C.F.R. » Title 45 » SUBCHAPTER B—REQUIREMENTS RELATING TO HEALTH CARE ACCESS › PART 155—EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT › Subpart A—General Provisions.

45 C.F.R. § 155.10

Basis and scope

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(a) Basis. This part is based on the following sections of title I of the Affordable Care Act:

(1) 1301. Qualified health plan defined

(2) 1302. Essential health benefits requirements

(3) 1303. Special rules

(4) 1304. Related definitions

(5) 1311. Affordable choices of health benefit plans.

(6) 1312. Consumer choice

(7) 1313. Financial integrity.

(8) 1321. State flexibility in operation and enforcement of Exchanges and related requirements.

(9) 1322. Federal program to assist establishment and operation of nonprofit, member-run health insurance issuers.

(10) 1331. State flexibility to establish Basic Health Programs for low-income individuals not eligible for Medicaid.

(11) 1334. Multi-State plans.

(12) 1402. Reduced cost-sharing for individuals enrolling in QHPs.

(13) 1411. Procedures for determining eligibility for Exchange participation, advance premium tax credits and reduced cost sharing, and individual responsibility exemptions.

(14) 1412. Advance determination and payment of premium tax credits and cost-sharing reductions.

(15) 1413. Streamlining of procedures for enrollment through an exchange and State Medicaid, CHIP, and health subsidy programs.

(b) Scope. This part establishes minimum standards for the establishment of an Exchange, minimum Exchange functions, eligibility determinations, enrollment periods, minimum SHOP functions, certification of QHPs, and health plan quality improvement.

Notes of Decisions
Cited in 1 case (1 in the last 5 years), 2024–2024 · leading case: D. McGrody v. PA Health Ins. Exch. Auth. d/b/a Pennie (Pa. Commw. Ct. 2024).
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D. McGrody v. PA Health Ins. Exch. Auth. d/b/a Pennie (Pa. Commw. Ct. 2024). “At issue are the federal regulations at 45 C.F.R. §§ 155.10 - 155.1515 (2024). The regulations provide a right to appeal from health insurance eligibility determinations: (b) Right to appeal.”
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