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We’re putting patients first. We pledge to put patients first in all of our programs – Medicaid, Medicare, and the Health Insurance Exchanges. To do this, we must empower patients to work with their doctors and make health care decisions that are best for them. This means giving them meaningful

Actived: Sunday Aug 16, 2020

URL: https://www.cms.gov/

Insurance Programs | CMS

Details: Insurance Programs The Affordable Care Act calls for the establishment of the Consumer Operated and Oriented Plan (CO-OP) Program, which will foster the creation of qualified nonprofit health insurance issuers to offer competitive health plans in the individual and small group markets.

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› Url: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Insurance-Programs Go Now

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Home - Centers for Medicare & Medicaid Services | CMS

Details: We’re putting patients first. We pledge to put patients first in all of our programs – Medicaid, Medicare, and the Health Insurance Exchanges. To do this, we must empower patients to work with their doctors and make health care decisions that are best for them. This means giving them meaningful

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› Url: https://www.cms.gov/ Go Now

› Get more:  Medicare,  HealthGo Now

Health Insurance Marketplaces | CMS

Details: The Affordable Care Act helps create a competitive private health insurance market through the creation of Health Insurance Marketplaces. These State-based, competitive marketplaces provide millions of Americans and small businesses with "one-stop shopping" for affordable coverage.

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› Url: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces Go Now

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Consumer Assistance Program | CMS

Details: Many states offer help to consumers with health insurance problems through Consumer Assistance Programs* (CAPs). Through a federal grant, many States have established CAPs in order to better assist consumers experiencing problems with their health insurance or seeking to learn about health coverage options. State CAPs offer direct assistance by phone, direct mail, email, or walk-in locations

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› Url: https://www.cms.gov/CCIIO/Resources/Consumer-Assistance-Grants Go Now

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Health Reimbursement Arrangements | CMS

Details: Among other medical care expenses, individual coverage HRAs can be used to reimburse premiums for individual health insurance chosen by the employee, promoting employee and employer flexibility, while also maintaining the same tax-favored status for employer contributions towards a traditional group health plan.

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› Url: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/Health-Reimbursement-Arrangements Go Now

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Consumer Information and Insurance Oversight | CMS

Details: Ensuring the Affordable Care Act Serves the American People The Center for Consumer Information and Insurance Oversight (CCIIO) is charged with helping implement many reforms of the Affordable Care Act, the historic health reform bill that was signed into law March 23, 2010. CCIIO oversees the implementation of the provisions related to private health insurance.

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› Url: https://www.cms.gov/CCIIO Go Now

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Mandatory Insurer Reporting for Group Health Plans (GHP) | CMS

Details: Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) added mandatory reporting requirements with respect to Medicare beneficiaries who have coverage under group health plan (GHP) arrangements as well as for Medicare beneficiaries who receive settlements, judgments, awards, or other payment from liability insurance (including self-insurance), no-fault insurance, or

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› Url: https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Group-Health-Plans/Overview Go Now

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Mandatory Insurer Reporting (NGHP) | CMS

Details: Mandatory Insurer Reporting for Non-Group Health Plans (NGHP) Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) added mandatory reporting requirements with respect to Medicare beneficiaries who have coverage under group health plan (GHP) arrangements as well as for Medicare beneficiaries who receive settlements, judgments, awards or other payment from liability

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› Url: https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Non-Group-Health-Plans/Overview Go Now

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CMS-43 | CMS

Details: Application for Hospital Insurance Benefits for Individuals with End Stage Renal Disease. Downloads. CMS-43 (ZIP) Home. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 7500 Security Boulevard, Baltimore, MD 21244. CMS & HHS Websites [CMS Global Footer]

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› Url: https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS-43 Go Now

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Positions at CMS | CMS

Details: Headquarters. Health Insurance Specialists develop, interpret and implement health care financing policy and affect the disbursement of billions of dollars each year. Among other things, they also analyze Medicare and Medicaid policies, identify trends in health care utilization, study the private health insurance industry, and participate in inspections and program evaluations.

