Plan Year 2026 (PY26) Notice Requirements

TRINIDAD NAVARRO COMMISSIONER STATE OF DELAWARE DEPARTMENT OF INSURANCE DOMESTIC AND FOREIGN BULLETIN NO. 154 TO: INSURERS, HEALTH SERVICE CORPORATIONS, AND MANAGED CARE ORGANIZATIONS THAT DELIVER OR ISSUE FOR DELIVERY IN THIS STATE INDIVIDUAL HEALTH BENEFIT PLANS SUBJECT TO REGULATION UNDER TITLE 18 OF THE DELAWARE CODE RE: PLAN YEAR 2026 (PY26) NOTICE REQUIREMENTS DATED: July ____, 2025 The Delaware Department of Insurance (the “Department”) is issuing this Bulletin to inform Qualified Health Plan (QHP) issuers operating in the Individual Market of its expectations following the July 16, 2025 recommendations issued by the Centers for Medicare & Medicaid Services (CMS), in the document titled Enforcement Safe Harbors Guidance for Plan Year 2026, available here. Background Pursuant to 45 CFR § 156.1255, QHP issuers are generally required to include premium and Advance Premium Tax Credit (APTC) information in renewal notices. However, due to operational challenges surrounding annual eligibility redeterminations, CMS has issued enforcement discretion for renewal and re-enrollment notices issued during the open enrollment period for PY26, permitting omission of certain data under defined conditions. The Department has chosen to adopt this approach for issuers operating in the Individual Market. Guidance for Plan Year 2026 Notices To be considered compliant with applicable federal and Delaware notice requirements, QHP issuers must: • Use CMS-approved Federal standard notices when omitting premium and Advance Premium Tax Credit (APTC) information from PY26 Individual Market renewal notices. • Continue to comply with all other applicable notice requirements under 45 CFR §§ 147.106(e) (guaranteed renewability) and 45 CFR § 156.1255 (renewal and re-enrollment notices). • Provide 90-day product discontinuation notices in accordance with federal and state law. • Adopt the updated CMS standard notices once approved by the Office of Management and Budget (OMB). • Maintain records and documentation of all notices issued. • Ensure full compliance with consumer protection standards and applicable regulatory obligations Questions, comments, or requests for clarification about this Bulletin should be emailed to compliance@delaware.gov. 28 NOTE: This Bulletin is intended solely for informational purposes. It is not intended to set forth legal rights, duties, or privileges, nor is it intended to provide legal advice. Readers should consult applicable statutes and rules and contact the Delaware Department of Insurance if additional information is needed. ♦INSURANCE.DELAWARE.GOV♦ 1351 W. NORTH ST., SUITE 101, DOVER, DELAWARE 19904 (302) 674-7300 DOVER♦ (302) 259-7554 GEORGETOWN♦ (302) 577-5280 WILMINGTON Page | 2 This Bulletin shall be effective immediately and shall remain in effect exclusively for PY26, unless withdrawn or superseded by subsequent law, regulation, or bulletin. ______________________________________ Trinidad Navarro Delaware Insurance Commissioner