§ 156.265Enrollment process for qualified individuals.
(a)General requirement. A QHP issuer must process enrollment in accordance with this section.
(b)Enrollment through the Exchange for the individual market.
(1) A QHP issuer must enroll a qualified individual only if the Exchange—
(i) Notifies the QHP issuer that the individual is a qualified individual; and
(ii) Transmits information to the QHP issuer as provided in § 155.400(a) of this subchapter.
(2) If an applicant initiates enrollment directly with the QHP issuer for enrollment through the Exchange, the QHP issuer must either—
(i) Direct the individual to file an application with the Exchange in accordance with § 155.310, or
(ii) Ensure the applicant received an eligibility determination for coverage through the Exchange through the Exchange Internet Web site.
(c)Acceptance of enrollment information. A QHP issuer must accept enrollment information consistent with the privacy and security requirements established by the Exchange in accordance with § 155.260 and in an electronic format that is consistent with § 155.270.
(d)Premium payment. A QHP issuer must follow the premium payment process established by the Exchange in accordance with § 155.240.
(e)Enrollment information package. A QHP issuer must provide new enrollees an enrollment information package that is compliant with accessibility and readability standards established in § 155.230(b).
(f)Enrollment reconciliation. A QHP issuer must reconcile enrollment files with the Exchange no less than once a month in accordance with § 155.400(d).
(g)Enrollment acknowledgement. A QHP issuer must acknowledge receipt of enrollment information transmitted from the Exchange in accordance with Exchange standards established in accordance with § 155.400(b)(2) of this subchapter.
Title 45 published on 2014-10-01.
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