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The Center for Consumer Information & Insurance Oversight

 

Qualified Health Plans

The 2016 Qualified Health Plan (QHP) Application is available to issuers applying for certification to participate in the Federally-facilitated Marketplaces. Click on the links below to access detailed application instructions, templates, justifications and supporting documents, and tools for issuers. Please read the application instructions carefully before beginning the application process.

Qualified Health Plan Application Instructions, Templates and Materials

A complete set of instructions for the Plan Year 2016 QHP Application is now available. Access instructions, templates, and supporting document by clicking on the links below. Application materials are organized by application area in the table below.

Application Area

Instructions

Template

Justifications/
Supporting Documents

General QHP Instructions Introduction
QHP Instructions Table of Contents
QHP Application Abbreviations
QHP Instructions Revision History
Stand-Alone Dental Plans
Template Field Crosswalk
Not applicable Justifications Overview
Administrative Administrative Administrative Template (v5.04) Not Applicable
Attestations Program Attestations No template – upload attestations in HIOS Issuer Module Compliance Plan and Organizational Chart Cover Sheet Checklist
Statement of Detailed Attestation Responses
Licensure State Licensure No template – upload attestations in HIOS Issuer Module Not Applicable
Good Standing Good Standing No template – upload attestations in HIOS Issuer Module Not Applicable
Accreditation Accreditation NCQA Template (v5.0)
URAC Template (v5.02)
AAAHC Template (v1.0)
Not applicable
SHOP Tying SHOP Tying No template – upload attestations in HIOS Benefits and Service Area Module SHOP Tying Provision
Network Adequacy Network Adequacy
Network ID
Network ID Template(v5.0)
Network Adequacy Template (v1.1)
Not applicable
Essential Community Providers Essential Community Provider ECP Template (v5.06) Supplementary Response: Inclusion of Essential Community Providers
Service Area Service Area Service Area Template.(v5.02) Supplemental Response: Partial County Explanation
Plans & Benefits Plans & Benefits Plans & Benefits Template (v5.12)
Plans & Benefits Add-In (v5.17)

EHB Substituted Benefit Justification

Discrimination- Cost Sharing Outlier

Discrimination- Language

Meaningful Difference

SADP Actuarial Value

SADP – Description of EHB Allocation

Prescription Drugs Prescription Drug Prescription Drug Template (v5.06)

Formulary- Inadequate Category-Class Count

Discrimination – Formulary Outlier Review

Discrimination – Formulary Clinical Appropriateness

Discrimination - Formulary Treatment Protocol

Rates Rating Data Rates Template (v5.05) Not applicable
Business Rules Issuer Business Rules Business Rules Template (v5.07) Not applicable
Unified Rate Review Unified Rate Review Template Instructions Unified Rate Review Template (v2.0.3) Not applicable
Plan Crosswalk Plan ID Crosswalk Template Instructions Plan Crosswalk Template (v2.0.1) State Authorization Form

 


Qualified Health Plan Application Tools

A series of automated data review tools are available to issuers to check templates for data errors prior to submitting to CMS for review. Issuers are encouraged to use these tools to identify and correct data errors prior to uploading materials to HIOS or SERFF.

Other Qualified Health Plan Application Resources