Plans and Benefits

All issuers are required to provide the following data on their health plans:
  • Plan identifiers
  • Plan attributes
  • Covered benefits and their limits
  • Cost-sharing information
Issuers enter these plan data in the Plans and Benefits Template, which consists of two worksheets: the benefits package worksheet and the cost share variances worksheet.

Issuers must also indicate essential health benefit (EHB) benchmark plan coverage requirements. To reflect these requirements, the Plans and Benefits Add-in file populates state- and market-specific EHB benchmark data in the benefits package worksheet.

Application Resources
  • Instructions
    • PY2024 QHP Issuer Application Instructions: Plans & Benefits (Coming soon!)
  • Template
    • PY2024 Plans & Benefits Template (Coming soon!)
    • PY2024 Plans & Benefits Add-In (Coming soon!)
    • PY2024 Standardized Plan Options Add-in (Coming soon!)

  • Justifications/Supporting Documents
    • PY2024 Discrimination Cost-Sharing Outlier: Supporting Documentation and Justification (Coming soon!)
    • PY2024 EHB-Substituted Benefit (Actuarial Equivalent) Supporting Documentation and Justification (Coming soon!)
    • PY2024 Unique Plan Design—Supporting Documentation and Justification (Coming soon!)

  • Frequently Asked Questions
  • Actuarial Value (AV) Calculator
    • 2024 Actuarial Value Calculator (Coming soon!)
      • The Actuarial Value Calculator User Guide is included in the first tab of the 2024 AV Calculator.
    • 2024 Actuarial Value Calculator Methodology (Coming soon!)
    • 2024 Actuarial Value Calculator Instructions (Coming soon!)

SBC Instructions and Template 

Authorized for use for plan or policy years that begin on or after January 1, 2021.

Issuers offering health insurance coverage on the Exchange must provide applicants, enrollees, and policyholders with an accurate Summary of Benefits and Coverage (SBC). Issuers are required to provide the SBC in a manner compliant with the standards set forth in 45 CFR 147.200, which implements section 2715 of the Public Health Service Act, as added by the Patient Protection and Affordable Care Act (PPACA). Specifically, issuers must fully comply with the requirements of § 147.200(a)(3), which requires issuers to “provide an SBC in the form, and in accordance with the instructions for completing the SBC, that are specified by the Secretary in guidance.” Instructions for completing the SBC are below.
Please refer to the Summary of Benefits and Coverage and Uniform Glossary section of the CCIIO website for additional information, including the approved SBC Template for issuers to use when completing their SBCs. Additional regulatory guidance related to SBCs can be found in the Draft 2024 Letter to Issuers.