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Marketplace Components

Updated 03/12/2020

Frequently Asked Questions

  • No. Issuers may submit as many plans as it wants to offer.

  • Issuers may file new plans and pricing for the Marketplace on an annual basis. Each year a filing window will be established during which new plans and pricing may be filed, along with required binders. New plans for both the Individual and Small Group Marketplace filed within the filing window will have a January 1 effective date for the subsequent year. Individual plan pricing remains as filed for the year. Small Group plans may submit 2nd and/or 3rd/4th quarter adjustments. DIFS issues guidance for quarterly rate changes each year in the “What’s New” section of the DIFS website.

  • CMS determines in the method as required under 45 CFR 155.270.

  • CMS includes information regarding special enrollment in its annual Notice of Benefit and Payment Parameters.

  • Yes, the open enrollment period will either be an open enrollment for an individual plan to be offered on or off the Marketplace. If an HMO off the Marketplace decides to limit enrollment to open and specific enrollment periods, the enrollment period must mirror the enrollment period on the Marketplace.

    Subsection E, 45 CFR 155.410 and 155.420 explains enrollment in QHPs, a link in provided for your reference: 45 CFR 155.410. For individual QHPs offered through the Marketplace, issuers, including HMOs, must adhere to the initial and annual open enrollment periods as required under 45 CFR 155.410. The initial open enrollment period begins October 1, 2013, and extends through March 31, 2014. For benefit years beginning on or after January 1, 2015, the annual open enrollment period begins October 15 and extends through December 7 of the preceding calendar year. 45 CFR 155.420(d) provides nine events that would trigger eligibility for qualified individuals to enroll in QHPs during a special enrollment period outside of the established annual open enrollment period.

  • The federal regulation supersedes state law in the above scenario. States can maintain their laws if it does not interfere with the implementation of federal law. In this case, the federal grace period requirement supersedes the state prompt pay law.

  • Michigan has not taken action specifically related to curtailing adverse selection.

  • Signing the issuer agreements with CMS will commit the issuer to the Marketplace for those selected products. Up to the time of signing, the issuer can decide whether it wants to market its plans on the Marketplace. The issuer must have indicated, at the time of filing, that the plan was for both on and off the Marketplace.

  • No, an issuer may decide prior to signing the agreement whether they want to market the plan on the Marketplace. All pediatric dental plans are Marketplace-certified, regardless of the sales market.

  • As an FFM state, Michigan will follow the federal guidelines on application and enrollments in the FFM.  Please review the document below for further information.

    FFM Enrollment Operational Policy & Guidance.

The answers provided are not meant to be a substitute for legal advice.