year (PDF)</a></li></ul></li><li>February 23, 2016<br>Compliance Reviews in the Federally-Facilitated<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/compliance_review_table.pdf" data-entity-type="media" data-entity-uuid="ffb05312-e5d7-4fa4-8136-246adea20011" data-entity-substitution="canonical" title="Compliance_Review_Table">Marketplace Key Priorities for FFM Compliance Reviews for the 2016 Benefit Year (PDF)</a></li></ul></li></ul><h3>Reports</h3><ul><li>August 23, 2013<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/report-on-sadp.pdf" data-entity-type="media" data-entity-uuid="1e9a5317-32da-40ba-b38c-ad386e021dbd" data-entity-substitution="canonical" title="Impact of Changing the Maximum Out-of-Pocket Amounts for Qualified Health Plans and Stand Alone Dental Plans">Impact of Changing the Maximum Out-of-Pocket Amounts for Qualified Health Plans and Stand Alone Dental Plans (PDF)</a></li><li>December 16, 2015<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2014_plan_year_issuer_compliance_summary_report.pdf" data-entity-type="media" data-entity-uuid="b3203e52-7553-437e-9cbc-60d6ae0e1139" data-entity-substitution="canonical" title="2014 Plan Year Issuer Compliance Summary Report">2014 Plan Year Issuer Compliance Summary Report (PDF)</a></li><li>August 11, 2016<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/final-risk-pool-analysis-8_11_16.pdf" data-entity-type="media" data-entity-uuid="b806911f-63e8-4134-98df-1c24b85c7d7d" data-entity-substitution="canonical" title="Final Risk Pool Analysis 8_11_16">Changes in ACA Individual Market Costs from 2014-2015: Near-Zero Growth Suggests an Improving Risk Pool (PDF)</a></li><li>March 15, 2017<br><a href="/newsroom/fact-sheets/health-insurance-marketplaces-2017-open-enrollment-period-final-enrollment-report-november-1-2016" data-entity-type="node" data-entity-uuid="9c9a7b98-0c21-4338-a51e-9859f14fdd61" data-entity-substitution="canonical" title="HEALTH INSURANCE MARKETPLACES 2017 OPEN ENROLLMENT PERIOD FINAL ENROLLMENT REPORT: NOVEMBER 1, 2016 – JANUARY 31, 2017">Health Insurance Exchanges 2017 Open Enrollment Report</a></li><li>April 3, 2018<br><a href="/newsroom/fact-sheets/health-insurance-exchanges-2018-open-enrollment-period-final-report" data-entity-type="node" data-entity-uuid="023f8d52-520b-4a18-9417-cad222796ce3" data-entity-substitution="canonical" title="HEALTH INSURANCE EXCHANGES 2018 OPEN ENROLLMENT PERIOD FINAL REPORT">Health Insurance Exchanges 2018 Open Enrollment Report</a></li><li>March 25, 2019<br><a href="/newsroom/fact-sheets/health-insurance-exchanges-2019-open-enrollment-report" data-entity-type="node" data-entity-uuid="08ce49eb-5e68-4ac7-9627-8bdbc045238d" data-entity-substitution="canonical" title="HEALTH INSURANCE EXCHANGES 2019 OPEN ENROLLMENT REPORT">Health Insurance Exchanges 2019 Open Enrollment Report</a></li><li>August 12, 2019<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/trends-subsidized-unsubsidized-enrollment-by17-18.pdf" data-entity-type="media" data-entity-uuid="d7b154bd-12ee-4e4a-827e-ced0837c445e" data-entity-substitution="canonical" type="application/pdf" title="Trends in Subsidized and Unsubsidized Enrollment – Benefit Years 2017 to 2018"><span>Trends in Subsidized and Unsubsidized Enrollment – Benefit Years 2017 to 2018 (PDF)</span></a><span> </span> </li><li>April 1, 2020<br><a href="/files/document/4120-health-insurance-exchanges-2020-open-enrollment-report-final.pdf" data-entity-type="media" data-entity-uuid="23401fbf-fdf2-44c7-a959-7cd19bcba7e3" data-entity-substitution="canonical" title="4.1.20 HEALTH INSURANCE EXCHANGES 2020 OPEN ENROLLMENT REPORT FINAL">Health Insurance Exchanges 2020 Open Enrollment Report (PDF)</a></li><li>June 25, 2020<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sep-report-nov-2020.pdf" data-entity-type="media" data-entity-uuid="b707651e-6c11-4d24-a5a0-2c5b32829d9b" data-entity-substitution="canonical" title="SEP-Report-June-2020">S<span>pecial Trends Report:  Enrollment Data and Coverage Options for Consumers During the COVID-19 Public Health Emergency</span> (PDF)</a> (note this report was updated on November 23, 2020)</li><li>July 22, 2020<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/early-2020-2019-effectuated-enrollment-report.pdf" data-entity-type="media" data-entity-uuid="44ae2298-e2d5-4809-ac6a-f057b679f083" data-entity-substitution="canonical" title="Early-2020-2019-Effectuated-Enrollment-Report">Early 2020 Effectuated Enrollment Snapshot (PDF)</a></li><li>October 9, 2020<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/trends-subsidized-unsubsidized-enrollment-by18-19.pdf" data-entity-type="media" data-entity-uuid="f49ea4e8-9ce5-449b-9a9e-0f3a96f6ded0" data-entity-substitution="canonical" title="Trends-Subsidized-Unsubsidized-Enrollment-BY18-19">T<span>rends in Subsidized and Unsubsidized Enrollment</span> (PDF)</a></li><li>October 30, 2020<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/issuer-participation-in-the-marketplace.pdf" data-entity-type="media" data-entity-uuid="10ce5ac2-6f15-4a89-8148-72cb963cc944" data-entity-substitution="canonical" title="Issuer-Participation-in-the-Marketplace"><span>Increasing Competition on the Exchanges to Improve Consumer Choice and Affordability (PDF)</span></a></li><li>October 30, 2020<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/agents-and-brokers-in-the-marketplace.pdf" data-entity-type="media" data-entity-uuid="c56f6fff-6c40-4431-909d-53567ace290b" data-entity-substitution="canonical" title="Agents-and-Brokers-in-the-Marketplace"><span>Agents and Brokers in the Marketplace</span>  (PDF)</a></li><li>November 23, 2020<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/sep-report-nov-2020.pdf" data-entity-type="media" data-entity-uuid="b707651e-6c11-4d24-a5a0-2c5b32829d9b" data-entity-substitution="canonical" title="SEP-Report-June-2020">Special Trends Report:  Enrollment Data and Coverage Options for Consumers During the COVID-19 Public Health Emergency (PDF)</a></li><li>December 16, 2020<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/effectuated-enrollment-first-half-2020.pdf" data-entity-type="media" data-entity-uuid="81a164c4-1ace-4e03-b600-d36d3d001c49" data-entity-substitution="canonical" title="Effectuated-Enrollment-First-Half-2020">Effectuated Enrollment for the First Half of 2020 (PDF) (PDF)</a></li><li>December 16, 2020<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2016-2020-effectuated-enrollment-tables.xlsx" data-entity-type="media" data-entity-uuid="d96423c5-353c-41e9-b397-680f118571ba" data-entity-substitution="canonical" hreflang="en" title="2016-2020-Effectuated-Enrollment-Tables">2016 2020 Effectuated Enrollment Tables (XLSX)</a></li><li>January 15, 2021<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/impact-ede-oep-2021-coverage.pdf" data-entity-type="media" data-entity-uuid="20eefe87-4e83-41ab-9c92-911dcdd2c6ef" data-entity-substitution="canonical" title="Impact-EDE-OEP-2021-Coverage">Impact of Enhanced Direct Enrollment During the Open Enrollment Period for 2021 Coverage (PDF)</a></li><li>January 19, 2021<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/impact-premium-affordability.pdf" data-entity-type="media" data-entity-uuid="07a51762-86a1-46de-a074-91c7a701e766" data-entity-substitution="canonical" title="Impact Premium Affordability"><span>The Unsubsidized Uninsured: The Impact of Premium Affordability on Insurance Coverage</span> (PDF)</a></li><li>April 21, 2021<br><a href="/files/document/health-insurance-exchanges-2021-open-enrollment-report-final.pdf" data-entity-type="media" data-entity-uuid="be2408b5-33ae-4071-89c5-dfec99599999" data-entity-substitution="canonical" title="Health insurance exchanges 2021 open enrollment report final"><span>Health Insurance Exchanges 2021 Open Enrollment Report</span> (PDF)</a></li><li>June 5, 2021<br><a href="/document/early-2021-2020-effectuated-enrollment-report.pdf" data-entity-type="media" data-entity-uuid="fbc1ed0c-168c-4ce0-92c6-27f4f18cba79" data-entity-substitution="canonical" title="Early-2021-2020-Effectuated-Enrollment-Report"><span>Effectuated Enrollment: Early 2021 Snapshot and Full Year 2020 Average</span> (PDF)</a></li><li>June 5, 2021<br><a href="/files/document/2016-2020-full-year-effectuated-enrollment-tables.xls" data-entity-type="media" data-entity-uuid="ed82f16d-5f41-4894-bd57-b352b83961c9" data-entity-substitution="canonical" title="2016-2020-Full-Year-Effectuated-Enrollment-Tables"><span>2016 2020 Full Year Effectuated Enrollment Tables</span> (XLSX)</a></li><li>June 5, 2021<br><a href="/files/document/2016-2021-feb-effectuated-enrollment-tables.xls" data-entity-type="media" data-entity-uuid="cd9e952e-fc63-49ac-b82d-784d81000d4b" data-entity-substitution="canonical" title="2016-2021-Feb-Effectuated-Enrollment-Tables"><span>2016 2021 Feb Effectuated Enrollment Tables</span> (XLSX)</a></li><li>September 15, 2021<br><a href="/files/document/2019-2021-aug-effectuated-enrollment.xlsx" data-entity-type="media" data-entity-uuid="4e21623a-b51e-4575-adad-30d137f58ecd" data-entity-substitution="canonical" title="2019-2021-Aug-Effectuated-Enrollment">2021 Aug 15 Effectuated Enrollment Table (XLSX)</a></li><li>December 3, 2021<br><a href="/files/document/2016-2021-1h-effectuated-enrollment-tables.xlsx" data-entity-type="media" data-entity-uuid="69b65801-a5e3-4279-b6e1-e7f10898f9ab" data-entity-substitution="canonical" title="2016-2021-1H-Effectuated-Enrollment-Tables">2016 2021 First Half Effectuated Enrollment Tables (XLSX)</a></li><li>March 23, 2022<br><a href="/files/document/health-insurance-exchanges-2022-open-enrollment-report-final.pdf" data-entity-type="media" data-entity-uuid="e65897e8-294f-4608-bbaf-b0b411940577" data-entity-substitution="canonical" title="Health-Insurance-Exchanges-2022-Open-Enrollment-Report-Final"><span>Health Insurance Exchanges 2022 Open Enrollment Report (PDF)</span></a></li><li><span>June 17, 2022</span><br><span>2022 HealthCare.gov Consumer Savings Under the American Rescue Plan</span><ul><li><a href="/files/document/2022-oep-arp-savings-state-cd.xlsx" data-entity-type="media" data-entity-uuid="4148f5d2-b2fc-4f9a-9fd8-6022b2ca877b" data-entity-substitution="canonical" title="2022 OEP ARP Savings by State CD"><span>Data by State and Congressional District (XLSX)</span></a></li><li><a href="/files/document/2022-oep-arp-savings-state-and-cd-methodology.pdf" data-entity-type="media" data-entity-uuid="639a8f0d-b6c4-4204-ba76-bed5ccff2faa" data-entity-substitution="canonical" title="2022 OEP ARP Savings by State and CD Methodology">Methodology (PDF)</a></li><li><a href="/files/document/marketplace-enrollment-and-savings-infographic.pdf" data-entity-type="media" data-entity-uuid="3cf588c9-6686-4b87-854d-7f8b4034ba64" data-entity-substitution="canonical" title="Marketplace Enrollment and Savings Infographic">Marketplace Enrollment and Savings Infographic (PDF)</a></li><li><a href="/files/document/marketplace-enrollment-and-savings-factoids.pdf" data-entity-type="media" data-entity-uuid="6c05f565-7cdb-422b-81e9-dbd050ab4014" data-entity-substitution="canonical" title="Marketplace Enrollment and Savings Factoids">Marketplace Enrollment and Savings Factoids (PDF)</a></li><li><a href="/files/document/ffm-marketplace-enrollment-and-savings-premium-table.pdf" data-entity-type="media" data-entity-uuid="dbe8fc38-1474-4792-b3ee-cf297121fb99" data-entity-substitution="canonical" title="FFM Marketplace Enrollment and Savings Premium Table">FFM Marketplace Enrollment and Savings Premium Table (PDF)</a></li></ul></li><li><span>September 16, 2022</span><ul><li><a href="/files/document/early-2022-and-full-year-2021-effectuated-enrollment-report.pdf" data-entity-type="media" data-entity-uuid="e4750c63-83dd-474e-a4c5-19e97e3efc3e" data-entity-substitution="canonical" title="Early-2022-and-Full-Year-2021-Effectuated-Enrollment-Report"><span>Effectuated Enrollment: Early 2022 Snapshot and Full Year 2021 Average (PDF)</span></a></li></ul></li><li><span>September 16, 2022</span><ul><li><a href="/files/document/2020-2021-full-year-effectuated-enrollment-tables.xlsx" data-entity-type="media" data-entity-uuid="3df1f2d1-a18c-46f0-a735-773367954cb6" data-entity-substitution="canonical" title="2020-2021-Full-Year-Effectuated-Enrollment-Tables"><span>2020-2021 Full Year Effectuated Enrollment Tables (XLSX)</span></a></li></ul></li><li><span>September 16, 2022</span><ul><li><a href="/files/document/2021-2022-feb-effectuated-enrollment-tables.xlsx" data-entity-type="media" data-entity-uuid="89fd8b08-363c-4f7b-b7b7-27bccab53ca4" data-entity-substitution="canonical" title="2021-2022-Feb-Effectuated-Enrollment-Tables"><span>2021-2022 Feb Effectuated Enrollment Tables (XLSX)</span></a></li></ul></li><li><span>November 29, 2022</span><ul><li><a href="/files/document/2021-2022-effectuated-enrollment-tables-first-six-months.xlsx" data-entity-type="media" data-entity-uuid="fd318a0c-88e5-48e1-89fd-0e152c127f88" data-entity-substitution="canonical" title="2021-2022 Effectuated Enrollment Tables, First Six Months"><span>2021-2022 Effectuated Enrollment Tables, First Six Months (XLSX)</span></a></li></ul></li><li>March 23, 2023<ul><li><a href="/files/document/health-insurance-exchanges-2023-open-enrollment-report-final.pdf" data-entity-type="media" data-entity-uuid="20b9864d-44cc-4619-8b2e-351fa9e1fa0a" data-entity-substitution="canonical" title="health-insurance-exchanges-2023-open-enrollment-report-final">Health Insurance Marketplaces 2023 Open Enrollment Report (PDF)</a></li></ul></li><li><span>July 25, 2023</span><ul><li><a href="/files/document/2020-2022-plan-selections-dmis-created.xlsx" data-entity-type="media" data-entity-uuid="8563dff5-507d-43a5-9fd2-0d931d71ffaf" data-entity-substitution="canonical" title="2020-2022 Plan Selections with DMIs Created"><span>2020-2022 Plan Selections with DMIs Created (XLSX)</span></a><span></span></li></ul></li><li><span>August 11, 2023</span><ul><li><a href="/files/document/early-2023-and-full-year-2022-effectuated-enrollment-report.pdf" data-entity-type="media" data-entity-uuid="2616c266-fc77-4f95-97d6-b83a21e81710" data-entity-substitution="canonical" title="Early 2023 and Full Year 2022 Effectuated Enrollment Report"><span>Effectuated Enrollment: Early 2023 Snapshot and Full Year 2022 Average (PDF)</span></a></li></ul></li><li><span>December 14, 2023</span><ul><li><a href="/files/document/full-year-effectuated-enrollment.xlsx-0" data-entity-type="media" data-entity-uuid="1f80c08d-5cf8-45a5-8567-2656c5e35875" data-entity-substitution="canonical" title="Full Year Effectuated Enrollment"><span>Effectuated Enrollment: Early Snapshot 2023 and Full Year 2022 Average </span> (XLSX)</a></li></ul></li><li><span>December 14, 2023</span><ul><li><a href="/files/document/first-half-effectuated-enrollment-tables.xlsx" data-entity-type="media" data-entity-uuid="42c28ae5-9355-4ed8-abd8-f5c7368abcc2" data-entity-substitution="canonical" title="First Half Effectuated Enrollment Tables"><span>2017 2023 First Half Effectuated Enrollment Tables</span> (XLSX)</a></li></ul></li><li><span>March 22, 2024</span><ul><li><a href="/files/document/health-insurance-exchanges-2024-open-enrollment-report-final.pdf" data-entity-type="media" data-entity-uuid="68c19485-e195-4c5b-90a7-d776fa25b062" data-entity-substitution="canonical" title="health-insurance-exchanges-2024-open-enrollment-report-final"><span>Health Insurance Marketplaces 2024 Open Enrollment Report</span> (PDF)</a></li></ul></li><li>July 02, 2024<ul><li><a href="/files/document/early-2024-and-full-year-2023-effectuated-enrollment-report.pdf" data-entity-type="media" data-entity-uuid="b34c3a4f-5dfa-4ce6-84f9-249be582cc61" data-entity-substitution="canonical" title="Early 2024 and Full Year 2023 Effectuated Enrollment Report">Effectuated Enrollment: Early Snapshot 2024 and Full Year 2023 Average (PDF)</a></li></ul></li><li>July 02, 2024<ul><li><a href="/files/document/february-effectuated-enrollment.xlsx" data-entity-type="media" data-entity-uuid="6b9729ca-c942-476f-9146-a24eda8e48fd" data-entity-substitution="canonical" title="February Effectuated Enrollment">February Effectuated Enrollment Tables (XLSX)</a></li></ul></li><li>July 02, 2024<ul><li><a href="/media/566281">Full Year Effectuated Enrollment Tables (XLSX)</a></li></ul></li></ul><h2><a class="ck-anchor" id="Planning_and_Establishment_Grants"></a>Planning and Establishment Grants</h2><h3>Pre-Application Conference Calls (Upcoming)</h3><ul><li>June 29, 2012<br>Dates and Times of Pre-Application Conference Calls for Exchange Establishment FOA:<ul><li>July 19, 2012 – 1:30-3:00pm EST</li><li>October 4, 2012 - 2:00-3:30pm EST</li><li>January 10, 2013 - 2:00-3:30pm EST</li><li>April 10, 2013 - 1 -2:30 PM EST<br>Call in: 1 877 267 1577; Meeting ID: 0360</li></ul></li></ul><h2><a class="ck-anchor" id="Consumer Operated and Oriented Plan (CO-OP) Program"></a>Consumer Operated and Oriented Plan (CO-OP) Program</h2><h2>Presentations</h2><ul><li>April 2012<br><a href="/cciio/resources/files/downloads/coop-slide-deck-for-website.pdf" data-entity-type="media" data-entity-uuid="e0b5a431-da81-46da-a695-d608e7c0934d" data-entity-substitution="canonical" title="coop-slide deck-for-website">Consumer Operated and Oriented Plan (CO-OP) Program (PDF)</a> (PDF – 347 KB)</li></ul><h2><a class="ck-anchor" id="Health_Insurance_Market_Reforms"></a>Health Insurance Market Reforms</h2><h2><a class="ck-anchor" id="Annual_Limits"></a>Annual Limits</h2><h3>Application Information</h3><ul><li>June 17, 2011<br>Annual Limit Waiver Application Forms and Instructions<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/alw_newappxls.xls" data-entity-type="media" data-entity-uuid="558d5910-dc5d-475a-9461-9c01378efba6" data-entity-substitution="canonical" title="alw_newapp.xls">Annual Limit Waiver Application—New Application Form (XLS)</a> (XLS – 49 MB)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/alw_waiver_extxls.xls" data-entity-type="media" data-entity-uuid="6cd12daf-2111-410f-a551-f661ba27978f" data-entity-substitution="canonical" title="alw_waiver_ext.xls">Annual Limit Waiver Application—Waiver Extension Form (XLS)</a> (XLS – 50 MB)</li><li><a href="/cciio/resources/files/downloads/annual-_limit_waivers_technical_instructions_update_081911-001.pdf" data-entity-type="media" data-entity-uuid="c01eadac-c748-4957-a1ba-48696145a9f4" data-entity-substitution="canonical" title="annual _limit_waivers_technical_instructions_update_081911-001">Annual Limit Waiver Application Instructions (PDF)</a> (PDF – 89 KB)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/data_dictionaryxls.xls" data-entity-type="media" data-entity-uuid="226a4b29-373d-43b2-bae0-b6fd2d0dec45" data-entity-substitution="canonical" title="data_dictionary.xls">Annual Limit Waiver Data Dictionary (XLS)</a> (XLS – 20 KB)</li></ul></li><li>January 6, 2012<ul><li><a href="/cciio/resources/files/approved_applications_for_waiver" data-entity-type="node" data-entity-uuid="203584e0-cf97-4119-ae75-0da73603663f" data-entity-substitution="canonical" title="Annual Limits Policy: Protecting Consumers, Maintaining Options, and Building a Bridge to 2014">Approved Applications for Waiver of the Annual Limits Requirements of the PHS Act Section 2711</a></li></ul></li></ul><h2><a class="ck-anchor" id="Coverage_for_Young_Adults"></a>Coverage for Young Adults</h2><h3>Data</h3><ul><li>January 12, 2010<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/uninsured_19-25xls.xls" data-entity-type="media" data-entity-uuid="6a2471af-7b5d-4bd8-bd5f-8c8362701656" data-entity-substitution="canonical" title="uninsured_19-25.xls">Estimated number of uninsured individuals ages 19-25, by county (XLS)</a> (XLS – 2 MB)</li></ul><h2><a class="ck-anchor" id="excepted-benefits"></a>Excepted Benefits</h2><ul><li>June 25, 2018<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/limited-wraparound-coverage-qs-instructions.pdf" data-entity-type="media" data-entity-uuid="34686d42-e569-49ae-be0b-f6dae08b4125" data-entity-substitution="canonical" type="application/pdf" title="Limited Wrap Around Coverage Questions and Instructions"><span>Limited Wrap Around Coverage Questions and Instructions (PDF)</span></a><span> </span> </li></ul></li></ul><h2><a class="ck-anchor" id="Medical_Loss_Ratio"></a>Medical Loss Ratio</h2><h3>Forms</h3><ul><li>May 19, 2011<br>Medical Loss Ratio (MLR) 2011 Quarterly Reporting Forms for “Mini-med” and Expatriate Plans<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2011_mlr_qtr_form_mmplanxls.xls" data-entity-type="media" data-entity-uuid="44dca119-a3b9-4892-ac41-1ba30747e7b7" data-entity-substitution="canonical" title="2011_mlr_qtr_form_mmplan.xls">MLR Quarterly Reporting Form for “Mini-med” Plans (XLS)</a> (XLS – 50 KB)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2011_mlr_qtr_form_expatxls.xls" data-entity-type="media" data-entity-uuid="6c2b222d-8686-41bb-a941-1c9909128273" data-entity-substitution="canonical" title="2011_mlr_qtr_form_expat.xls">MLR Quarterly Reporting Form for Expatriate Plans (XLS)</a> (XLS – 52 KB)</li><li><a href="/cciio/resources/files/downloads/2011_mlr_qtr_form_instructions.pdf" data-entity-type="media" data-entity-uuid="2462518d-539f-4083-91f4-a77dea399d7e" data-entity-substitution="canonical" title="2011_mlr_qtr_form_instructions">MLR Quarterly Reporting Form Instructions (PDF)</a> (PDF – 68 KB)</li></ul></li><li>June 17, 2011 (corrected)<br><a href="/cciio/resources/files/downloads/2011_mlr_qtr_form_instructions.pdf" data-entity-type="media" data-entity-uuid="2462518d-539f-4083-91f4-a77dea399d7e" data-entity-substitution="canonical" title="2011_mlr_qtr_form_instructions">MLR Quarterly Reporting Form Instructions (PDF)</a> (PDF – 70 KB)</li><li><p>May 11, 2012<br>Medical Loss Ratio (MLR) 2011 Annual Reporting Form (OMB 0938-1164)</p><p>Medical Loss Ratio (MLR) Rebate Notices to Policyholders and Subscribers (OMB 0938-1164)</p><ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/mlr-annual-formxlsx.xlsx" data-entity-type="media" data-entity-uuid="f736537f-c82c-48b7-a116-1f66a2edcd09" data-entity-substitution="canonical" title="mlr-annual-form.xlsx">MLR Annual Reporting Form (XLSX)</a> (XLSX - 119 KB)</li><li><a href="/cciio/resources/files/downloads/mlr-annual-form-instructions051612.pdf" data-entity-type="media" data-entity-uuid="113897e0-bd3e-4889-ae33-893e96390445" data-entity-substitution="canonical" title="mlr-annual-form-instructions051612">MLR