<html> <head> <meta name=Generator content="Microsoft Office HTML Filter 2.0"> <meta http-equiv=Content-Type content="text/html; charset=windows-1252"> <style> <!-- --> </style> </head> <body lang=EN-US link=blue vlink=purple> <div> <p align=center><b>CHAPTER 20:06:55</b></p> <p align=center><b>&nbsp;</b></p> <p align=center><b>MARKET REGULATIONS</b></p> <p>Section</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:01">20:06:55:01</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Eligibility of children up to age 26.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:02">20:06:55:02</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Restrictions on plan definition of dependent.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:03">20:06:55:03</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Coverage of grandchildren not required.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:04">20:06:55:04</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Uniformity irrespective of age.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:05">20:06:55:05</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Individuals whose coverage ended by reason of reaching a dependent eligibility threshold -- Applicability.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:06">20:06:55:06</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Individuals whose coverage ended by reason of reaching a dependent eligibility threshold -- Opportunity to enroll required.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:07">20:06:55:07</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Individuals whose coverage ended by reason of reaching a dependent eligibility threshold -- Written notice.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:08">20:06:55:08</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Individuals whose coverage ended by reason of reaching a dependent eligibility threshold -- Effective date.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:09">20:06:55:09</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Individuals whose coverage ended by reason of reaching a dependent eligibility threshold -- Group health plan special enrollee.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:10">20:06:55:10</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Special rule for grandfathered group health plans.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:11">20:06:55:11</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Applicability.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:12">20:06:55:12</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Choice of primary care providers.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:13">20:06:55:13</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Emergency services.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:14">20:06:55:14</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Rescissions.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:15">20:06:55:15</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Group plans -- Lifetime limits.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:16">20:06:55:16</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Group plans -- Annual limits.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:17">20:06:55:17</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Group plans -- Eligibility.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:18">20:06:55:18</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Group plans -- Notices and enrollment.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:19">20:06:55:19</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Group plans -- Special enrollment.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:20">20:06:55:20</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Group plans -- Applicability.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:21">20:06:55:21</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Individual plans -- Lifetime limits.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:22">20:06:55:22</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Individual plans -- Annual limits.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:23">20:06:55:23</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Reinstatement of coverage.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:24">20:06:55:24</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Individual plans -- Applicability.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:25">20:06:55:25</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:25.01">20:06:55:25.01</a>&nbsp;&nbsp; Individual plans -- No preexisting condition.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:26">20:06:55:26</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Group plans -- No preexisting condition.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:27">20:06:55:27</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Excepted benefits -- Defined.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:28">20:06:55:28</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:29">20:06:55:29</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:30">20:06:55:30</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:31">20:06:55:31</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:32">20:06:55:32</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Definitions.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:33">20:06:55:33</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Certifying qualified health plans.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:34">20:06:55:34</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Issuer standards and certification criteria.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:35">20:06:55:35</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Qualified health plan defined.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:36">20:06:55:36</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Exchange network adequacy standards.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:37">20:06:55:37</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Network adequacy standards.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:38">20:06:55:38</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Essential community providers defined.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:39">20:06:55:39</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Essential community providers.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:40">20:06:55:40</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Payment of federally-qualified health centers.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:41">20:06:55:41</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Treatment of direct primary care medical homes.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:42">20:06:55:42</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Recertification of qualified health plans.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:43">20:06:55:43</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Decertification of qualified health plan.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:44">20:06:55:44</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Non-renewal and decertification of qualified health plans.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:45">20:06:55:45</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Rates.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:46">20:06:55:46</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Health plan applications and notices.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:47">20:06:55:47</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Accreditation of qualified health plan issuers.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:48">20:06:55:48</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Repealed.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:49">20:06:55:49</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Annual open enrollment period.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:50">20:06:55:50</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Changing qualified health plans.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:50.01">20:06:55:50.01</a>&nbsp;&nbsp; Loss of coverage.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:50.02">20:06:55:50.02</a>&nbsp;&nbsp; Special enrollment period effective dates.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:51">20:06:55:51</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Compensation.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:52">20:06:55:52</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Plan offerings in the exchange.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:53">20:06:55:53</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Applicability and effective dates.</p> <p><a href="DisplayRule.aspx?Rule=20:06:55:0A">Appendix A</a>&nbsp; Model Choice of Health Care Professional Notice Language.</p> </div> </body> </html>