Service Area

Issuers must identify the proposed service areas that will be associated with their QHPs, by state and by county. In most cases, HHS will only approve service areas covering full counties. In instances when the issuer proposes a service area that will cover only part of a county, the service area must also indicate associated zip codes. All issuers are required to submit service area information as part of their QHP Application.

Key Changes for PY2022:
  • You must create separate service area IDs for your Individual market service areas and your Small Business Health Options Program (SHOP) market service areas. If you submit via the National Association of Insurance Commissioners’ (NAIC’s) System for Electronic Rates & Forms Filing (SERFF) you must use the same Service Area Template across all binders or ensure that no service area IDs repeat across the binders.

Tips for the Service Area Section

  • You may not change a service area after the initial submission deadline unless you submit a data change request to do so and make this change during the timeframe CMS has specified. This applies even if you submit via SERFF and make the change in response to an error issued by the state. See the Service Area Data Change Request Process in the Review Periods, Revision Process, and Certification section for more information. 
  • If you are a dual-product issuer, you must create two different service area IDs, one each for QHPs and SADPs, regardless of whether the service area is intended to serve both plan types. 
  • If you are a dual-product issuer, you must use the word “dental” in the service area name for your dental service area to distinguish the dental service area from the QHP service area.
  • If you offer plans in the Individual and SHOP markets, you must create separate service area IDs for each market, regardless of whether the service area is intended to serve both markets.
Application Resources

Service Area Data Change Request

For information about submitting a service area data change request, including the requisite documentation, please refer to the Data Change Windows page.

HPSA Zip Code Listing

HHS periodically designates health professional shortage areas (HPSAs). Areas must fulfill 3 criteria to receive HPSA designation:
  1. The geographic area involved must be rational for the delivery of health services;
  2. A specified population-to-practitioner ratio representing shortage must be exceeded within the area; and
  3. Resources in contiguous areas must be shown to be overutilized, excessively distant, or otherwise inaccessible.
The latest list of HPSA zip codes is below.