This document has been updated with the latest rules and input from our federal partner agencies
including the Office of Health & Human Services (OHHS) and the Center for Medicare and Medicaid
Services (CMS).
General topics addressed in the Policy Manual include:
  • Eligibility determinations for qualified health plans (QHP) & Medicaid
  • Eligibility for Advanced Premium Tax Credits (APTCs) and Cost Sharing Reductions (CSRs)
  • Enrollment & disenrollment policies
  • Billing, late payment & termination policies
  • Customer account creation & maintenance policies

This final version was informed by feedback collected during a two week open comment period in late August and early September. Thank you to everyone who reviewed and improved this document.