Consumer Support and Information
Consumer Assistance Program Grants
Reports
External Appeals
Model Notice
Notice of Privacy Act Rights
Federal Register Notice
Summary of Benefits and Coverage and Uniform Glossary
SBC Materials and Supporting Documents (Authorized for use on and after April 1, 2017)
Applicability: Health plans and issuers that maintain an annual open enrollment period will be required to use the April, 2017 edition of the SBC template and associated documents beginning on the first day of the first open enrollment period that begins on or after April 1, 2017 with respect to coverage for plan years (or, in the individual market, policy years) beginning on or after that date. For plans and issuers that do not use an annual open enrollment period, this SBC template and associated documents is required beginning on the first day of the first plan year (or, in the individual market, policy year) that begins on or after April 1, 2017.
Forms
- Summary of Benefits and Coverage (SBC) Template
- Uniform Glossary
Instructions/Guidance
SBC Materials and Supporting Documents (Authorized for use prior to April 1, 2017)
Forms
- Summary of Benefits and Coverage (SBC) Template
- Standard Format (Authorized for second year of applicability) (DOC – 182 KB)
- Accessible Format (Authorized for second year of applicability) (PDF – 366 KB)
- Standard Format (Authorized for first year of applicability) (DOC - 175 KB)
- Accessible Format (Authorized for first year of applicability) (PDF - 607 KB)
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Chinese (Authorized for second year of applicability) [DOCX, 78KB]
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Chinese (Authorized for second year of applicability) [PDF, 618KB]
- Chinese (Authorized for first year of applicability) (DOC – 54 KB)
- Chinese (Authorized for first year of applicability) (PDF- 565 KB)
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Navajo (Authorized for second year of applicability) [DOCX, 3MB]
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Navajo (Authorized for second year of applicability) [PDF, 163KB]
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Navajo Oral Translation (Authorized for second year of applicability) [MP3, 27MB]
- Navajo (Authorized for first year of applicability) (DOC – 67 KB)
(Note: In order to use the Navajo SBC template in Word format, it may be necessary to install Times New Roman Navajo fonts. Times New Roman Navajo fonts are available free of charge on a number of sources on the Internet.)
- Navajo (Authorized for first year of applicability) (PDF – 258 KB)
- Navajo (Authorized for first year of applicability) - Oral Translation (MP3 – 21 MB)
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Spanish (Authorized for second year of applicability) [DOCX, 83KB]
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Spanish (Authorized for second year of applicability) [PDF, 534KB]
- Spanish (Authorized for first year of applicability) (DOC – 170KB)
- Spanish (Authorized for first year of applicability) (PDF – 458 KB)
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Tagalog (Authorized for second year of applicability) [DOCX, 81KB]
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Tagalog (Authorized for second year of applicability) [PDF, 481KB]
- Tagalog (Authorized for first year of applicability) (DOC – 71 KB)
- Tagalog (Authorized for first year of applicability) (PDF – 446 KB)
- Uniform Glossary
Instructions/Guidance
Content Requirements for Plan Finder
Q&A
Instructions/Guidance
- March 28, 2013
Plan Finder State User Manual (PDF – 1.4 MB)
- March 20, 2015
Plan Finder Issuer User Manual (PDF – 1.5MB)
- February 12, 2016
Plan Finder Quick Reference Guide (PDF – 1.5MB)
- April 14, 2016
HIOS Portal Quick Guide for Administrators
- June 1, 2016
CMS.gov Enterprise Portal Quick Reference Guide for Existing Users Adding Multi-Factor Authentication (MFA) to their Health Insurance Oversight System (HIOS) Application Role
- June 1, 2016
Abbreviated Reference Guide for Existing Users Adding Multi-Factor Authentication (MFA) to their Health Insurance Oversight System (HIOS) Application Role
- June 1, 2016
EIDM YouTube video for Multi Factor Authentication Registration
- July 28, 2016
Rate and Benefit Information System (RBIS) User Manual (PDF – 3.7MB)
- August 4, 2016
HIOS Portal Quick Guide (PDF – 1.5MB)
- November 1, 2016
HIOS Portal User Manual
Pre-Existing Condition Insurance Plan (PCIP)
Data
Reports
Early Retiree Reinsurance Program (ERRP)
Reports
Health Insurance Marketplaces
Presentations
Marketplace Year 3: Issuer Insights and Innovation - June 9, 2016
Forum Agenda
CMS Acting Administrator Andy Slavitt Remarks
HHS Secretary Burwell Remarks
Marketplace Success Stories Blog by CEO Kevin Counihan
Forum Recording:
Session Slides:
Marketplace Year 3: Issuer Insights and Innovation – October 5, 2016
Forum Agenda
CMS Acting Administrator Andy Slavitt Remarks
HHS Secretary Burwell Remarks
Forum Recordings (Forthcoming)
Session Slides
Forms
- May 16, 2012
Paperwork Reduction Act (PRA) display of Draft Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges (click on CMS – 10416).
