---
kind: "section"
citation: "45 C.F.R. § 155.1020"
title: "45"
number: "155.1020"
heading: "QHP issuer rate and benefit information."
url: "https://uscodex.org/cfr/45/155.1020"
---

# §155.1020. QHP issuer rate and benefit information.

- (a) **Receipt and posting of rate increase justification.** The Exchange must ensure that a QHP issuer submits a justification for a rate increase for a QHP prior to the implementation of such an increase, except for multi-State plans, for which the U.S. Office of Personnel Management will provide a process for the submission of rate increase justifications. The Exchange must ensure that the QHP issuer has prominently posted the justification on its Web site as required under [§ 156.210](/cfr/45/156.210.md). To ensure consumer transparency, the Exchange must also provide access to the justification on its Internet Web site described in [§ 155.205(b)](/cfr/45/155.205.md?p=b).
- (b) **Rate increase consideration.**
  - (1) The Exchange must consider rate increases in accordance with section 1311(e)(2) of the Affordable Care Act, which includes consideration of the following:
    - (i) A justification for a rate increase prior to the implementation of the increase;
    - (ii) Recommendations provided to the Exchange by the State in accordance with section 2794(b)(1)(B) of the PHS Act; and
    - (iii) Any excess of rate growth outside the Exchange as compared to the rate of such growth inside the Exchange.
  - (2) This paragraph does not apply to multi-State plans for which the U.S. Office of Personnel Management will provide a process for rate increase consideration.
- (c) **Benefit and rate information.** The Exchange must receive the information described in this paragraph, at least annually, from QHP issuers for each QHP in a form and manner to be specified by HHS. Information about multi-State plans may be provided in a form and manner determined by the U.S. Office of Personnel Management. The information identified in this paragraph is:
  - (1) Rates;
  - (2) Covered benefits; and
  - (3) **Cost-sharing requirements.**

## Notes

### Amendments

[77 FR 18467, Mar. 27, 2012, as amended at 77 FR 31515, May 29, 2012]

### Source

Source: 77 FR 18467, Mar. 27, 2012, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 18021-18024, 18031-18033, 18041-18042, 18051, 18054, 18071, and 18081-18083.

### Source

Source: 77 FR 11718, Feb. 27, 2012, unless otherwise noted.

### Amendments

[77 FR 18467, Mar. 27, 2012, as amended at 77 FR 31515, May 29, 2012]