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 2022 Individual Marketplace

Covered California will accept Letters of Intent to Apply until 5:00 pm PST February 12, 2021. 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.

Prospective Applicants may request the draft Actuarial Value (AV) Calculator screenshots for the proposed 2022 plan designs to proceed with pricing and product design for the 2022 plan year. Please email QHPCertification@covered.ca.gov with “AV Calculator” in the subject line.

Qualified Dental Plan Certification Application for Plan Year 2022 Individual Marketplace

Covered California will accept Letters of Intent to Apply until 5:00 pm PST February 12, 2021. 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 2022 Covered California Small Business Marketplace

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

Due dates for Currently Contracted Small Business Applicant: Due dates for Currently Contracted Individual-New Small Business Entrant Applicant: Due dates for New Entrant Applicant
Letter of Intent (LOI) due to Covered California
  • Q1: February 12, 2021
  • Q2: June 1, 2021
  • Q3: September 1, 2021
  • Q4: December 1, 2021
  • Q1: February 12, 2021
  • Q2: June 1, 2021
  • Q3: September 1, 2021
  • Q4: December 1, 2021
  • Q1: February 12, 2021
  • Q2: June 1, 2021
  • Q3: September 1, 2021
  • Q4: December 1, 2021

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.

Prospective applicants may request the draft Actuarial Value (AV) Calculator screenshots for the proposed 2022 plan designs to proceed with pricing and product design for the 2022 plan year. Please email QHPCertification@covered.ca.gov with “AV Calculator” in the subject line.

Qualified Dental Plan Certification Application for Plan Year 2022 Covered California Small Business Marketplace

Covered California will accept Letters of Intent to Apply until 5:00 pm PST February 12, 2021. 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 14, 2021: UPDATED Draft 2022 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 14, 2021: UPDATED Draft 2022 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 3, 2020: Draft 2022 Qualified Health Plan and Qualified Dental Plan Certification Application Individual Marketplace

Covered California is accepting comments on the draft QHP and QDP Certification Application until close of business Friday December 18, 2020. 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.


December 3, 2020: Draft 2022 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.