Annual Reporting Form Instructions (PDF)</a> (PDF - 204 KB)</li><li><a href="/files/document/mlr-notice-1-individual-market-rebate-subscribers-2023-07.pdf" data-entity-type="media" data-entity-uuid="116623ff-f553-48c8-8413-7957c8cfc2b9" data-entity-substitution="canonical" title="MLR Notice 1 Individual Market Rebate to Subscribers 2023-07">Notice to Subscribers in the Individual Market (Notice #1) (PDF) (PDF – 38 KB)</a></li><li><a href="/cciio/resources/files/downloads/mlr-notice-2-group-markets-rebate-to-policyholder.pdf" data-entity-type="media" data-entity-uuid="fe6d44f3-6c3e-46bc-9048-9d2b368a9da0" data-entity-substitution="canonical" title="mlr-notice-2-group-markets-rebate-to-policyholder">Notice to Group Policyholders and Their Subscribers, Rebate Sent to the Policyholder (Notice #2) (PDF) </a>(PDF - 54 KB)</li><li><a href="/cciio/resources/files/downloads/mlr-notice-3-group-markets-rebate-to-subscribers.pdf" data-entity-type="media" data-entity-uuid="398130e4-95ea-4303-b074-9939e56537cd" data-entity-substitution="canonical" title="mlr-notice-3-group-markets-rebate-to-subscribers">Notice to Subscribers of Group Policyholders, Rebate Sent to the Subscribers (Notice #3) (PDF)</a> (PDF - 41 KB)</li><li><a href="/cciio/resources/files/downloads/mlr-rebate-notice-instructions051612.pdf" data-entity-type="media" data-entity-uuid="8d3d2808-ca88-4eae-8f86-46ff9a386070" data-entity-substitution="canonical" title="mlr-rebate-notice-instructions051612">Instructions for Notices 1, 2 and 3 (PDF)</a> (PDF - 87 KB)</li></ul></li><li>May 16, 2012<br><a href="/cciio/resources/files/downloads/2012-0511-medical-loss-ratio-information.pdf" data-entity-type="media" data-entity-uuid="6cbf6fed-a216-41d8-b76a-795608fbbdd0" data-entity-substitution="canonical" title="2012-0511-medical-loss-ratio-information">Notice to Policyholders and Subscribers when MLR Standard is Met (PDF)</a> (PDF - 15 KB)</li><li>March 29, 2013<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/mlr-annual-form-2012xlsx.xlsx" data-entity-type="media" data-entity-uuid="cee27f02-09a4-43b0-ace1-f468699de96a" data-entity-substitution="canonical" title="mlr-annual-form-2012.xlsx">MLR 2012 Annual Reporting Form (XLSX)</a>  (XLSX – 116 KB)</li><li><a href="/cciio/resources/files/downloads/mlr_annual_form_instructions_2012.pdf" data-entity-type="media" data-entity-uuid="03b9b874-32dd-417e-9362-c2ae32a00872" data-entity-substitution="canonical" title="mlr_annual_form_instructions_2012">MLR 2012 Annual Reporting Form Instructions (PDF)</a> (PDF – 639 KB)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2012_mlr_calculator_and_formula_toolxlsm.xlsm" data-entity-type="media" data-entity-uuid="5f7a7528-488e-47d9-9429-5706e413454f" data-entity-substitution="canonical" title="2012_MLR_Calculator_and_Formula_Tool.xlsm">MLR 2012 Annual Reporting Form Calculator and Formula Tool (VND.MS-EXCEL.SHEET.MACROENABLED.12)</a> (XLSM - 102 KB)    </li></ul></li><li>March 25, 2014<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2013-mlr-reporting-form-20140328.xlsx" data-entity-type="media" data-entity-uuid="aeee87da-ce40-499c-b771-5db920062ee0" data-entity-substitution="canonical" type="application/vnd.openxmlformats-officedocument.spreadsheetml.sheet" title="MLR 2013 Annual Reporting Form"><span>MLR 2013 Annual Reporting Form (XLSX)</span></a></li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2013-mlr-reporting-form-instructions-20140326.pdf" data-entity-type="media" data-entity-uuid="eec354b7-9527-4929-99cc-d6902c396979" data-entity-substitution="canonical" type="application/pdf" title="MLR 2013 Annual Reporting Form Instructions"><span>MLR 2013 Annual Reporting Form Instructions (PDF)</span></a></li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/system-validations-for-the-2013-reporting-year-20140324.pdf" data-entity-type="media" data-entity-uuid="1699002c-f04f-402c-8da6-566680708845" data-entity-substitution="canonical" type="application/pdf" title="MLR 2013 System Validations"><span>MLR 2013 System Validations (PDF)</span></a></li></ul></li><li>May 14, 2014<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2013_mlr_formula_tool_20140513.xlsm" data-entity-type="media" data-entity-uuid="1694230a-5657-49ac-99cf-62b3311695b2" data-entity-substitution="canonical" type="application/vnd.ms-excel.sheet.macroenabled.12" title="MLR 2013 Calculator and Formula Tool"><span>MLR 2013 Calculator and Formula Tool (VND.MS-EXCEL.SHEET.MACROENABLED.12)</span></a></li></ul></li><li>May 29, 2015 Medical Loss Ratio (MLR) Rebate Notices to Policyholders and Subscribers (OMB 0938-1164)<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2014-risk-corridors-plan-level-data-form-20150528.xlsx" data-entity-type="media" data-entity-uuid="5a35595b-1080-486b-abc0-c74dc3eab24c" data-entity-substitution="canonical" title="Risk Corridors 2014 Plan Level Data Form">Risk Corridors 2014 Plan Level Data Form (XLSX)</a> (XLSX - 98 KB)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2014-risk-corridor-plan-level-instructions-20150528.pdf" data-entity-type="media" data-entity-uuid="e1fdf7f7-3506-43d6-b36c-f985f2167fac" data-entity-substitution="canonical" title="Risk Corridors 2014 Plan-Level Instructions">Risk Corridors 2014 Plan-Level Instructions (PDF)</a> (PDF - 262 KB)</li><li><a href="/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/mlr-notice-1-to-subscribers-in-individual-market-20150528.pdf">Notice to Subscribers in the Individual Market (Notice #1) (PDF)</a> (PDF - 56 KB)</li><li><a href="/files/document/mlr-notice-2-group-markets-rebate-policyholder-2023-07.pdf" data-entity-type="media" data-entity-uuid="8b8f47e2-5f22-4149-9ccd-d10cf1e01083" data-entity-substitution="canonical" title="MLR Notice 2 Group Markets Rebate to Policyholder 2023-07">Notice to Group Policyholders and Their Subscribers, Rebate Sent to the Policyholder (Notice #2) (PDF) </a>(PDF - 65 KB)</li><li><a href="/files/document/mlr-notice-3-group-markets-rebate-subscribers-2023-07.pdf" data-entity-type="media" data-entity-uuid="1651829c-9e50-4d0b-ac3e-7ef111d178a2" data-entity-substitution="canonical" title="MLR Notice 3 Group Markets Rebate to Subscribers 2023-07">Notice to Subscribers of Group Policyholders, Rebate Sent to the Subscribers (Notice #3) (PDF) </a>(PDF - 44 KB)</li><li><a href="/files/document/mlr-notice-instructions-2023-07.pdf" data-entity-type="media" data-entity-uuid="600b358d-3184-4ac8-bed8-c0bcbfede9bf" data-entity-substitution="canonical" title="MLR Notice Instructions 2023-07">Instructions for Notices 1, 2 and 3 (PDF) </a>(PDF - 66 KB)</li></ul></li><li>June 4, 2015<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2014-mlr-reporting-form-20150528c.xlsx" data-entity-type="media" data-entity-uuid="05042080-96be-4855-b031-f9dc22daf874" data-entity-substitution="canonical" title="MLR 2014 Annual Reporting Form">MLR 2014 Annual Reporting Form (XLSX)</a> (XLSX – 115 KB)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2014-mlr-annual-reporting-form-instructions-20150528c.pdf" data-entity-type="media" data-entity-uuid="c10c248e-1268-4a4d-8645-7b643f9f5f17" data-entity-substitution="canonical" title="MLR 2014 Annual Reporting Form Instructions">MLR 2014 Annual Reporting Form Instructions (PDF)</a> (PDF – 427 KB)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2014-mlr-calculator-20150602.xlsm" data-entity-type="media" data-entity-uuid="c2c08133-3cc8-42dc-a95e-c5e170357a34" data-entity-substitution="canonical" title="MLR 2014 Calculator and Formula Tool">MLR 2014 Calculator and Formula Tool (VND.MS-EXCEL.SHEET.MACROENABLED.12)</a> (XLSM – 147 KB)</li></ul></li><li>June 19, 2015<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/system-validations-for-the-2014-reporting-year-20150617.pdf" data-entity-type="media" data-entity-uuid="fad7676d-1bd8-45a2-89de-3329a0a5f147" data-entity-substitution="canonical" title="MLR and Risk Corridors 2014 System Validations">MLR and Risk Corridors 2014 System Validations (PDF)</a> (PDF – 258 KB)</li></ul></li><li>May 9, 2016<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2015-mlr-reporting-form-20160510.xlsx" data-entity-type="media" data-entity-uuid="5e20ad5e-b727-4404-9a7c-36a38cd44395" data-entity-substitution="canonical" title="2015-mlr-reporting-form-20160510">MLR 2015 Annual Reporting Form (XLSX)</a>  (XLSX – 121 KB)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2015-mlr-form-instructions-2016-05-08.pdf" data-entity-type="media" data-entity-uuid="55595324-7696-4a0e-a2dd-5df9a1a75779" data-entity-substitution="canonical" title="2015-MLR-Form-Instructions-2016-05-08">MLR 2015 Annual Reporting Form Instructions (PDF)</a>  (PDF – 359 KB)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2015-mlr-calculator-20160606.xlsm" data-entity-type="media" data-entity-uuid="e7996bcc-8570-4518-84aa-206de42b7bbd" data-entity-substitution="canonical" title="2015-MLR-Calculator-20160606">MLR 2015 Calculator and Formula Tool (VND.MS-EXCEL.SHEET.MACROENABLED.12)</a>  (XLSM – 139 KB)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2015-risk-corridors-plan-level-data-form-20160323.xlsx" data-entity-type="media" data-entity-uuid="7b14d5e4-ebb4-4a70-bdeb-ee7871f61c31" data-entity-substitution="canonical" title="2015-risk-corridors-plan-level-data-form-20160323">Risk Corridors 2015 Plan-Level Data Form (XLSX)</a>  (XLSX – 95 KB)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2015-risk-corridor-plan-level-instructions-2016-05-09.pdf" data-entity-type="media" data-entity-uuid="c23831c0-706e-461e-821e-971370380c11" data-entity-substitution="canonical" title="2015-Risk-Corridor-Plan-Level-Instructions-2016-05-09">Risk Corridors 2015 Plan-Level Instructions (PDF)</a>  (PDF – 228 KB)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/system-validations-for-the-2015-mlr-reporting-year.pdf" data-entity-type="media" data-entity-uuid="d453f73b-4514-4335-9323-62357dfcc89d" data-entity-substitution="canonical" title="System-Validations-for-the-2015-MLR-Reporting-Year">MLR and Risk Corridors 2015 System Validations (PDF)</a>  (PDF – 202 KB)</li></ul></li><li>June 5, 2017<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2016-mlr-reporting-form.xlsx" data-entity-type="media" data-entity-uuid="148f0882-b84d-4c28-a34a-6c69a53a3a58" data-entity-substitution="canonical" type="application/vnd.openxmlformats-officedocument.spreadsheetml.sheet" title="MLR 2016 Annual Reporting Form"><span>MLR 2016 Annual Reporting Form (XLSX)</span></a><span> </span>  </li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2016-risk-corridors-plan-level-form.xlsx" data-entity-type="media" data-entity-uuid="b1692b18-e47b-4196-a14f-cf44e6ba7c05" data-entity-substitution="canonical" type="application/vnd.openxmlformats-officedocument.spreadsheetml.sheet" title="Risk Corridors 2016 Plan-Level Data Form"><span>Risk Corridors 2016 Plan-Level Data Form (XLSX)</span></a><span> </span> </li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2016-risk-corridor-plan-level-instructions.pdf" data-entity-type="media" data-entity-uuid="d577da1a-4d47-438f-a6db-80385f000335" data-entity-substitution="canonical" type="application/pdf" title="Risk Corridors 2016 Plan-Level