C.F.R. » Title 45 » SUBCHAPTER B—REQUIREMENTS RELATING TO HEALTH CARE ACCESS › PART 156—HEALTH INSURANCE ISSUER STANDARDS UNDER THE AFFORDABLE CARE ACT, INCLUDING STANDARDS RELATED TO EXCHANGES › Subpart C—Qualified Health Plan Minimum Certification Standards

45 C.F.R. § 156.210

QHP rate and benefit information

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(a) General rate requirement. A QHP issuer must set rates for an entire benefit year, or for the SHOP, plan year.

(b) Rate and benefit submission. A QHP issuer must submit rate and benefit information to the Exchange.

(c) Rate justification. A QHP issuer must submit to the Exchange a justification for a rate increase prior to the implementation of the increase. A QHP issuer must prominently post the justification on its Web site.

(d) Rate requirements for stand-alone dental plans. For benefit and plan years beginning on or after January 1, 2024:

(1) Age on effective date. The premium rate charged by an issuer of stand-alone dental plans may vary with respect to the particular plan or coverage involved by determining the enrollee's age. Any age calculation for rating and eligibility purposes must be based on the age as of the time of policy issuance or renewal.

(2) Guaranteed rates. An issuer of stand-alone dental plans must set guaranteed rates.

[77 FR 18469, Mar. 27, 2012, as amended at 88 FR 25922, Apr. 27, 2023]
Notes of Decisions
Cited in 2 cases (2 in the last 5 years), 2022–2024 · leading case: In Re Blue Cross & Blue Shield 2022 Individual & Small Grp. Mkt. Filing, 2022 VT 53 (Vt. 2022).
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In Re Blue Cross & Blue Shield 2022 Individual & Small Grp. Mkt. Filing, 2022 VT 53 (Vt. 2022). “See 45 C.F.R. § 156.210 (a) (providing qualified health plan “issuer must set rates for an entire benefit year”); 33 V.”
Antidote Health Plan of Arizona, Inc. v. Becerra (D.D.C. 2024). “45 C.F.R. § 156.210 . Second, it must provide an accurate directory of in-network medical providers so beneficiaries can get in touch with their doctors.”
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