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› Url: https://www.cms.gov/About-CMS/Career-Information/CareersatCMS/Positions Go Now

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Self-Funded, Non-Federal Governmental Plans | CMS

Details: Non-Federal governmental plans are not regulated the same way as insurance companies or private employer health plans. The statutory framework for enforcement of non-Federal governmental plans was established in Part A of title XXVII of the PHS Act with the enactment of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

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› Url: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/nonfedgovplans Go Now

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Liability, No-Fault and Workers’ Compensation Reporting | CMS

Details: Liability insurance (including self-insurance) is coverage that protects the policyholder or self-insured entity against claims based on negligence, inappropriate action, or inaction that results in bodily injury or damage to property. Liability insurance includes, but is not limited to, the following: Homeowners’ liability insurance

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› Url: https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Beneficiary-Services/Liability-No-Fault-and-Workers-Compensation-Reporting/Liability-No-Fault-and-Workers-Compensation-Reporting Go Now

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Reporting Other Health Insurance | CMS

Details: The insurance that pays second is called the secondary payer. The secondary payer only pays if there are costs the primary insurer didn't cover. The Medicare Coordination of Benefits (COB) program wants to make sure Medicare pays your claims right the first time, every time. The Benefits Coordination & Recovery Center (BCRC) collects

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› Url: https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Beneficiary-Services/Reporting-Other-GHP-Insurance/Reporting-Other-Health-Insurance Go Now

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General Resources | CMS

Details: This page contains a dynamic list of resources that provide helpful information for agents and brokers as well as web-brokers who enroll consumers in the Health Insurance Marketplace and small employers in Small Business Health Options Program (SHOP) health insurance. This list includes guidance, regulations, newsletters, previous webinar slides, quick reference guides, and more.

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› Url: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/General-Resources Go Now

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How Health Coverage Affects Your 2020 Taxes

Details: individual health insurance mandate in 2020 and you didn’t have qualifying coverage (or an exemption), you’ll be charged a fee when you file your 2020 state taxes, but not your federal taxes. Check with your state’s tax department or your tax preparer to find out if there’s a fee for not having health coverage.

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› Url: https://www.get-insurance-quotes.net Go Now

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APPLICATION FOR ENROLLMENT IN MEDICARE PART B (MEDICAL

Details: application is to sign up to get medical insurance under Medicare. If you don’t have Part A and want to sign up, please contact Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. 3. Name: Write your name as you did when you applied for Social Security or Medicare. List last name, first name and

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Medical Loss Ratio | CMS

Details: Many insurance companies spend a substantial portion of consumers’ premium dollars on administrative costs and profits, including executive salaries, overhead, and marketing. The Affordable Care Act requires health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement, also

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› Url: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/Medical-Loss-Ratio Go Now

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Reporting a Case | CMS

Details: Liability Insurance (Including Self-Insurance): Exposure, Ingestion, and Implantation Issues and December 5, 1980. Medicare has consistently applied the Medicare Secondary Payer (MSP) provision for liability insurance (including self-insurance) effective 12/5/1980.

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› Url: https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Attorney-Services/Reporting-a-Case/Reporting-a-Case Go Now

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Thank Obamacare for the Rise of the Uninsured | CMS

Details: Thank Obamacare for the Rise of the Uninsured The U.S. Census Bureau released their annual report on health insurance coverage in the United States which shows the number of uninsured Americans rose from 2017 to 2018. As usual, critics of President Trump have been quick to blame the Administration’s healthcare policies for this increase.

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› Url: https://www.cms.gov/blog/thank-obamacare-rise-uninsured Go Now

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Medicare Advantage Value-Based Insurance Design Model

Details: Through the Medicare Advantage Value-Based Insurance Design (VBID) Model, CMS is testing a broad array of complementary Medicare Advantage (MA) health plan innovations designed to reduce Medicare program expenditures, enhance the quality of care for Medicare beneficiaries, including those with low incomes such as dual-eligibles, and improve the

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› Url: https://innovation.cms.gov/innovation-models/vbid Go Now

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Eligibility Inquiry | CMS

Details: CMS offers an X12 270/271 Eligibility System (HETS 270/271). The HIPAA Eligibility Transaction System (HETS) is intended to allow the release of eligibility data to Medicare Providers, Suppliers, or their authorized billing agents for the purpose of preparing an accurate Medicare claim, determining Beneficiary liability or determining eligibility for specific services.

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› Url: https://www.cms.gov/Medicare/Billing/ElectronicBillingEDITrans/Eligibility Go Now

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Creditable Coverage | CMS

Details: The Medicare Modernization Act (MMA) requires entities (whose policies include prescription drug coverage) to notify Medicare eligible policyholders whether their prescription drug coverage is creditable coverage, which means that the coverage is expected to pay on average as much as the standard Medicare prescription drug coverage.