Instructions"><span>Risk Corridors 2016 Plan-Level Instructions (PDF)</span></a></li></ul></li><li>July 12, 2017<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2016-mlr-form-instructions-revised.pdf" data-entity-type="media" data-entity-uuid="5a3b3c99-adc5-47ac-8d02-7e8879956312" data-entity-substitution="canonical" type="application/pdf" title="MLR 2016 Annual Reporting Form Instructions - Revised "><span>MLR 2016 Annual Reporting Form Instructions - Revised (PDF)</span></a><span> </span> </li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2016-mlr-calculator-7-12-17.xlsm" data-entity-type="media" data-entity-uuid="8c077f66-876b-401c-a2a6-1d7fb9309b7e" data-entity-substitution="canonical" type="application/vnd.ms-excel.sheet.macroenabled.12" title="MLR 2016 Calculator and Formula Tool - Revised"><span>MLR 2016 Calculator and Formula Tool - Revised (VND.MS-EXCEL.SHEET.MACROENABLED.12)</span></a><span> </span> </li></ul></li><li>June 5, 2018<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2017-mlr-reporting-form.xlsx" data-entity-type="media" data-entity-uuid="4feb140f-c5ed-488b-827d-1aa3da1e0138" data-entity-substitution="canonical" type="application/vnd.openxmlformats-officedocument.spreadsheetml.sheet" title="MLR 2017 Annual Reporting Form"><span>MLR 2017 Annual Reporting Form (XLSX)</span></a></li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2017-mlr-system-validations.pdf" data-entity-type="media" data-entity-uuid="c285fc6d-de84-4dcf-9426-ba00003b3653" data-entity-substitution="canonical" type="application/pdf" title="MLR 2017 System Validations"><span>MLR 2017 System Validations (PDF)</span></a><span> </span> </li></ul></li><li>July 16, 2018<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2017-mlr-form-instructions.pdf" data-entity-type="media" data-entity-uuid="1fd709ce-db3e-40db-b147-412543cdbdc7" data-entity-substitution="canonical" type="application/pdf" title="MLR 2017 Annual Reporting Form Instructions - Revised"><span>MLR 2017 Annual Reporting Form Instructions - Revised (PDF)</span></a><span> </span> </li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2017-mlr-calculator-6-20-18.xlsm" data-entity-type="media" data-entity-uuid="ef184f8f-172a-4997-86e6-f50fe722f49d" data-entity-substitution="canonical" type="application/vnd.ms-excel.sheet.macroenabled.12" title="MLR 2017 Calculator and Formula Tool - Revised"><span>MLR 2017 Calculator and Formula Tool - Revised (VND.MS-EXCEL.SHEET.MACROENABLED.12)</span></a><span> </span> </li></ul></li><li>June 25, 2019<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2018-mlr-form-instructions.pdf" data-entity-type="media" data-entity-uuid="c9585b81-459f-4add-9f57-d4a6cc3cac73" data-entity-substitution="canonical" type="application/pdf" title="MLR 2018 Annual Reporting Form Instructions"><span>MLR 2018 Annual Reporting Form Instructions (PDF)</span></a><span> </span> </li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2018-mlr-reporting-form.xlsx" data-entity-type="media" data-entity-uuid="5afcc28c-8721-4c1c-9f77-d014ee9d1076" data-entity-substitution="canonical" type="application/vnd.openxmlformats-officedocument.spreadsheetml.sheet" title="MLR 2018 Annual Reporting Form"><span>MLR 2018 Annual Reporting Form (XLSX)</span></a><span> </span> </li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2018_mlr_calculator.xlsm" data-entity-type="media" data-entity-uuid="d6863f8b-a0f4-434b-bba6-30f3411f2a14" data-entity-substitution="canonical" type="application/vnd.ms-excel.sheet.macroenabled.12" title="2018-MLR-Calculator"><span>2018-MLR-Calculator (VND.MS-EXCEL.SHEET.MACROENABLED.12)</span></a><span> </span> </li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2018-mlr-system-validations.pdf" data-entity-type="media" data-entity-uuid="28f4855e-6b72-4ba3-b74d-83f4242c986f" data-entity-substitution="canonical" type="application/pdf" title="MLR 2018 System Validations"><span>MLR 2018 System Validations (PDF)</span></a><span> </span> </li></ul></li><li>July 30, 2020<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2019-mlr-form-instructions.pdf" data-entity-type="media" data-entity-uuid="0d5b5d30-e061-4634-8e23-de8ac62a9b5e" data-entity-substitution="canonical" title="2019-MLR-Form-Instructions"><span>MLR 2019 Annual Reporting Form Instructions</span> (PDF)</a></li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2019-mlr-reporting-form.xlsx" data-entity-type="media" data-entity-uuid="16cccf25-6c5a-4572-875b-5903fe42f4f4" data-entity-substitution="canonical" title="2019-MLR-Reporting-Form"><span>MLR 2019 Annual Reporting Form </span> (XLSX)</a> </li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2019-mlr-calculator.xlsm" data-entity-type="media" data-entity-uuid="f8c5c5c8-f6a8-42e7-9cf9-c2d11cd42a07" data-entity-substitution="canonical" title="2019-MLR-Calculator">MLR 2019 Calculator and Formula Tool (XLSM)</a></li></ul></li><li>February 16, 2022<ul><li><a href="/files/document/2020-mlr-form-instructions.pdf" data-entity-type="media" data-entity-uuid="f0f288f9-fb73-4f38-a58a-b942283eb25b" data-entity-substitution="canonical" title="2020-MLR-Form-Instructions"><span>MLR 2020 Annual Reporting Form Instructions</span> (PDF)</a></li><li><a href="/files/document/2020-mlr-annual-reporting-form.xlsx" data-entity-type="media" data-entity-uuid="f3163b57-b578-4c96-a690-dc05aa0eab0b" data-entity-substitution="canonical" title="2020-MLR-Annual-Reporting-Form"><span>MLR 2020 Annual Reporting Form </span> (XLSX) </a></li><li><a href="/files/document/2020-mlr-calculator-and-formula-tool.xlsm" data-entity-type="media" data-entity-uuid="2c1d100c-9789-4ac0-943a-350694460163" data-entity-substitution="canonical" title="2020-MLR-Calculator-and-Formula-Tool">MLR 2020 Calculator and Formula Tool (XLSM)</a></li></ul></li><li>June 27, 2022<ul><li><a href="/files/document/2021-mlr-form-instructions.pdf" data-entity-type="media" data-entity-uuid="a8e3beb3-cc9b-4efe-9782-c2e3f74747b3" data-entity-substitution="canonical" title="2021 MLR Form Instructions">MLR 2021 Annual Reporting Form Instructions (PDF)</a></li><li><a href="/files/document/2021-mlr-reporting-form.xlsx" data-entity-type="media" data-entity-uuid="e287403b-8ab7-49c5-9e07-f546fffe85c2" data-entity-substitution="canonical" title="2021 MLR Reporting Form">MLR 2021 Annual Reporting Form (XLSX)</a></li><li><a href="/files/document/2021-mlr-calculator.xlsm" data-entity-type="media" data-entity-uuid="78396a31-1140-4d90-b65f-d90e2053ef58" data-entity-substitution="canonical" title="2021 MLR Calculator">MLR 2021 Calculator and Formula Tool (XLSM)</a></li></ul></li><li>June 23, 2023<ul><li><a href="/files/document/2022-mlr-form-instructions.pdf" data-entity-type="media" data-entity-uuid="1193e739-bbdd-4878-9480-77baf34fb00d" data-entity-substitution="canonical" title="2022 MLR Form Instructions">MLR 2022 Annual Reporting Form Instructions (PDF)</a></li><li><a href="/files/document/2022-mlr-reporting-forms.xlsx" data-entity-type="media" data-entity-uuid="82ab1441-e967-489c-87b5-91dd0fe32267" data-entity-substitution="canonical" title="2022 MLR Reporting Forms">MLR 2022 Annual Reporting Form (XLSX)</a></li><li><a href="/files/document/2022-mlr-calculator.xlsm" data-entity-type="media" data-entity-uuid="f474b901-ac03-4877-9884-0da5a47b62b6" data-entity-substitution="canonical" title="2022 MLR Calculator">MLR 2022 Calculator and Formula Tool (XLSM)</a></li></ul></li><li>June 23, 2023 Medical Loss Ratio (MLR) Rebate Notices to Policyholders and Subscribers<ul><li><a href="/files/document/mlr-notice-1-individual-market-rebate-subscribers-2023-07.pdf">Notice to Subscribers in the individual Market (Notice #1) (PDF)</a></li><li><a href="/files/document/mlr-notice-2-group-markets-rebate-policyholder-2023-07.pdf" data-entity-type="media" data-entity-uuid="8b8f47e2-5f22-4149-9ccd-d10cf1e01083" data-entity-substitution="canonical" title="MLR Notice 2 Group Markets Rebate to Policyholder 2023-07">Notice to Group Policyholders and their Subscribers, Rebate Sent to the Policyholder (Notice #2) (PDF)</a></li><li><a href="/files/document/mlr-notice-3-group-markets-rebate-subscribers-2023-07.pdf" data-entity-type="media" data-entity-uuid="1651829c-9e50-4d0b-ac3e-7ef111d178a2" data-entity-substitution="canonical" title="MLR Notice 3 Group Markets Rebate to Subscribers 2023-07">Notice to Subscribers of Group Policyholders, Rebate Sent to the Subscribers (Notice #3) (PDF)</a></li><li><a href="/files/document/mlr-notice-instructions-2023-07.pdf" data-entity-type="media" data-entity-uuid="600b358d-3184-4ac8-bed8-c0bcbfede9bf" data-entity-substitution="canonical" title="MLR Notice Instructions 2023-07">Instructions for Notices 1, 2 and 3 (PDF)</a></li></ul></li><li>May 13, 2024<ul><li><a href="/files/document/2023-mlr-form-instructions.pdf" data-entity-type="media" data-entity-uuid="65dfecc6-0720-493b-9e71-fdad5455931a" data-entity-substitution="canonical" title="2023 MLR Form Instructions">MLR 2023 Annual Reporting Form Instructions (PDF)</a></li><li><a href="/files/document/2023-mlr-reporting-form.xlsx" data-entity-type="media" data-entity-uuid="9ae24b2a-11a2-4705-9d81-87d3d954f1a0" data-entity-substitution="canonical" title="2023 MLR Reporting Form">MLR 2023 Annual Reporting Form (XLSX)</a></li><li><a href="/files/document/2023-mlr-calculator.xlsm" data-entity-type="media" data-entity-uuid="2f66d34f-8e27-4179-90bd-8de8ae3e130d" data-entity-substitution="canonical" title="2023 MLR Calculator">MLR 2023 Calculator and Formula Tool (XLSM)</a></li></ul></li></ul><h3>Reports:</h3><ul><li> <ul><li>June 21, 2012<br><a href="/cciio/resources/forms-reports-and-other-resources/mlr-rebates06212012a" data-entity-type="node" data-entity-uuid="3a12f333-a6a4-44ac-b2b8-4a81a78d9c95" data-entity-substitution="canonical" title="The 80/20 Rule: Providing Value and Rebates to Millions of Consumers">The 80/20 Rule: Providing Value and Rebates to Millions of Consumers</a></li><li>February 15, 2013<br><a href="/cciio/resources/files/downloads/mlr-report-02-15-2013.pdf" data-entity-type="media" data-entity-uuid="5616bbad-c3c4-4d58-8e47-f41f7494b844" data-entity-substitution="canonical" title="mlr-report-02-15-2013">The 80/20 Rule: How Insurers Spend Your Health Insurance Premiums (PDF)</a></li><li>June 20, 2013<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2012-medical-loss-ratio-report.pdf" data-entity-type="media" data-entity-uuid="2f2abf08-066d-49eb-926f-bb15489ac0fb" data-entity-substitution="canonical" type="application/pdf" title="80/20 Rule Delivers More Value to Consumers in 2012"><span>80/20 Rule Delivers More Value to Consumers in 2012 (PDF)</span></a></li><li>July 24, 2014<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/final-mlr-report_07-22-2014.pdf" data-entity-type="media" data-entity-uuid="71ebe58e-8a3f-4b46-8518-bb0248af64a4" data-entity-substitution="canonical" type="application/pdf" title="Consumers Benefit from 80/20 Rule in 2013"><span>Consumers Benefit from 80/20 Rule in 2013 (PDF)</span></a></li><li>November 19, 2015<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2014_medical_loss_ratio_report.pdf" data-entity-type="media" data-entity-uuid="2f4535fc-e4ed-4db1-84c1-cf9dbb9e9625" data-entity-substitution="canonical" title="Consumers