QHP Agreement

Issuers offering QHPs or stand-alone dental plans (SADPs) in the Federally-facilitated Exchanges (FFEs), including issuers in states performing plan management functions, must sign and submit a QHP Certification Agreement and Privacy and Security Agreement (the QHP Certification Agreement) and a Senior Officer Acknowledgement. Off-Exchange only SADP issuers do not sign the QHP Certification Agreement.

  • The QHP Certification Agreement includes provisions for safeguarding plan and participant privacy and standards for issuer testing before Open Enrollment starts. The agreement must be signed by an officer of the legal entity who has legal authority to contractually bind the issuer.
  • The Senior Officer Acknowledgment confirms that a senior officer of the issuer has knowledge of the content of the issuer’s plans, as well as the content of the completed attestations and the Letter to Issuers.
  • When executing these documents, issuers should use the same legal entity information listed in the Health Insurance Oversight System (HIOS) under the Issuer General Information section.

Once CMS receives an accurate and complete QHP Certification Agreement and Senior Officer Acknowledgment, they will sign and return the QHP Certification Agreement to issuers with a final list of certified QHPs. The documents will apply to all QHPs offered by a single issuer in an FFE at the HIOS Issuer ID level or designee company. Receipt of a QHP Certification Agreement with CMS signature and final validated plan list completes the certification process for the upcoming plan year.

CMS will not return the Senior Officer Acknowledgement.