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 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


Qualified Health Plan Certification Application For Plan Year 2019 Individual Marketplace

Covered California will accept Letters of Intent to Apply until 4:59pm PST February 15, 2018. Interested applicants must use template provided. Letters of Intent are nonbinding, but are required to obtain access to the electronic application submission portal.

Intent to Apply 2019 QHP Covered California Individual

Covered California Confidentiality Agreement

Application


Qualified Dental Plan Certification Application For Plan Year 2019 Individual Marketplace

Covered California will accept Letters of Intent to Apply until 4:59pm PST February 15, 2018. Interested applicants must use template provided. Letters of Intent are nonbinding, but are required to obtain access to the electronic application submission portal.

Intent to Apply 2019 QDP Covered California Individual

Application


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

Covered California will accept Letters of Intent to Apply until 4:59pm PST February 15, 2018. Interested applicants must use template provided. Letters of Intent are nonbinding, but are required to obtain access to the electronic application submission portal.

Intent to Apply 2019 QHP Covered California for Small Business

Covered California Confidentiality Agreement

Application


Qualified Dental Plan Certification Application For Plan Year 2019 Covered California Small Business Marketplace

Covered California will accept Letters of Intent to Apply until 4:59pm PST February 15, 2018. Interested applicants must use template provided. Letters of Intent are nonbinding, but are required to obtain access to the electronic application submission portal.

Intent to Apply 2019 QDP Covered California for Small Business

Application