Get Rebates, More Premium Value and Stability Protection in 2014">Consumers Get Rebates, More Premium Value and Stability Protection in 2014 (PDF)</a> (PDF – 778KB)</li><li>November 18, 2016<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/medical_loss_ratio_annual_report_2016-11-22.pdf" data-entity-type="media" data-entity-uuid="c8de89d5-fba9-4006-94e3-60ab6433afa6" data-entity-substitution="canonical" title="Medical Loss Ratio Annual Report 2016-11-22">Medical Loss Ratio Report: The 80/20 Rule Increases Value for Consumers for Fifth Year in a Row (PDF)</a> (PDF – 774KB)</li><li>December 28, 2017<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/medical_loss_ratio_2016_annual_reportpdf.pdf" data-entity-type="media" data-entity-uuid="8b73373f-e86d-4310-8f79-e172c94eeedb" data-entity-substitution="canonical" title="Medical_Loss_Ratio_2016_Annual_Report.pdf">Summary of 2016 Medical Loss Ratio Results (PDF-326KB) (PDF)</a></li></ul></li></ul><h2><a class="ck-anchor" id="mental-health-parity"></a>Mental Health Parity</h2><h3>Forms</h3><ul><li>April 23, 2018<br><a href="https://www.dol.gov/sites/default/files/ebsa/laws-and-regulations/laws/mental-health-parity/mhpaea-disclosure-template-draft-revised.pdf" title="Form to Request Documentation from an Employer-Sponsored Health Plan or and Issuer Concerning Treatment Limitations - Opens in a new window" target="T220671"><span>Form to Request Documentation from an Employer-Sponsored Health Plan or and Issuer Concerning Treatment Limitations</span><span class="LinkDisclaimer"> - Opens in a new window</span></a><span> </span> </li></ul><h3>Reports</h3><ul><li>December 12, 2017<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/hhs-2008-mhpaea-enforcement-period.pdf" data-entity-type="media" data-entity-uuid="15c17b8b-c82d-49c6-94d4-984ce7d20ef2" data-entity-substitution="canonical" type="application/pdf" title="Department of Health and Human Services (HHS) Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) Enforcement Report"><span>Department of Health and Human Services (HHS) Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) Enforcement Report (PDF)</span></a><span> </span> </li><li>April 23, 2018<br><a href="https://www.hhs.gov/sites/default/files/parity-action-plan.pdf" title="21st Century Cures Act: Section 13002 Action Plan for Enhanced Enforcement of Mental Health and Substance Use Disorder Coverage - Opens in a new window" target="T220626"><span>21st Century Cures Act: Section 13002 Action Plan for Enhanced Enforcement of Mental Health and Substance Use Disorder Coverage</span><span class="LinkDisclaimer"> - Opens in a new window</span></a><span> </span> </li><li>March 29, 2019<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/fy2018-mhpaea-enforcement-report.pdf" data-entity-type="media" data-entity-uuid="d18dde3e-7fb3-400b-9c49-c529fa82505c" data-entity-substitution="canonical" type="application/pdf" title="Department of Health and Human Services (HHS) Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) Enforcement Report for the 2018 Federal Fiscal Year"><span>Department of Health and Human Services (HHS) Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) Enforcement Report for the 2018 Federal Fiscal Year (PDF)</span></a><span> </span> </li><li>March 16, 2020<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/mhpaea-enforcement-2019.pdf" data-entity-type="media" data-entity-uuid="0ea6eff2-52fa-4082-baa6-e225d8e725d0" data-entity-substitution="canonical" title="mhpaea-enforcement-2019"><span>FY2019  </span>MHPAEA Enforcement Fact Sheet (PDF)</a> <br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/mhpaea-enforcement-2019-fact-sheet-appendix.pdf" data-entity-type="media" data-entity-uuid="b24bc16f-1d6e-4b01-96c9-0e17af169a7b" data-entity-substitution="canonical" title="mhpaea-enforcement-2019-fact-sheet-appendix">Appendix (PDF)</a></li><li>January 15, 2021<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/mhpaea-enforcement-2020.pdf" data-entity-type="media" data-entity-uuid="b7dc6502-25cf-4374-83aa-92525d239a31" data-entity-substitution="canonical" title="mhpaea-enforcement-2020">FY2020 MHPAEA Enforcement Fact Sheet (PDF)</a><br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/mhpaea-enforcement-2020-fact-sheet-appendix.pdf" data-entity-type="media" data-entity-uuid="420b62f2-9aba-433b-97c5-f74afcc99641" data-entity-substitution="canonical" title="mhpaea-enforcement-2020-fact-sheet-appendix">Appendix (PDF)</a></li><li>January 25, 2022<br><a href="/files/document/2022-mhpaea-report-congress.pdf" data-entity-type="media" data-entity-uuid="64cb76ec-8fc5-45f4-b323-edca7ef50e5e" data-entity-substitution="canonical" title="2022-MHPAEA-Report-to-Congress">2022 MHPAEA Report to Congress (PDF)</a></li><li>July 25, 2023<br><a href="/files/document/2023-mhpaea-report-congress.pdf" data-entity-type="media" data-entity-uuid="7e6bd918-3625-4168-b500-cea1188d7c17" data-entity-substitution="canonical" title="2023 MHPAEA Report to congress">2023 MHPAEA Report to Congress (PDF) (PDF)</a><br><a href="/files/document/mhpaea-enforcement-2022.pdf" data-entity-type="media" data-entity-uuid="0b266321-60d8-4d1d-a35b-f4f4323b538f" data-entity-substitution="canonical" title="mhpaea enforcement 2022">FY2022 MHPAEA Enforcement Fact Sheet (PDF)</a><br><a href="/files/document/mhpaea-enforcement-2022-fact-sheet-appendix.pdf" data-entity-type="media" data-entity-uuid="8e8b520d-20fb-4903-9f69-ad3e607b880f" data-entity-substitution="canonical" title="mhpaea enforcement 2022 fact sheet appendix">Appendix (PDF)</a></li></ul><h2><a class="ck-anchor" id="Patient’s Bill of Rights"></a>Patient’s Bill of Rights</h2><h3>Q&A</h3><ul><li>October 13, 2010<br><a href="/cciio/resources/files/factsheet" data-entity-type="node" data-entity-uuid="674eda64-5784-476e-86cb-05121e7b3bca" data-entity-substitution="canonical" title="Questions and Answers on Enrollment of Children Under 19 Under the New Policy That Prohibits Pre-Existing Condition Exclusions">Enrollment of Children Under 19 Under the New Policy That Prohibits Pre-Existing Condition Exclusions</a></li></ul><h3>Data</h3><ul><li>January 19, 2011<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/first_estimate_pre_existing_by_cdxls.xls" data-entity-type="media" data-entity-uuid="5eed943e-2049-4079-8ead-b39e8051242f" data-entity-substitution="canonical" title="first_estimate_pre_existing_by_cd.xls">Data Files – First Estimate (XLS)</a> (XLS – 151 KB)<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/second_estimate_pre_existing_by_cdxls.xls" data-entity-type="media" data-entity-uuid="5bb71cfc-d447-4739-b256-e4c093e8ec6c" data-entity-substitution="canonical" title="second_estimate_pre_existing_by_cd.xls">Data Files – Second Estimate (XLS)</a> (XLS – 151 KB)<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/pre_existing_by_state_first_and_second_estimatesxls.xls" data-entity-type="media" data-entity-uuid="a092709a-7e50-485c-b465-e38070619154" data-entity-substitution="canonical" title="pre_existing_by_state_first_and_second_estimates.xls">Data Files – First and Second Estimates by State (XLS)</a> (XLS – 35.5 KB)</li></ul><h3>Methodology</h3><ul><li>January 12, 2011<br><a href="/cciio/resources/files/pre_existing_conditions_methodology" data-entity-type="node" data-entity-uuid="ff1fea49-e6cd-4772-895a-806d6966e2ca" data-entity-substitution="canonical" title="Methodology for Children and Adults with Pre-existing Conditions">Methodology for Children and Adults with Pre-Existing Conditions, by Congressional District</a></li></ul><h3>Reports</h3><ul><li>September 23, 2011<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/patients-bill-of-rights09232011a.pdf" data-entity-type="media" data-entity-uuid="470257ca-430f-4ac3-b86c-38d472e52880" data-entity-substitution="canonical" title="patients-bill-of-rights09232011a">Patient’s Bill of Rights (PDF)</a> (PDF – 238 KB)</li></ul><h2><a class="ck-anchor" id="Prevention"></a>Prevention</h2><h3>Forms</h3><ul><li><p>June 28, 2013<br>Self-certification Form (To be used for plan years beginning on or after January 1, 2014)</p><ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/cms-10459-certificationdocx.docx" data-entity-type="media" data-entity-uuid="3b2765bb-1840-4f65-a599-4817d1c206a3" data-entity-substitution="canonical" title="Standard Format">Standard Format (DOCX)</a> (DOC – 28 KB)</li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/cms-10459-certification.pdf" data-entity-type="media" data-entity-uuid="dbff5b68-782f-488d-a28b-bcc2cdcc16d3" data-entity-substitution="canonical" title="Accessible Format">Accessible Format (PDF)</a> (PDF – 22 KB)</li></ul><p><a href="/cciio/resources/forms-reports-and-other-resources/downloads/cms-10459-enrollee-notice.pdf" data-entity-type="media" data-entity-uuid="2693d3f7-6fde-458b-9d6b-8b1ddb886cb0" data-entity-substitution="canonical" title="Model Notice of Availability of Separate Payments for Contraceptive Services">Model Notice of Availability of Separate Payments for Contraceptive Services (PDF)</a> (PDF – 39 KB)</p></li></ul><h2><a class="ck-anchor" id="Review_of_Insurance_Rates"></a>Review of Insurance Rates</h2><h3>Forms</h3><ul><li>February 2, 2015<br>Effective Rate Review (ERR) Annual Survey (OMB 0938-1121)<br>o <a href="/cciio/resources/forms-reports-and-other-resources/downloads/err-determination-and-status-questions-5-20-14.pdf" data-entity-type="media" data-entity-uuid="2765bd4e-a143-440a-a6a3-b928f9eb13dd" data-entity-substitution="canonical" title="ERR Determination and Status Questions 5-20-14">2015 ERR Annual Determination and Status Questions (PDF)</a><br>o <a href="/cciio/resources/forms-reports-and-other-resources/downloads/effective-rate-review-survey-instructions-20150202-final.pdf" data-entity-type="media" data-entity-uuid="77ebcb79-86c5-4e63-a53e-86511d6c8961" data-entity-substitution="canonical" title="Effective Rate Review Survey Instructions 20150202 Final">2015 ERR Instructions (PDF)</a></li><li>February 25, 2015<br>Unified Rate Review (URR) Reporting Requirements for Single Risk Pool Plans (OMB 0938-1141)<br>o <a href="/cciio/resources/forms-reports-and-other-resources/downloads/2016-unified-rate-review-instructions-20150222-final.pdf" data-entity-type="media" data-entity-uuid="a254e25e-cb41-4d64-91a1-cd1a66d7f21b" data-entity-substitution="canonical" title="2016 Unified Rate Review Instructions 20150222 Final">2016 URR Instructions (Parts I, II, & III) (PDF)</a><br>o <a href="/cciio/resources/forms-reports-and-other-resources/downloads/unified_rate_review_template.xlsm" data-entity-type="media" data-entity-uuid="c4be6deb-264f-47a2-bb31-4304d32b452a" data-entity-substitution="canonical" title="Unified_Rate_Review_Template">2016 URR Template (URRT) (VND.MS-EXCEL.SHEET.MACROENABLED.12)</a> (Updated on April 15, 2015)</li><li>o <a href="/cciio/resources/forms-reports-and-other-resources/downloads/instructions_for_the_redacted_actuarial_memorandum_20150416.pdf" data-entity-type="media" data-entity-uuid="947d4f7a-74dd-4a59-ae94-9324b9d73ee6" data-entity-substitution="canonical" title="Instructions for the Redacted Actuarial Memorandum 20150416">2016 Instructions for Submitting a