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› Url: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/CreditableCoverage Go Now

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Newborns' and Mothers' Health Protection Act (NMHPA) | CMS

Details: The Newborns' and Mothers' Health Protection Act of 1996 (NMHPA) is a federal law that affects the length of time a mother and newborn child are covered for a hospital stay in connection with childbirth. In general, group health plans and health insurance issuers that are subject to NMHPA may NOT restrict benefits for a hospital stay in connection with childbirth to less than 48 hours

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› Url: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/nmhpa_factsheet Go Now

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Health Insurance Market Reforms | CMS

Details: The Affordable Care Act includes a number of provisions that reform the health insurance market. These reforms work to put American consumers back in charge of their health coverage and care, ensuring they receive value for their premium dollars. The law creates a more level playing field by cracking down on unreasonable health insurance premiums and holding insurance companies accountable for

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› Url: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms Go Now

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Guide to Confirming your Income Information

Details: The Health Insurance Marketplace uses annual household income along with other information to decide if you qualify for help paying for health coverage through the Marketplace, like . premium tax credits and plans with lower copayments, coinsurance, and deductibles.

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› Url: https://www.get-insurance-quotes.net Go Now

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Medicare Benefit Policy Manual - CMS

Details: Hospice care is a benefit under the hospital insurance program. To be eligible to elect hospice care under Medicare, an individual must be entitled to Part A of Medicare and be certified as being terminally ill. An individual is considered to be terminally ill if the

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Transitioning from Medicaid Coverage to Other Health Coverage

Details: Department of Insurance. 17 Consumers with Me dicare can see any Medicare provider and may be able to continue seeing their preferred provider under Medicaid if that provider is also a Medicare provider . To find a Medicare provider, consumers can use th e following search tool :

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Compliance and Enforcement | CMS

Details: Ensuring Compliance with the Health Insurance Market Reforms Title XXVII of the Public Health Service Act (PHS Act) contemplates that states will exercise primary enforcement authority over health insurance issuers in the group and individual markets to ensure compliance with health insurance market reforms.

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› Url: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/compliance Go Now

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Student Health Plans | CMS

Details: Individual Health Insurance Coverage The Department of Health and Human Services (HHS) has issued a proposed regulation that would ensure students enrolled in these plans benefit from important consumer protections created by the Affordable Care Act. The proposed regulations clarify that these plans would be defined as “individual health

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› Url: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/Student-Health-Plans Go Now

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Plan Year 2021 Registration and Training | CMS

Details: For plan year 2021, training is offered by America's Health Insurance Plans, Inc. (AHIP). This vendor may charge a fee to participate in training and is required to offer CEU credits in a minimum of five states where the Marketplace operates. These CEUs can be used to meet state licensure requirements for continuing education.

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› Url: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/Plan-Year-2021-Registration-and-Training Go Now

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Value-Based Insurance Design Model (VBID) Fact Sheet CY

Details: Value-Based Insurance Design by Condition, Socioeconomic Status, or both. Non-uniform benefit design to provide reduced cost-sharing or additional supplemental benefits for enrollees based on condition and/or certain socioeconomic (i.e. low-income subsidy eligibility or dual-eligible) status

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› Url: https://www.cms.gov/newsroom/fact-sheets/value-based-insurance-design-model-vbid-fact-sheet-cy-2020 Go Now

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Summary of Benefits & Coverage & Uniform Glossary | CMS

Details: Under the Affordable Care Act, health insurers and group health plans will provide the 180 million Americans who have private insurance with clear, consistent and comparable information about their health plan benefits and coverage. Specifically, the regulations will ensure consumers have access to two forms that will help them understand and evaluate their health insurance choices.

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Medicare and the Marketplace | CMS

Details: The Relationship between Medicare and the Health Insurance Marketplace This page contains a downloadable document listing frequently asked questions (FAQs) regarding the relationship between Medicare and the Health Insurance Marketplace. Topics include: general enrollment, End Stage Renal Disease (ERSD), and coordination of benefits.

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› Url: https://www.cms.gov/Medicare/Eligibility-and-Enrollment/Medicare-and-the-Marketplace/Overview1 Go Now

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Medicare Secondary Payer (MSP) Liability Insurance, No

Details: insurance which is defined by statute as follows: “An entity that engages in a business, trade, or profession shall be deemed to have a self-insured plan if it carries its own risk (whether by a failure to obtain insurance, or otherwise) in whole or in part.”

