THE AFFORDABLE CARE ACT. Professor Leonard J. Nelson, III. OVERVIEW OF AFFORDABLE CARE ACT . Insurance Exchanges Essential Benefits Benefit Tiers “Three Legged Stool” Individual Mandate Insurance Reforms Premium Subsidies. Employer Responsibilities Grandfathered Plans
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“ The Secretary shall require an Exchange to provide for—
(A) an initial open enrollment… (B) annual open enrollment periods, as determined by the Secretary for calendar years after the initial enrollment period;(C) special enrollment periods specified in section 9801 of the Internal Revenue Code of 1986 and other special enrollment periods under circumstance similar to such periods under part D of title XVIII of the Social Security Act…”
§ 155.410 Initial and annual open enrollment periods.
(a) General requirements.
(1) The Exchange must provide an initial open enrollment period and annual open enrollment periods consistent with this section, during which qualified individuals may enroll in a QHP or enrollees may change QHPs.
(2) The Exchange may only permit a qualified individual to enroll in a QHP or an enrollee to change QHPs during the initial open enrollment period specified in paragraph (b) of this section, the annual open enrollment period specified in paragraph (e) of this section, or a special enrollment period described in § 155.420 of this subpart for which the qualified individual or enrollee has been determined eligible.
If states choose not to select a benchmark, HHS intends to propose that the default benchmark will be the small group plan with the largest enrollment in the state.
The benefits and services included in the benchmark health insurance plan selected by the state would be the essential health benefits package. Plans could modify coverage within a benefit category so long as they do not reduce the value of coverage.”