Redacted Actuarial Memorandum (PDF)</a> (Posted April 16, 2015)</li><li>April 03, 2015<br>Rate Review Justification (RRJ) Reporting Requirements for Transitional Plans and Student Health Plans (OMB 0938-1141)<br>o <a href="/cciio/resources/forms-reports-and-other-resources/downloads/rrj-instructions-manual-20150401-final.pdf" data-entity-type="media" data-entity-uuid="5f49321b-ca36-491d-82d3-600c7e8f12b4" data-entity-substitution="canonical" title="RRJ Instructions Manual 20150401 Final">RRJ Instructions (PDF)</a><br>o <a href="/cciio/resources/forms-reports-and-other-resources/downloads/rrj-ratesummarytemplate.xls" data-entity-type="media" data-entity-uuid="c6cf5647-3f5a-441b-b752-32cf39febd42" data-entity-substitution="canonical" title="RRJ RateSummaryTemplate">RRJ Template (XLS)</a></li><li>February 22, 2016<br>Unified Rate Review (URR) Reporting Requirements for Single Risk Pool Plans (OMB 0938-1141)<br>o <a href="/cciio/resources/forms-reports-and-other-resources/downloads/508_cms-10379-2017-unified-rate-review-instructions.pdf" data-entity-type="media" data-entity-uuid="4f19b9a4-a57e-4ce8-a9d5-0200f502a909" data-entity-substitution="canonical" title="508_CMS-10379 - 2017 Unified Rate Review Instructions">Draft 2017 URR Instructions (Parts I, II, & III) (PDF)</a><br>o <a href="https://www.gpo.gov/fdsys/pkg/FR-2016-02-19/pdf/2016-03474.pdf">Federal Register Notice</a></li><li>o <a href="/cciio/resources/forms-reports-and-other-resources/downloads/508_cms-10379-rate-review-supporting-statement.pdf" data-entity-type="media" data-entity-uuid="a3fa4cc1-4e37-4fea-9318-09e9444be29e" data-entity-substitution="canonical" title="508_CMS-10379 Rate Review - Supporting Statement">PRA Supporting Statement (PDF)</a></li><li>o<a href="/cciio/resources/forms-reports-and-other-resources/downloads/unified_rate_review_template-318.xlsm" data-entity-type="media" data-entity-uuid="383a1935-42c7-4c84-af69-ba0893fc9f2a" data-entity-substitution="canonical" title="Unified_Rate_Review_Template 3.18">2017 URR Template v3.3 (URRT) (VND.MS-EXCEL.SHEET.MACROENABLED.12)</a> (Updated March 18, 2016)</li><li>August 18, 2016<br><a href="/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/FINAL-2017-Unified-Rate-Review-Instructions.pdf">Unified Rate Review (URR) Reporting Requirements for Single Risk Pool Plans (OMB 0938-1141) (PDF)</a><br><a href="/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/FINAL-2017-Unified-Rate-Review-Instructions.pdf">Final 2017 URR Instructions (Parts I, II, & III) (Updated August 10, 2016) (PDF)</a></li><li>February 23, 2017<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/unified_rate_review_template_41-22317.xlsm" data-entity-type="media" data-entity-uuid="f3a28abf-da86-4b22-80e9-b3bcb7832a57" data-entity-substitution="canonical" title="Unified_Rate_Review_Template_4.1 2.23.17">2018 URR Template v4.1 (VND.MS-EXCEL.SHEET.MACROENABLED.12)</a></li><li>April 7, 2017<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/unified-rate-review-urr-reporting-requirements-for-single-risk-pool-plans-omb-0938-1141-final-2018-urr-instructions-parts-i-ii-and-iii-.pdf" data-entity-type="media" data-entity-uuid="5b934019-362a-4ef2-b114-af1e3da99833" data-entity-substitution="canonical" type="application/pdf" title="Unified Rate Review (URR) Reporting Requirements for Single Risk Pool Plans (OMB 0938-1141) Final 2018 URR Instructions (Parts I, II, & III) "><span>Unified Rate Review (URR) Reporting Requirements for Single Risk Pool Plans (OMB 0938-1141) Final 2018 URR Instructions (Parts I, II, & III) (PDF)</span></a><span> </span> </li><li>April 9, 2018<br>Unified Rate Review (URR) Reporting Requirements for Single Risk Pool Plans (OMB 0938-1141)<br>o <a href="/cciio/resources/regulations-and-guidance/downloads/2019-urr-instructions.pdf" data-entity-type="media" data-entity-uuid="4ba1dfc1-549e-4a8c-ab52-2f123eda4cb8" data-entity-substitution="canonical" type="application/pdf" title="Final 2019 URR Instructions (Parts I, II, & III)"><span>Final 2019 URR Instructions (Parts I, II, & III) (PDF)</span></a><span> </span> <br>o <a href="/cciio/resources/regulations-and-guidance/downloads/unified-rate-review-template-v43.xlsm" data-entity-type="media" data-entity-uuid="9cd6ecb3-bf5c-446f-b912-26395617cbaa" data-entity-substitution="canonical" type="application/vnd.ms-excel.sheet.macroenabled.12" title="2019 URR"><span>2019 URR (VND.MS-EXCEL.SHEET.MACROENABLED.12)</span></a><span> </span> </li><li>April 9, 2018<br>Rate Review Justification (RRJ) Reporting Requirements for Transitional Plans (OMB 0938-1141)  <br>o <a href="/cciio/resources/regulations-and-guidance/downloads/2019-rrj-instructions.pdf" data-entity-type="media" data-entity-uuid="e7050511-61ba-4a74-b696-13220928ec94" data-entity-substitution="canonical" type="application/pdf" title="RRJ Instructions"><span>RRJ Instructions (PDF)</span></a><span> </span> <br>o <a href="/cciio/resources/regulations-and-guidance/downloads/rrj-rate-summary-template.xls" data-entity-type="media" data-entity-uuid="f6891a32-4328-4891-b0ab-21bdac7a60ac" data-entity-substitution="canonical" type="application/vnd.ms-excel" title="RRJ Template"><span>RRJ Template (XLS)</span></a><span> </span> </li><li>May 8, 2019<ul><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2020-draft-urr-instructions-508d.pdf" data-entity-type="media" data-entity-uuid="7a6ee280-0843-42dc-a324-4aab382539fd" data-entity-substitution="canonical" type="application/pdf" title="Draft 2020 URR Instructions (Parts I, II, & III)"><span>Draft 2020 URR Instructions (Parts I, II, & III) (PDF)</span></a><span> </span> </li><li><a href="/cciio/resources/forms-reports-and-other-resources/downloads/urrt-v50-508d.xlsm" data-entity-type="media" data-entity-uuid="d6b202c2-f79f-4295-8103-889fd97b70a0" data-entity-substitution="canonical" type="application/vnd.ms-excel.sheet.macroenabled.12" title="Draft 2020 URR Template v5.0"><span>Draft 2020 URR Template v5.0 (VND.MS-EXCEL.SHEET.MACROENABLED.12)</span></a><span> </span> </li></ul></li><li>December 20, 2019 <br>Unified Rate Review (URR) Reporting Requirements for Single Risk Pool Plans (OMB 0938-1141)  <br>o <a href="/cciio/resources/forms-reports-and-other-resources/downloads/2020-urr-instructions.pdf" data-entity-type="media" data-entity-uuid="422efb11-8958-486e-9a03-6527d5a7eddb" data-entity-substitution="canonical" title="2020-URR-Instructions">Final 2020 URR Instructions (PDF)<span>(Parts I, II, & III) (PDF)</span></a><span>  </span><br>o <a href="/cciio/resources/forms-reports-and-other-resources/downloads/urrt-v5.0.xlsm" data-entity-type="media" data-entity-uuid="63e7e9c8-b484-4da4-9770-7499c4f1125b" data-entity-substitution="canonical" title="URRT-v5.0"><span>2020 URR Template v5.0</span> (XLSM)</a></li><li>April 7, 2020 <br>Unified Rate Review (URR) Reporting Requirements for Single Risk Pool Plans (OMB 0938-1141)  <br>o <a href="/cciio/resources/forms-reports-and-other-resources/downloads/2021-urr-instructions.pdf" data-entity-type="media" data-entity-uuid="e4d38927-577f-4f6c-b566-a5ed58327841" data-entity-substitution="canonical" title="2021 URR Instructions">Final PY2021 URR Instructions (PDF)<span>(Parts I, II, & III)</span> (PDF)</a><br>o <a href="/cciio/resources/forms-reports-and-other-resources/downloads/unified-rate-review-template-v5.2.xlsm" data-entity-type="media" data-entity-uuid="c08410c2-5940-4704-a1c1-32329295bc9a" data-entity-substitution="canonical" title="Unified-Rate-Review-Template-v5.2"><span>URR Template v5.2</span> (XLSM) (XLSM)</a></li><li>March 16, 2021<br>Unified Rate Review (URR) Reporting Requirements for Single Risk Pool Plans (OMB 0938-1141) <br>o <a href="/cciio/resources/forms-reports-and-other-resources/downloads/urr_v5.3-instructions.pdf" data-entity-type="media" data-entity-uuid="9cc5269a-4a60-4de4-b144-7452efb75925" data-entity-substitution="canonical" title="URR v5.3 instructions">Final PY2022 URR Instructions (Parts I, II & III) (PDF)</a><br>o <a href="/cciio/resources/forms-reports-and-other-resources/downloads/urrt_v5.3.xlsm" data-entity-type="media" data-entity-uuid="646d861d-9aeb-4232-a449-c942ca892c99" data-entity-substitution="canonical" title="URRT v5.3">URR Template v5.3 (XLSM)</a> </li><li>April 9, 2021<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/hios-rate-review-technical-instructions-for-states-and-health-insurance-issuers.pdf" data-entity-type="media" data-entity-uuid="ef4e3d16-ac9b-4d90-9fe3-6ab801dd9e95" data-entity-substitution="canonical" title="HIOS-RRJ-IssuerandStateTechnicalInstructions-03_00_00">Health Insurance Oversight System (HIOS) Rate Review System Technical Instructions for States and Health Insurance Issuers (PDF)</a> (RRJ Module for Transitional Plans)</li><li>April 4, 2022<br>Unified Rate Review (URR) Reporting Requirements for Single Risk Pool Plans (OMB 0938-1141)  <br>o <a href="/files/document/urr-py23-instructions.pdf" data-entity-type="media" data-entity-uuid="77c3f256-c08b-4f88-9692-17bd9acc49e1" data-entity-substitution="canonical" title="URR PY23 Instructions">Final PY2023 URR Instructions <span>(Parts I, II, & III)</span> (PDF)</a><br>o <a href="/files/document/urrt-v54.xlsm" data-entity-type="media" data-entity-uuid="4a97c4d9-0f1e-49e3-9ad8-d827a145a614" data-entity-substitution="canonical" title="URRT v.5.4">URR Template v5.4 (XLSM)</a></li><li>March 2, 2023<br>o <a href="/files/document/unified-rate-review-template-v60.xlsm" data-entity-type="media" data-entity-uuid="3fe46ba8-cbdc-410d-aaea-f48d1a057577" data-entity-substitution="canonical" title="Unified Rate Review Template v6.0">URR Template v6.0 (XLSM)</a></li></ul><h3><a href="/files/document/urrt-v54.xlsm" data-entity-type="media" data-entity-uuid="4a97c4d9-0f1e-49e3-9ad8-d827a145a614" data-entity-substitution="canonical" title="URRT v.5.4">Reports (XLSM)</a></h3><ul><li><a href="/files/document/urrt-v54.xlsm" data-entity-type="media" data-entity-uuid="4a97c4d9-0f1e-49e3-9ad8-d827a145a614" data-entity-substitution="canonical" title="URRT v.5.4">September 20, 2011 (XLSM)</a><br><a href="/cciio/resources/files/downloads/rate_review_report_092011.pdf" data-entity-type="media" data-entity-uuid="a4617d2a-f384-4810-b4d0-70155a488eaf" data-entity-substitution="canonical" title="rate_review_report_092011">Report: Early Achievements of Health Insurance Rate Review Grants (PDF)</a> (PDF - 268 KB)<br><em>Note: The Cycle II proposal summary for the California Department of Managed Health Care was corrected on September 22, 2011.