Description
This opportunity is a certification application for health‑insurance issuers that wish to offer Qualified Health Plans (QHPs) on California’s state health exchange, Covered California, for the 2017 plan year. Applicants must provide extensive documentation covering licensing, network design, provider data, financial capacity, quality‑improvement strategies, and compliance with HIPAA and state regulations. The application is reviewed on a rolling basis, with a practical cut‑off of July 15 2017 for timely review, and requires readiness for data‑interface testing by September 1 2017. Successful certification may lead to multi‑year contracts for delivering QHPs across the state’s rating regions.
• Submit complete QHP proposals (all metal tiers) and attest to compliance with 2017 CMS Standard Benefit Plan Designs.
• Provide detailed network architecture, provider‑directory files, and evidence of operational capacity (org chart, IT interfaces, customer‑service plans).
• Deliver financial disclosures, fraud‑waste‑abuse policies, quality‑improvement strategies, and required attachments (accreditations, business‑continuity plans, etc.).