Ill. Admin. Code tit. 50 § 4500.60

Current through Register Vol. 48, No. 45, November 8, 2024

Section 4500.60 - Non-certification of QHPs

a) If a QHP issuer elects not to seek certification for a subsequent, consecutive certification cycle within the Exchange, the QHP issuer, at a minimum, must:

1) Notify the Exchange of its decision before the beginning of the recertification process, and no later than the deadline specified in 215 ILCS 97/60, and adhere to the procedures adopted by the Exchange under 45 CFR 155.1075 (Feb. 27, 2015) (no later editions or amendments);

2) fulfill its obligation to cover benefits for each enrollee through the end of the plan or benefit year through the Exchange;

3) fulfill data reporting obligations from the last plan or benefit year of the certification;

4) provide notice to enrollees as described in subsection (b); and

5) terminate the coverage or enrollment through the Exchange of enrollees in the QHP in accordance with 45 CFR 156.270 (Apr. 27, 2023) (no later editions or amendments), as applicable (see 45 CFR 156.290(a) (Dec. 22, 2016) (no later editions or amendments)).

b) When, for a subsequent, consecutive certification cycle, a QHP issuer elects not to seek certification with the Exchange, or the Exchange denies certification of a QHP, the QHP issuer must provide written notice to each enrollee in the form and manner specified in 50 Ill. Adm. Code 2025 (see 45 CFR 156.290(b)).

Ill. Admin. Code tit. 50, § 4500.60

Added at 48 Ill. Reg. 12312, effective 8/1/2024