Covered California Certification of Qualified Health Plans

Introduction

Soon after the passage of national health care reform through the Patient Protection and Affordable Care Act of 2010 (ACA), California enacted legislation to establish a qualified health benefit exchange. (California Government Code § 100500 et seq.) The California state law is referred to as the California Patient Protection and Affordable Care Act (CA-ACA).

The Exchange offers a statewide health insurance marketplace to make it easier for individuals and small businesses to compare plans and buy affordable, high quality health insurance in the private market. Health and Dental issuers interested in participating in the Exchange are encouraged to review the application and model contract for issuer participation requirements. Interested issuers must apply for certification and be selected by the Exchange in order to participate.

Application Evaluation and Selection

The evaluation of QHP Certification Applications is not based on a single, strict formula; instead, the evaluation will consider the mix of health plans for each region of California that best meet the needs of consumers in that region and the Exchange's goals. The Exchange strives to provide an appropriate range of high quality health plans to participants in the individual and small group markets at the best available price that is balanced with the need for consumer stability and long-term affordability. In consideration of the mission and values of the Exchange, the Board of the Exchange articulated guidelines for the selection and oversight of Qualified Health Plans which are used when reviewing the Applications. These guidelines are:

  • Promote affordability for the consumer– both in terms of premium and at point of care
  • Encourage "Value" Competition Based upon Quality, Service, and Price
  • Encourage Competition Based upon Meaningful QHP Choice and Product Differentiation: Patient-Centered Benefit Plan Designs
  • Encourage Competition throughout the State
  • Encourage Alignment with Providers and Delivery Systems that Serve the Low-Income Population
  • Encourage Delivery System Improvement, Effective Prevention Programs and Payment Reform
  • Demonstrate Administrative Capability and Financial Solvency
  • Encourage Robust Customer Service

Qualified Health Plan Certification Application for Plan Year 2020 Individual Marketplace

Covered California will accept Letters of Intent to Apply until 5:00pm PT February 15, 2019. Interested applicants must use template provided. Letters of Intent are nonbinding but are required to obtain access to the electronic application submission portal. Questions and comments can be submitted to QHPCertification@covered.ca.gov.


Qualified Dental Plan Certification Application for Plan Year 2020 Individual Marketplace

Covered California will accept Letters of Intent to Apply until 5:00pm PT February 15, 2019. Interested applicants must use template provided. Letters of Intent are nonbinding but are required to obtain access to the electronic application submission portal. Questions and comments can be submitted to QHPCertification@covered.ca.gov.


Qualified Health Plan Certification Application for Plan Year 2020 Covered California Small Business Marketplace

Covered California will accept Letters of Intent to Apply until 5:00pm PT by the following dates for the applicable Quarter:

Quarter Currently Contracted CCSB Applicant Currently Contracted Individual-New CCSB Entrant Applicant New Entrant Applicant
Quarter 1 February 15, 2019 February 15, 2019 February 15, 2019
Quarter 2 October 18, 2019 August 16, 2019 August 16, 2019
Quarter 3 February 7, 2020 November 15, 2019 November 15, 2019
Quarter 4 May 8, 2020 February 14, 2020 February 14, 2020

Interested applicants must use template provided. Letters of Intent are nonbinding but are required to obtain access to the electronic application submission portal. Questions and comments can be submitted to QHPCertification@covered.ca.gov.


Qualified Dental Plan Certification Application for Plan Year 2020 Covered California Small Business Marketplace

Covered California will accept Letters of Intent to Apply until 5:00pm PT February 15, 2019. Interested applicants must use template provided. Letters of Intent are nonbinding but are required to obtain access to the electronic application submission portal. Questions and comments can be submitted to QHPCertification@covered.ca.gov.


January 15, 2019: UPDATED Draft 2020 Qualified Health Plan and Qualified Dental Plan Certification Application Individual Marketplace

Covered California has updated the draft QHP and QDP Individual Applications reflecting changes from Public Comment. Applicants will ultimately complete the applications electronically and questions will populate based on Applicant type (currently contracted QHP Issuer or New Entrant Applicant) as indicated in application documents.


January 15, 2019: UPDATED Draft 2020 Qualified Health Plan and Qualified Dental Plan Applications Covered California for Small Business Marketplace

Covered California has updated the draft QHP and QDP Small Business Applications reflecting changes from Public Comment. Applicants will ultimately complete the applications electronically and questions will populate based on Applicant type (currently contracted QHP Issuer or New Entrant Applicant) as indicated in application documents.


December 24, 2018: Draft 2020 Qualified Health Plan Certification Application - Individual Marketplace and Small Business Marketplace

Covered California is accepting comments on the draft QHP Certification Application for Sections 18 and 19 until close of business Monday, January 7, 2019 . Please use the comment template and submit to QHPCertification@covered.ca.gov. Please note, Applicants will ultimately complete the applications electronically and questions will populate based on Applicant type (currently contracted QHP Issuer or New Entrant Applicant) as indicated in application documents.

Please note: Throughout Sections 18 and 19, Covered California has worked to revise questions for clarity and simplicity and to reflect the evolution of the current Attachment 7 multi-year efforts and expectations. Given the approved one year contract extension, Covered California is recommending additional questions in Section 18 (Quality) of the 2020 QHP Certification Application for currently contracted Applicants.


December 17, 2019: Draft 2020 Qualified Health Plan and Qualified Dental Plan Certification Application Individual Marketplace

Covered California is accepting comments on the draft QHP Certification Application until close of business Monday, December 31, 2018 . Please use the comment template and submit to QHPCertification@covered.ca.gov. Please note, Applicants will ultimately complete the applications electronically and questions will populate based on Applicant type (currently contracted QHP Issuer or New Entrant Applicant) as indicated in application documents.

Please note: Section 18 (Quality) and Section 19 (Quality Improvement Strategy) are under review. Updated draft applications with edits to Sections 18 and 19 are forthcoming for review and public comment.


December 17, 2019: Draft 2020 Qualified Health Plan and Qualified Dental Plan Applications Covered California for Small Business Marketplace

Covered California is accepting comments on the draft QHP and QDP CCSB Certification Applications until close of business Monday, December 31, 2018. Please use the comment template and submit to QHPCertification@covered.ca.gov. Please note, Applicants will ultimately complete the applications electronically and questions will populate based on Applicant type (currently contracted QHP Issuer or New Entrant Applicant) as indicated in application documents.

Please note: Section 18 (Quality) and Section 19 (Quality Improvement Strategy) are under review. Updated draft applications with edits to Sections 18 and 19 are forthcoming for review and public comment.


Qualified Health Plan Quarterly Certification Application for Plan Year 2019 Covered California Small Business Marketplace

Interested applicants must use template provided. Letters of Intent (LOI) are nonbinding, but are required to obtain access to the electronic application submission portal. Covered California for Small Business Applicants must submit an LOI and a Plan Year 2019 CCSB QHP Quarterly Certification Application by the date designated in the Application for the appropriate quarter. Questions and comments can be submitted to QHPCertification@covered.ca.gov.

Intent to Apply 2019 Quarterly QHP Covered California for Small Business

Covered California Confidentiality Agreement

Application

Attachments & Appendices