Annual Eligibility Redetermination, Product Discontinuation and Renewal Notices (CMS-10527)

The final rule "Patient Protection and Affordable Care Act; Annual Eligibility Redeterminations for Exchange Participation and Insurance Affordability Programs; Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to Exchanges", provides that a Marketplace may choose to conduct the annual redetermination process for a plan year (1) in accordance with the existing procedures described in 45 CFR 155.335; (2) in accordance with procedures described in guidance issued by the Secretary for the coverage year; or (3) using an alternative proposed by the Marketplace and approved by the Secretary. The guidance document "Guidance on Annual Redeterminations for Coverage for 2015" contains the procedures that the Secretary is specifying for the 2015 coverage year, as noted in (2) above. These procedures will be adopted by the Federally-facilitated Marketplace. Under this option, the Marketplace will provide three notices. The final rule also amends the requirements for product renewal and re-enrollment (or nonrenewal) notices to be sent by Qualified Health Plan (QHP) issuers in the Exchanges and specifies content for these notices. The accompanying guidance document "Form and Manner of Notices When Discontinuing or Renewing a Product in the Group or Individual Market" provides standard notices for product discontinuation and renewal to be sent by issuers of QHPs and issuers in the individual market. Issuers in the small group market may use the draft Federal standard small group notices released in the June 26, 2014 bulletin "Draft Standard Notices When Discontinuing or Renewing a Product in the Small Group or Individual Market", or any forms of the notice otherwise permitted by applicable laws and regulations. States that are enforcing the Affordable Care Act may develop their own standard notices, for product discontinuances, renewals, or both, provided the State-developed notices are at least as protective as the Federal standard notices.

The latest form for Annual Eligibility Redetermination, Product Discontinuation and Renewal Notices (CMS-10527) expires 2023-04-30 and can be found here.

Product Renewal and Discontinuance Notice for QHP Issuers

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