Annual Eligibility Redetermination, Product Discontinuation and Renewal Notices (CMS-10527)

ICR 202506-0938-018

OMB: 0938-1254

Federal Form Document

ICR Details
0938-1254 202506-0938-018
Received in OIRA 202504-0938-012
HHS/CMS CCIIO
Annual Eligibility Redetermination, Product Discontinuation and Renewal Notices (CMS-10527)
Revision of a currently approved collection   No
Regular 07/01/2025
  Requested Previously Approved
36 Months From Approved 06/30/2026
5,397 5,881
66,091 72,002
0 0

The final rule "Patient Protection and Affordable Care Act; Annual Eligibility Redeterminations for Exchange Participation and Insurance Affordability Programs; Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to Exchanges", provides that a Marketplace may choose to conduct the annual redetermination process for a plan year (1) in accordance with the existing procedures described in 45 CFR 155.335; (2) in accordance with procedures described in guidance issued by the Secretary for the coverage year; or (3) using an alternative proposed by the Marketplace and approved by the Secretary. The guidance document "Guidance on Annual Redeterminations for Coverage for 2015" contains the procedures that the Secretary is specifying for the 2015 coverage year, as noted in (2) above. These procedures will be adopted by the Federally-facilitated Marketplace. Under this option, the Marketplace will provide three notices. The final rule also amends the requirements for product renewal and re-enrollment (or nonrenewal) notices to be sent by Qualified Health Plan (QHP) issuers in the Exchanges and specifies content for these notices. The accompanying guidance document "Form and Manner of Notices When Discontinuing or Renewing a Product in the Group or Individual Market" provides standard notices for product discontinuation and renewal to be sent by issuers of QHPs and issuers in the individual market. Issuers in the small group market may use the draft Federal standard small group notices released in the June 26, 2014 bulletin "Draft Standard Notices When Discontinuing or Renewing a Product in the Small Group or Individual Market", or any forms of the notice otherwise permitted by applicable laws and regulations. States that are enforcing the Affordable Care Act may develop their own standard notices, for product discontinuances, renewals, or both, provided the State-developed notices are at least as protective as the Federal standard notices.

PL: Pub.L. 111 - 148 1411(f)(1)(B) Name of Law: Affordable Care Act
  
PL: Pub.L. 111 - 148 Section 1411(f)(1)(B) Name of Law: Affordable Care Act

0938-AV61 Final or interim final rulemaking 90 FR 27074 06/25/2025

No

  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 5,397 5,881 0 0 -484 0
Annual Time Burden (Hours) 66,091 72,002 0 0 -5,911 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
The burden for individual market QHP issuers has increased by approximately 423.5 hours (from 12,820.5 to 13,244) due to an increase in the estimated number of QHP issuers (from 333 to 344). The burden for issuers in the individual market outside the Exchange and issuers in the small group market has decreased by 6,335 hours (from 59,326 to 52,992) due to a decrease in the estimated number of issuers in those markets (from 1,340 to 1,206). In total, there is a reduction in burden by approximately 5,911 hours.

$0
No
    No
    No
Yes
No
No
No
Jamaa Hill 301 492-4190

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
07/01/2025


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