Qualified Health Plan Certification
The Qualified Health Plan (QHP) Application is available to issuers applying for certification to participate in the Federally-facilitated Marketplaces (FFMs). Health plans, including dental, must meet a number of standards in order to be certified as QHPs. As defined in the Affordable Care Act (ACA), a QHP is an insurance plan that is certified by the Health Insurance Marketplace, provides essential health benefits (EHBs), follows established limits on cost sharing, and meets other requirements outlined within the application process.
Issuers seeking QHP certification should review and submit the QHP Application and complete the certification process. The QHP Application, including templates, instructions, tools, and FAQs, is now located on the new QHP website - Opens in a new window .
Quick Links:
- QHP Application Templates and Tools - Opens in a new window
- QHP Application Instructions - Opens in a new window
- QHP Submission Checklist - Opens in a new window
- Data Correction Windows - Opens in a new window
- Withdrawal Information - Opens in a new window
- FAQs - Opens in a new window
QHP Certification Timeline
| Activity | Dates |
|
Initial QHP Application Submission Window |
5/10/17 – 6/21/17 |
|
CMS Reviews Initial QHP Applications as of 6/21/17 |
6/22/17 – 7/25/17 |
|
CMS Sends First Correction Notice |
8/1/17 – 8/2/17 |
|
Deadline for Service Area Petition |
8/4/17 |
|
Final Deadline for Issuer Changes to QHP Application |
8/16/2017 |
|
CMS Reviews Final QHP Submissions as of 8/16/17 |
8/17/2017 – 9/11/2017 |
|
CMS Sends Final Correction Notice to Issuers with Agreements for Signature and Plan Lists for Confirmation |
9/14/2017 – 9/15/17 |
|
States Send CMS Final Plan Recommendations |
9/27/2017 |
|
Issuers Send Signed Agreements, Confirmed Plan Lists and Final Plan Crosswalks to CMS |
9/16/2017 – 9/27/2017 |
|
CMS Sends Certification Notices with Countersigned Agreements and Final Plan Lists to Issuers |
10/11/2017 – 10/12/2017 |
|
Limited Data Correction Window: Outreach to Issuers with CMS or State Identified Data Errors; Issuers Submit Corrections; CMS Reviews and Finalizes Data for Open Enrollment |
9/15/2017 –10/7/2017 |
|
Open Enrollment |
Begins 11/1/2017 |
Contact Us
Frequently Asked Questions (FAQs) related to QHP certification are posted here - Opens in a new window and will be updated throughout the application and certification period. Issuers may also contact the Exchange Operations Support Center (XOSC) Help Desk at CMS_FEPS@cms.hhs.gov or at 855-CMS-1515.
Updates
- March 5, 2020 Information Related to COVID–19 Individual and Small Group Market Insurance Coverage
- March 12, 2020 FAQs on Essential Health Benefits Coverage and the Coronavirus (COVID-19)
- March 18, 2020 FAQs on Catastrophic Plan Coverage and the Coronavirus Disease 2019 (COVID-19)
- March 24, 2020 FAQs on Availability and Usage of Telehealth Services through Private Health Insurance Coverage in Response to Coronavirus Disease 2019 (COVID-19)
- March 24, 2020 Payment and Grace Period Flexibilities Associated with the COVID-19 National Emergency
- March 24, 2020 FAQs on Prescription Drugs and the Coronavirus Disease 2019 (COVID-19) for Issuers Offering Health Insurance Coverage in the Individual and Small Group Markets
- April 11, 2020 FAQs about Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act Implementation
*This document was updated on April 15, 2020, to correct an error in footnote 10 regarding the current end date of the public health emergency related to COVID 19. - April 13, 2020 Postponement of 2019 Benefit Year HHS-operated Risk Adjustment Data Validation (HHS-RADV)