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Women's Health and Cancer Rights Act (WHCRA) | CMS

Details: Health insurance sold to individuals (not through employment) is primarily regulated by State insurance departments. WHCRA requires group health plans and health insurance companies (including HMOs), to notify individuals regarding coverage required under the law. Notice about the availability of these mastectomy-related benefits must be given:

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› Url: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/whcra_factsheet Go Now

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Glossary of Health Coverage and Medical Terms

Details: insurance or plan has a “tiered” network and you must pay extra to see some providers. Out-of-network Co-insurance . The percent (for example, 40%) you pay of the allowed amount for covered health care services to providers who do not contract with your health insurance or plan. Out-of-network co-insurance usually costs you more than in-

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CMS' Value-Based Programs | CMS

Details: What are the value-based programs? Value-based programs reward health care providers with incentive payments for the quality of care they give to people with Medicare. These programs are part of our larger quality strategy to reform how health care is delivered and paid for. Value-based programs also support our three-part aim:

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The Transitional Reinsurance Program - Reinsurance

Details: March 24, 2020 FAQs on Availability and Usage of Telehealth Services through Private Health Insurance Coverage in Response to Coronavirus Disease 2019 (COVID-19) March 24, 2020 Payment and Grace Period Flexibilities Associated with the COVID-19 National Emergency

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Agent Broker Compensation | CMS

Details: Below is a link to a file containing the amounts that companies pay independent agents/brokers to sell their Medicare drug and health plans. Companies that contract with Medicare to provide health care coverage or prescription drugs typically use agents/brokers to sell their Medicare plans to Medicare beneficiaries.

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› Url: https://www.cms.gov/Medicare/Health-Plans/ManagedCareMarketing/AgentBroker Go Now

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Help On Demand for Agents and Brokers | CMS

Details: Help On Demand is a consumer assistance referral system that connects consumers seeking assistance with Marketplace-registered, state-licensed agents and brokers in their area who can provide immediate assistance with Marketplace plans and enrollments.Help On Demand is a CMS-contracted service developed and hosted by Help On Demand (formerly known as BigWave Systems).

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› Url: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/Help-On-Demand-for-Agents-and-Brokers Go Now

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Michigan Geographic Rating Areas: Including State Specific

Details: March 24, 2020 FAQs on Availability and Usage of Telehealth Services through Private Health Insurance Coverage in Response to Coronavirus Disease 2019 (COVID-19) March 24, 2020 Payment and Grace Period Flexibilities Associated with the COVID-19 National Emergency

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› Url: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/mi-gra Go Now

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COBRA Continuation Coverage Questions and Answers | CMS

Details: March 24, 2020 FAQs on Availability and Usage of Telehealth Services through Private Health Insurance Coverage in Response to Coronavirus Disease 2019 (COVID-19) March 24, 2020 Payment and Grace Period Flexibilities Associated with the COVID-19 National Emergency

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› Url: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/cobra_qna Go Now

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Young Adults and the Affordable Care Act: Protecting Young

Details: You should ask your parents’ employer, or your State Insurance Department if this applies, and if so, how you would request the extended coverage. You may be eligible for special enrollment in individual coverage purchased through the Health Insurance Marketplace. To special enroll in Marketplace coverage, you must enroll within 60 days of

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› Url: https://www.cms.gov/CCIIO/Resources/Files/adult_child_faq Go Now

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FEDERAL HEALTH INSURANCE EXCHANGE 2021 OPEN ENROLLMENT | CMS

Details: The Federal Health Insurance Exchange (also known as the Marketplace) Open Enrollment Period runs from November 1, 2020 to December 15, 2020, for coverage starting on January 1, 2021. Similar to previous years, the Centers for Medicare & Medicaid Services (CMS) is taking a strategic and cost-effective approach to inform individuals about Open Enrollment, deliver a smooth enrollment experience

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› Url: https://www.cms.gov/newsroom/fact-sheets/federal-health-insurance-exchange-2021-open-enrollment Go Now

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Illinois Geographic Rating Areas: Including State Specific

Details: March 24, 2020 FAQs on Availability and Usage of Telehealth Services through Private Health Insurance Coverage in Response to Coronavirus Disease 2019 (COVID-19) March 24, 2020 Payment and Grace Period Flexibilities Associated with the COVID-19 National Emergency

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› Url: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/il-gra Go Now

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Market Rating Reforms | CMS

Details: The Affordable Care Act limits the factors that can be used to charge consumers greater health insurance premiums. For insurance coverage effective January 1, 2014, health insurance issuers in the individual and small group markets are allowed to vary premiums based on age (within a 3:1 ratio for adults), tobacco use (within a 1.5:1 ratio and subject to wellness program requirements in the

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Marketplace Application Checklist

Details: When you apply for or re-enroll in your Health Insurance Marketplace coverage, you’ll need to provide some information about you and your household. Use this checklist to help you gather what you need. Information about your household size. Figure out who in your household will apply together before you start your application. Visit

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COBRA Continuation Coverage | CMS

Details: The special enrollment right is provided by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and permits an individual who loses group health plan or health insurance coverage to enroll in a spouse's plan without having to wait for an open enrollment period. If a group health plan provided by a spouse's employer is

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