</em></li><li>September 11, 2012<br><a href="/cciio/resources/forms-reports-and-other-resources/rate-review09112012a" data-entity-type="node" data-entity-uuid="a25fa874-10ca-443f-98a2-5f676052bf53" data-entity-substitution="canonical" title="2012 Annual Rate Review Report: Rate Review Saves Estimated $1 Billion for Consumers">Annual Rate Review Report</a></li><li>September 12, 2013<br><a href="http://aspe.hhs.gov/health/reports/2013/acaannualreport/ratereview_rpt.cfm" title="Rate Review Annual Report - Opens in a new window" target="T169802"><span>Rate Review Annual Report</span><span class="LinkDisclaimer"> - Opens in a new window</span></a></li><li>December 30, 2015<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/rate-review-annual-report_508.pdf" data-entity-type="media" data-entity-uuid="3960b974-934f-46da-9a5e-758d5dcb17ee" data-entity-substitution="canonical" title="Rate Review Annual Report_508">Rate Review Annual Report (PDF)</a></li></ul><p> </p><h2><a class="ck-anchor" id="Self-Funded Non-Federal Governmental Plans"></a>Self-Funded Non-Federal Governmental Plans</h2><h3>Compliance Checklists</h3><ul><li>July 12, 2016 <br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/market-reforms-aca-and-hipaa-non-grandfathered-plan-provisions.pdf" data-entity-type="media" data-entity-uuid="3f2e30c8-bf01-49c9-a6d1-61faf83a09fe" data-entity-substitution="canonical" title="Market Reforms (ACA & HIPAA) non grandfathered plan provisions">Market Reforms (ACA & HIPAA) Non-Grandfathered Plan Provisions Self-Funded Non-Federal Governmental Group Health Plans Compliance Checklist (PDF)</a><br><br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/market-reforms-aca-and-hipaa-grandfathered-plan-provisions.pdf" data-entity-type="media" data-entity-uuid="7c2b92a5-f317-425f-ac24-baeebf67abf4" data-entity-substitution="canonical" title="Market Reforms (ACA HIPAA) Grandfathered Plan Provisions Self-Funded">Market Reforms (ACA & HIPAA) Grandfathered Plan Provisions Self-Funded Non-Federal Governmental Group Health Plans Compliance Checklist (PDF)</a></li></ul><h3>Presentations</h3><ul><li>April 15, 2019<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/01302019_non_fed_101_slides.pdf" data-entity-type="media" data-entity-uuid="fa152285-2026-4cfb-9302-244efb6532d9" data-entity-substitution="canonical" type="application/pdf" title="Non-Federal Governmental Plans: An Introduction"><span>Non-Federal Governmental Plans: An Introduction (PDF)</span></a><span> </span> </li><li>July 8, 2019<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/non-federal-governmental-plans-mhpaea-presentation-6-4-19.pdf" data-entity-type="media" data-entity-uuid="e234feea-dcf0-44f5-a0b6-42a9cac20ec2" data-entity-substitution="canonical" type="application/pdf" title="Non-Federal Governmental Plans and MHPAEA"><span>Non-Federal Governmental Plans and MHPAEA (PDF)</span></a></li><li>September 3, 2021<br><a href="/files/document/mhpaea-nqtl-presentation-non-federal-governmental-plans.pdf" data-entity-type="media" data-entity-uuid="487538fb-49ac-4ea2-8151-07c31f469aa6" data-entity-substitution="canonical" title="MHPAEA-NQTL Presentation Non-Federal Governmental Plans"><span>Non-Federal Governmental Plans and NQTL Comparative Analysis Reviews for MHPAEA Compliance (PDF)</span></a></li><li>March 29, 2023<br><a href="/files/document/mhpaea-presentation.pdf" data-entity-type="media" data-entity-uuid="2744ce87-e33c-4866-a15c-e635714947b7" data-entity-substitution="canonical" title="MHPAEA-Presentation"><span>Non-Federal Governmental Plans and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)</span> (PDF)</a></li></ul><h3>HIPAA Opt-Out Materials</h3><ul><li>September 21, 2010<br><a href="/cciio/resources/files/downloads/opt_out_memo.pdf" data-entity-type="media" data-entity-uuid="976a0234-fd88-479e-9296-ce6aa67ef388" data-entity-substitution="canonical" title="opt_out_memo">Memo on Amendments to the HIPAA Opt-Out Provision made by the Affordable Care Act (PDF)</a> (PDF – 44 KB)</li><li>July 21, 2014    <br><a href="/files/document/hipaa-exemption-guidance-7212014.pdf" data-entity-type="media" data-entity-uuid="2a8e3646-e3de-407d-b1ea-a76614be1f72" data-entity-substitution="canonical" title="hipaa-exemption-guidance-7212014"><span>Updated Procedures and Requirements for HIPAA Exemption Election through the Health Insurance Oversight System (HIOS) (PDF)</span></a></li><li>December 31, 2014<br><a href="/cciio/resources/files/hipaa_exemption_election_instructions_04072011" data-entity-type="node" data-entity-uuid="361a918c-7fb1-41b3-9619-9d958df16aa2" data-entity-substitution="canonical" title="Self-Funded Non-Federal Governmental Plans">Procedures and Requirements for HIPAA Exemption Election</a></li><li>August 18, 2016<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/hios-non-federal-governmental-health-plan-module-training.pdf" data-entity-type="media" data-entity-uuid="35e92ab9-e40f-43ff-aeaf-a78bec0f1f0e" data-entity-substitution="canonical" title="HIOS Non-Federal Governmental Health Plan Module Training">HIOS Non-Federal Governmental Health Plan Module Training (PDF)</a></li><li>September 11, 2018<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/hios-nonfed-usermanual.pdf" data-entity-type="media" data-entity-uuid="a39a0582-0105-482a-9975-557431b95cf4" data-entity-substitution="canonical" title="HIOS-NonFed-UserManual-03"><span>HIOS-Non-Fed-User Manual</span> (PDF)</a></li><li>July 31, 2023<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/hipaaoptouts073123.pdf" data-entity-type="media" data-entity-uuid="b886f840-763b-4d3d-a6ed-326fe3c2a88a" data-entity-substitution="canonical" title="Final HIPAA Opt_Out Published Report 7.31.2023"><span>List of HIPAA Opt-Out Elections for Self-Funded, Non-Federal Governmental Plans (PDF)</span></a></li><li>October 11, 2024<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/hipaaoptouts-7124.pdf" data-entity-type="media" data-entity-uuid="515b4b4b-d41b-459b-87e7-28e11ee7bc55" data-entity-substitution="canonical" title="HIPAA-Opt-Outs-7124">List of HIPAA Opt-Out Elections for Self-Funded, Non-Federal Governmental Plans (PDF)</a></li></ul><h3><a class="ck-anchor" id="Standard_Notices"></a>Standard Notices</h3><ul><li>August 12, 2020<br><a href="/files/document/2021-enforcement-safe-harbor-product-discontinuation-notices.pdf" data-entity-type="media" data-entity-uuid="036f8d50-36d1-4e11-8acb-3c3bdffed134" data-entity-substitution="canonical" title="2021-Enforcement-Safe-Harbor-Product-Discontinuation-Notices">Enforcement Safe Harbor for Individual Market Product Discontinuation Notices in Connection with the Open Enrollment Period for Coverage in the 2021 Benefit Year (PDF)</a></li></ul><p> </p><h2 id="Premium_Stabilization_Programs">Premium Stabilization Programs</h2><h3>White Papers</h3><ul><li><strong>September 12, 2011</strong><br><a href="/cciio/resources/files/downloads/riskadjustment_whitepaper_web.pdf" data-entity-type="media" data-entity-uuid="47be9d03-9e68-4eb5-9bad-605b1752e817" data-entity-substitution="canonical" title="riskadjustment_whitepaper_web">Risk Adjustment Implementation Issues – White Paper (PDF)</a> (PDF – 2 MB)<br><a href="/cciio/resources/forms-reports-and-other-resources/risk_adjustment_implementation_issues" data-entity-type="node" data-entity-uuid="898e7071-354b-4371-be91-256f64abfab8" data-entity-substitution="canonical" title="Risk Adjustment Implementation Issues">Questions and Answers on Risk Adjustment White Paper</a></li><li>March 24, 2016<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/ra-march-31-white-paper-032416.pdf" data-entity-type="media" data-entity-uuid="e958bccd-39a4-42cb-b9c1-bba82fb4599c" data-entity-substitution="canonical" title="RA_March_31_White_Paper_032416">March 31, 2016, HHS-Operated Risk Adjustment Methodology Meeting Discussion Paper (PDF)</a></li></ul><h3>Risk Adjustment Spring Meeting (May 7-8, 2012)</h3><ul><li><a href="http://www.gpo.gov/fdsys/pkg/FR-2012-04-11/pdf/2012-8771.pdf" title="CMS-9966-N: Notice of Meeting - Opens in a new window" target="T163924"><span>CMS-9966-N: Notice of Meeting</span><span class="LinkDisclaimer"> - Opens in a new window</span></a><span> </span>(PDF - 194 KB)</li><li>Registration: Register by April 30, 2012, 5 pm est.<br>To register, please visit the <a href="http://www.regonline.com/riskadjustment">Registration Website</a>.</li><li>Conference Materials<ul><li><a href="/cciio/resources/files/downloads/fm-1a-risk-adj-overview.pdf" data-entity-type="media" data-entity-uuid="a45ec02c-b77f-4bbb-902e-a7e23a12b02d" data-entity-substitution="canonical" title="fm-1a-risk-adj-overview">Risk Adjustment Overview (PDF)</a> (PDF – 268 KB)</li><li><a href="/cciio/resources/files/downloads/fm-1b-risk-adj-final-rule.pdf" data-entity-type="media" data-entity-uuid="2d3b13de-963e-434f-b454-c495430b1230" data-entity-substitution="canonical" title="fm-1b-risk-adj-final-rule">Reinsurance, Risk Corridors, and Risk Adjustment Final Rule: Risk Adjustment (PDF)</a> (PDF – 252 KB)</li><li><a href="/cciio/resources/files/downloads/fm-1c-risk-adj-model.pdf" data-entity-type="media" data-entity-uuid="3560e223-e65d-4d03-b1b3-2aa78af71bd7" data-entity-substitution="canonical" title="fm-1c-risk-adj-model">HHS Risk Adjustment Model (PDF)</a> (PDF – 340 KB)</li><li><a href="/cciio/resources/files/downloads/fm-1d-p-and-c.pdf" data-entity-type="media" data-entity-uuid="2e0ccc44-e4bf-4ff0-a649-2840059b7aa8" data-entity-substitution="canonical" title="fm-1d-p-and-c">Risk Adjustment Payment Transfer Methodology (PDF)</a> (PDF – 763 KB)</li><li><a href="/cciio/resources/files/downloads/fm-1e-state-flex.pdf" data-entity-type="media" data-entity-uuid="63a10fee-1361-4c54-82a5-8feb63ccbbae" data-entity-substitution="canonical" title="fm-1e-state-flex">State Flexibility and Alternate Methodologies (PDF)</a> (PDF – 336 KB)</li><li><a href="/cciio/resources/files/downloads/fm-2a-fed-ra-ov-dv.pdf" data-entity-type="media" data-entity-uuid="17f942d8-ea41-4c88-bfd3-3a89f4938944" data-entity-substitution="canonical" title="fm-2a-fed-ra-ov-dv">Risk Adjustment Program: HHS Operations (PDF)</a> (PDF – 608 KB)</li><li><a href="/cciio/resources/files/downloads/fm-2b-dist-mdl-tech-prop.pdf" data-entity-type="media" data-entity-uuid="7822a49e-c574-4948-ba3b-186730f3447c" data-entity-substitution="canonical" title="fm-2b-dist-mdl-tech-prop">Proposed Technical Concept: Distributed Data Processing (PDF)</a> (PDF – 290 KB)</li><li><a href="/cciio/resources/files/downloads/fm-2c-state-flex-imp.pdf" data-entity-type="media" data-entity-uuid="f913f9cf-30ff-49dc-b5db-873523644e27" data-entity-substitution="canonical" title="fm-2c-state-flex-imp">State Flexibility and Risk Adjustment Implementation (PDF)</a> (PDF – 410 KB)</li></ul></li></ul><h3>Instructions</h3><ul><li>August 27, 2015<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/2014-risk-corridors-validation-instructions.pdf" data-entity-type="media" data-entity-uuid="ee151b9c-0bef-4a00-82ae-f607d6a30326" data-entity-substitution="canonical" title="2014 Risk Corridors Validation Instructions">Instructions for 2014 Risk Corridors Discrepancy Worksheet (PDF)</a></li><li><p>October 13, 2015<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/faqs-for-tpa-issuer-user-fee-final.pdf" data-entity-type="media" data-entity-uuid="672e9068-d515-4f14-9006-771f4a1984a1" data-entity-substitution="canonical" title="FAQs-for-TPA-Issuer-User-Fee-FINAL">FAQs for User Fee Adjustment Data Submission  (PDF 125 KB) (PDF)</a></p><div><a href="/cciio/resources/forms-reports-and-other-resources/downloads/tpa-jobaid-final.pdf" data-entity-type="media" data-entity-uuid="a7c16d12-e6a5-439c-9a88-2914bc0cbc95" data-entity-substitution="canonical" title="TPA-JobAid-FINAL">Job Aid: TPA user fee adjustment data submission  (PDF 366 KB) (PDF)</a><br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/issuer-jobaid-final.pdf" data-entity-type="media" data-entity-uuid="80b524dc-10df-43a6-8226-07ca34d9cf3e" data-entity-substitution="canonical" title="Issuer-JobAid-FINAL">Job