Non-Standardized Plan Option Limit Exception Justification Form (CMS-10878)

Section 1311(c)(1) of the ACA directs the Secretary to establish criteria for the certification of health plans as qualified health plans (QHPs). Section 1321(a)(1)(B) of the ACA directs the Secretary to issue regulations that set standards for meeting the requirements of title I of the ACA for, among other things, the offering of QHPs through such Exchanges. In the HHS Notice of Benefit and Payment Parameters for 2024 Final Rule (2024 Payment Notice Final Rule), HHS exercised its authority under Sections 1311(c)(1) and 1321(a)(1)(B) of the ACA to limit the number of non-standardized plan options that issuers of QHPs can offer through Exchanges on the Federal platform, including both through Federally-facilitated Exchanges (FFEs) and State-Based Exchanges on the Federal platform (SBE-FPs), to four non-standardized plan options per product network type (as described in the definition of “product” at 45 C.F.R. 144.103), metal level (excluding catastrophic plans), inclusion of dental and/or vision benefit coverage, and service area for plan year (PY) 2024, and two for PY 2025 and subsequent plan years. This information collection request (ICR) serves as the formal request for a new information collection clearance associated with the HHS Notice of Benefit and Payment Parameters for 2025 Proposed Rule (2025 Payment Notice Proposed Rule) regarding the authority to allow HHS to collect the necessary information to enable QHP issuers to seek to be excepted from the non-standardized plan option limit of two per product network type, metal level, inclusion of dental and/or vision benefit coverage, and service area for PY 2025 and subsequent years, if they so choose.

The latest form for Non-Standardized Plan Option Limit Exception Justification Form (CMS-10878) expires 2027-07-31 and can be found here.