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.
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.
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|General||Not applicable||Justifications Overview|
|Administrative||Administrative Template (v5.04)||Not Applicable|
No template – respond to attestations in HIOS Issuer Module
If applicable, upload Statement of Detailed Attestation Responses in HIOS Benefits and Service Area Module or in SERFF
|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||NCQA Template (v5.0)
URAC Template (v5.02)
AAAHC Template (v1.0)
|SHOP Tying||SHOP Tying||No template – upload attestations in HIOS Benefits and Service Area Module||SHOP Tying Provision|
|Network Adequacy||Network ID Template(v5.0)
Network Adequacy Template (v1.1)
|Essential Community Providers||ECP Template (v5.06)||Supplementary Response: Inclusion of Essential Community Providers|
|Service Area||Service Area Template.(v5.02)||Supplemental Response: Partial County Explanation|
|Plans & Benefits||Plans & Benefits Template (v5.12)
Plans & Benefits Add-In (v5.17)
|Prescription Drugs||Prescription Drug Template (v5.06)|
|Rates||Rates Template (v5.05)||Not applicable|
|Business Rules||Business Rules Template (v5.07)||Not applicable|
|Unified Rate Review||Unified Rate Review Template Instructions||Unified Rate Review Template (v2.0.4)||Not applicable|
|Plan Crosswalk||Plan ID Crosswalk Template Instructions||Plan Crosswalk Template (v2.0.3)||State Authorization Form|
|General Reference||Not applicable||Not applicable|
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.