Aid:  Issuer user fee adjustment data submission form  (PDF 193 KB) (PDF)</a></div></li><li>March 23, 2018<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/user-fee-reduction-obligation-faq-032318.pdf" data-entity-type="media" data-entity-uuid="0854f4c7-c271-4d02-bad7-3313f4c1682c" data-entity-substitution="canonical" type="application/pdf" title="FAQ for Federally-facilitated Exchange (FFE) User Fee Adjustment Obligation Reduction"><span>FAQ for Federally-facilitated Exchange (FFE) User Fee Adjustment Obligation Reduction (PDF)</span></a><span> </span> </li><li>May 16, 2018<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/ffe-user-fee-adj-webform-quick-start-guide.pdf" data-entity-type="media" data-entity-uuid="0448c12b-7c33-4445-acac-d8ac64632d74" data-entity-substitution="canonical" type="application/pdf" title="Federally-facilitated Exchange (FFE) User Fee Adjustment Web Form Quick Start Guide"><span>Federally-facilitated Exchange (FFE) User Fee Adjustment Web Form Quick Start Guide (PDF)</span></a><span> </span> </li></ul><h3>Forms</h3><ul><li>January 29, 2015<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/transitional-reporting-form-2-9-15.xlsx" data-entity-type="media" data-entity-uuid="3f71e925-ebdb-42aa-aec8-896c09e1bc1f" data-entity-substitution="canonical" title="2014 Transitional Reporting Form (Excel)">2014 Transitional Reporting Form (Excel) (XLSX)</a></li><li>August 22, 2016<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/uf-webguide-5cr-081816.pdf" data-entity-type="media" data-entity-uuid="cf4186e2-baca-4bfa-9336-7909d92847b4" data-entity-substitution="canonical" title="UF-WebGuide-5CR-081816">Federally-facilitated Marketplace (FFM) User Fee Adjustment Web Form Quick Start Guide (PDF)</a></li><li>March 23, 2018<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/ffm-user-fee-reduction-attestation-032318.xlsx" data-entity-type="media" data-entity-uuid="64a2e993-ad98-4e95-970b-d9751d8d343b" data-entity-substitution="canonical" type="application/vnd.openxmlformats-officedocument.spreadsheetml.sheet" title="Federally-facilitated Exchange (FFE) User Fee Adjustment Obligation Reduction Attestation Form"><span>Federally-facilitated Exchange (FFE) User Fee Adjustment Obligation Reduction Attestation Form (XLSX)</span></a><span> </span> </li><li>March 29, 2018<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/csr-reconciliation-attestation-forma-final-by2017.xlsx" data-entity-type="media" data-entity-uuid="efd29d63-4165-4653-ada1-51479a9bd319" data-entity-substitution="canonical" type="application/vnd.openxmlformats-officedocument.spreadsheetml.sheet" title="Cost-Sharing Reduction Reconciliation Attestation Form A – Benefit Year 2017"><span>Cost-Sharing Reduction Reconciliation Attestation Form A – Benefit Year 2017 (XLSX)</span></a><span> </span><br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/csr-reconciliation-attestation-formb-final-by2017.xlsx" data-entity-type="media" data-entity-uuid="ea05866b-3514-4b94-92c7-2f09ea77669f" data-entity-substitution="canonical" type="application/vnd.openxmlformats-officedocument.spreadsheetml.sheet" title="Cost-Sharing Reduction Reconciliation Attestation Form B – Benefit Year 2017"><span>Cost-Sharing Reduction Reconciliation Attestation Form B – Benefit Year 2017 (XLSX)</span></a><span> </span><br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/csr-reconciliation-attestation-formc-final-by2016.xlsx" data-entity-type="media" data-entity-uuid="436ded82-ec05-4b1c-806f-bcb149f6ee78" data-entity-substitution="canonical" type="application/vnd.openxmlformats-officedocument.spreadsheetml.sheet" title="Cost-Sharing Reduction Reconciliation Attestation Form C – Benefit Year 2016"><span>Cost-Sharing Reduction Reconciliation Attestation Form C – Benefit Year 2016 (XLSX)</span></a><span> </span> </li><li>April 3, 2019<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/csr_reconciliation_attestation_form_a-benefit_year_2018or2017.xlsx" data-entity-type="media" data-entity-uuid="31943cfe-ec88-456f-8fa6-91fc55b02cab" data-entity-substitution="canonical" type="application/vnd.openxmlformats-officedocument.spreadsheetml.sheet" title="Cost-sharing Reduction Reconciliation Attestation Form A – Benefit Year 2018"><span>Cost-sharing Reduction Reconciliation Attestation Form A – Benefit Year 2018 (XLSX)</span></a><span> </span> <br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/csr_reconciliation_attestation_form_b-benefit_year_2018or2017.xlsx" data-entity-type="media" data-entity-uuid="f3955d43-54d6-4cae-bcb4-2a278731ba86" data-entity-substitution="canonical" type="application/vnd.openxmlformats-officedocument.spreadsheetml.sheet" title="Cost-sharing Reduction Reconciliation Attestation Form B – Benefit Year 2018"><span>Cost-sharing Reduction Reconciliation Attestation Form B – Benefit Year 2018 (XLSX)</span></a><span> </span> </li><li>May 29, 2019<br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/csr-reconcilliation-attestation-forma-benefit-year-2017-or-2018-secondwindow.xlsx" data-entity-type="media" data-entity-uuid="b2446d90-c352-4ff7-a449-c513608e7578" data-entity-substitution="canonical" type="application/vnd.openxmlformats-officedocument.spreadsheetml.sheet" title="CSR Reconciliation Attestation Form A Benefit Year 2018 or 2017"><span>CSR Reconciliation Attestation Form A Benefit Year 2018 or 2017 (XLSX)</span></a><span> </span> <br><a href="/cciio/resources/forms-reports-and-other-resources/downloads/csr-reconcilliation-attestation-formb-benefit-year-2017-or-2018-secondwindow.xlsx" data-entity-type="media" data-entity-uuid="b53d170d-d5c9-4420-b243-807b0f4667d7" data-entity-substitution="canonical" type="application/vnd.openxmlformats-officedocument.spreadsheetml.sheet" title="CSR Reconciliation Attestation Form B Benefit Year 2018 or 2017"><span>CSR Reconciliation Attestation Form B Benefit Year 2018 or 2017 (XLSX)</span></a><span> </span> </li><li>April 24, 2020<br><a href="/cciio/resources/regulations-and-guidance/downloads/document-5-csr-reconciliation-attestation-form-a-benefit-year-2019-or-2018.pdf" data-entity-type="media" data-entity-uuid="19a48da3-3810-4e1c-988d-190f175699d1" data-entity-substitution="canonical" title="Document-5-CSR-Reconciliation-Attestation-Form-A-Benefit-Year-2019-or-2018"><span lang="EN">Cost-sharing Reduction Reconciliation Attestation Form A Benefit Year 2019 </span>(PDF)<span> or 2018 (PDF)</span></a><span> </span> <br><a href="/cciio/resources/regulations-and-guidance/downloads/document-6-csr-reconciliation-attestation-form-b-benefit-year-2019-or-2018.pdf" data-entity-type="media" data-entity-uuid="2a5dd450-26d5-49f9-b49b-cd46232048fd" data-entity-substitution="canonical" title="Document-6-CSR-Reconciliation-Attestation-Form-B-Benefit-Year-2019-or-2018"><span lang="EN">Cost-sharing Reduction Reconciliation Attestation Form B Benefit Year 2019 </span><span>or 2018</span> (PDF)</a></li><li>April 13, 2021<br><a href="/cciio/resources/regulations-and-guidance/downloads/document-5-csr-reconciliation-attestation-form-a-benefit-year-2020-or-2019.pdf" data-entity-type="media" data-entity-uuid="275b2b78-9dab-4b66-9e36-8477b5cc3974" data-entity-substitution="canonical" title="Document #5 CSR_Reconciliation_Attestation_Form_A-Benefit_Year_2020 or 2019">Cost-sharing Reduction Reconciliation Attestation Form A Benefit Year 2020 or 2019 (XLSX)</a><br><a href="/cciio/resources/regulations-and-guidance/downloads/document-6-csr-reconciliation-attestation-form-b-benefit-year-2020-or-2019.pdf" data-entity-type="media" data-entity-uuid="8abd3c53-329a-44d6-ac9d-d9f94e1dd084" data-entity-substitution="canonical" title="Document #6 CSR_Reconciliation_Attestation_Form_B-Benefit_Year_2020 or 2019">Cost-sharing Reduction Reconciliation Attestation Form B Benefit Year 2020 or 2019 (XLSX)</a></li><li>April 4, 2022<br><a href="/files/document/document-5-csr-reconciliation-attestation-form-benefit-year-2021-or-2020.xlsx" data-entity-type="media" data-entity-uuid="30a6c680-b74f-4511-b48f-2a11afee4084" data-entity-substitution="canonical" title="Document-5-CSR-Reconciliation-Attestation-Form-A-Benefit-Year-2021-or-2020">Cost-sharing Reduction Reconciliation Attestation Form A Benefit Year 2021 or 2020 (XLSX)</a><br><a href="/files/document/document-6-csr-reconciliation-attestation-form-b-benefit-year-2021-or-2020.xlsx" data-entity-type="media" data-entity-uuid="b333f3d9-44b8-4ec4-8c22-242c6fe80054" data-entity-substitution="canonical" title="Document-6-CSR-Reconciliation-Attestation-Form-B-Benefit-Year-2021-or-2020">Cost-sharing Reduction Reconciliation Attestation Form B Benefit Year 2021 or 2020 (XLSX)</a></li></ul><h2><a class="ck-anchor" id="COBRA"></a>COBRA</h2><h3>Forms</h3><ul><li>October 17, 2012<br><a href="/cciio/resources/files/downloads/cms-request-for-review-cobra-premium-assist-denial.pdf" data-entity-type="media" data-entity-uuid="5fe26726-53f7-4a45-a0e3-938f76671427" data-entity-substitution="canonical" title="cms-request-for-review-cobra-premium-assist-denial">CMS Request for Review of Premium Assistance Denial (PDF)</a> (PDF - 992 KB)</li></ul><p> </p><h2><a class="ck-anchor" id="Reports"></a>Reports</h2><h2><a class="ck-anchor" id="GAO"></a>GAO</h2><ul><li>March 16, 2011<br><a href="http://www.gao.gov/new.items/d11268.pdf">"Private Health Insurance: Data on Application and Coverage Denials"</a> (PDF – 1.13 MB)</li></ul><h2>State High Risk Pool Grant Program</h2><ul><li><a href="/cciio/resources/files/downloads/cms_rtc_hrp_final073109.pdf" data-entity-type="media" data-entity-uuid="a9b6c795-de34-4db8-9c6c-441e4c83abbd" data-entity-substitution="canonical" title="cms_rtc_hrp_final073109">Report to Congress on the High Risk Pool Grant Program for Fiscal Years 2006 and 2007 (PDF)</a>  (PDF - 298 KB)</li></ul><h2>CCIIO </h2><ul><li>   September 13, 2023<br><a href="/files/document/cciio-behavioral-health-report-508.pdf" data-entity-type="media" data-entity-uuid="391ca7ae-e040-4a4d-9367-fe3645971dbc" data-entity-substitution="canonical" title="CCIIO Behavioral Health report 508">"CCIIO-led Behavioral Health & Telehealth Collaborative in Seven States" (PDF)</a> (PDF – 5MB)</li></ul><p> </p></div></div> </div> </div> <div class="block block-layout-builder block-field-blocknodesection-pagefield-downloads"> <div class="content"> <span class="create-date"> </span> <div class="field field--name-field-downloads field--type-entity-reference field--label-above cms-accented-block cms-accented-block--padded"> <h2 class="field__label block-title-icon"><i class="far fa-cloud-download"></i>Downloads</h2> <ul class="field__items"> <li class="field__item"> <article class="media media--type-document media--view-mode-file-list"> <a href="/files/document/hipaaoptouts03182021.pdf">HIPAAOptOuts03182021 (PDF)</a> </article> </li> <li class="field__item"> <article class="media media--type-document media--view-mode-file-list"> <a href="/files/document/2021-mlr-reporting-form.xlsx">2021 MLR Reporting Form (XLSX)</a> </article> </li> <li class="field__item"> <article class="media 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