- August 14, 2012 (Revised November 16, 2012)
Final Blueprint for Exchanges (PDF - 731 KB)
- November 9, 2012
Frequently Asked Questions on the Blueprint for Exchanges
- October 9, 2013
Marketplace Consumer Application
- April 7, 2014
Compliance Reviews in the Federally-Facilitated Marketplace
- April 2, 2015
- Compliance Reviews in the Federally-Facilitated
- February 23, 2016
Compliance Reviews in the Federally-Facilitated
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Reports
Planning and Establishment Grants
Pre-Application Conference Calls (Upcoming)
- June 29, 2012
Dates and Times of Pre-Application Conference Calls for Exchange Establishment FOA:
- July 19, 2012 – 1:30-3:00pm EST
- October 4, 2012 - 2:00-3:30pm EST
- January 10, 2013 - 2:00-3:30pm EST
- April 10, 2013 - 1 -2:30 PM EST
Call in: 1 877 267 1577; Meeting ID: 0360
Consumer Operated and Oriented Plan (CO-OP) Program
Presentations
Health Insurance Market Reforms
Annual Limits
Application Information
- June 17, 2011
Annual Limit Waiver Application Forms and Instructions
- January 6, 2012
Coverage for Young Adults
Data
Medical Loss Ratio
Forms
Reports:
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Patient’s Bill of Rights
Q&A
Data
Methodology
Reports
Prevention
Forms
Review of Insurance Rates
Forms
- February 2, 2015
Effective Rate Review (ERR) Annual Survey (OMB 0938-1121)
o 2015 ERR Annual Determination and Status Questions
o 2015 ERR Instructions
- February 25, 2015
Unified Rate Review (URR) Reporting Requirements for Single Risk Pool Plans (OMB 0938-1141)
o 2016 URR Instructions (Parts I, II, & III)
o 2016 URR Template (URRT) (Updated on April 15, 2015)
- o 2016 Instructions for Submitting a Redacted Actuarial Memorandum (Posted April 16, 2015)
- April 03, 2015
Rate Review Justification (RRJ) Reporting Requirements for Transitional Plans and Student Health Plans (OMB 0938-1141)
o RRJ Instructions
o RRJ Template
- February 22, 2016
Unified Rate Review (URR) Reporting Requirements for Single Risk Pool Plans (OMB 0938-1141)
o Draft 2017 URR Instructions (Parts I, II, & III)
o Federal Register Notice
- o PRA Supporting Statement
- o2017 URR Template v3.3 (URRT) (Updated March 18, 2016)
- August 18, 2016
Unified Rate Review (URR) Reporting Requirements for Single Risk Pool Plans (OMB 0938-1141)
Final 2017 URR Instructions (Parts I, II, & III) (Updated August 10, 2016)
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Reports
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Self-Funded Non-Federal Governmental Plans
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Compliance Checklists
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HIPAA Opt-Out Materials
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Premium Stabilization Programs
White Papers
Risk Adjustment Spring Meeting (May 7-8, 2012)
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Instructions