When a field note cites 8 USC 1611 or 45 CFR 155.305, this glossary gives you the plain language summary and a link to the official source. Entries power the dotted underline citations in field notes. For ACA acronyms like APTC and SLCSP, see the ACA glossary.
US Code
26 USC 36BSection 36B of the Internal Revenue Code
The tax code section that creates the Premium Tax Credit (APTC) for ACA Marketplace coverage. Defines who qualifies and how the credit is calculated.
Verified Jul 8, 2026
26 USC 5000ASection 5000A of the Internal Revenue Code
The individual shared responsibility provision. Federal penalty was reduced to zero starting 2019 but the section remains in the code and some state mandates still reference it.
Verified Jul 8, 2026
42 USC 18022Section 18022 of Title 42, US Code
ACA section defining the ten Essential Health Benefits and the metal tier actuarial values (Bronze 60%, Silver 70%, Gold 80%, Platinum 90%).
Verified Jul 8, 2026
42 USC 18081Section 18081 of Title 42, US Code
ACA provision governing verification of eligibility for Marketplace enrollment and APTC. Sources the income and coverage checks.
Verified Jul 8, 2026
47 USC 227Section 227 of Title 47, US Code (TCPA)
The Telephone Consumer Protection Act. Restricts autodialed calls and text messages to consumers. Statutory damages $500 to $1,500 per violation.
Verified Jul 8, 2026
8 USC 1611Section 1611 of Title 8, US Code
Section of US immigration law defining which non citizens can access federal public benefits. Excludes DACA recipients from federal Marketplace eligibility.
Verified Jul 8, 2026
8 USC 1613Section 1613 of Title 8, US Code
Section that codifies the five year bar on federal means tested benefits for most lawful permanent residents.
Related:PRWORAVerified Jul 8, 2026
IRC Section 105Section 105 of the Internal Revenue Code
Tax code section that permits employer funded Health Reimbursement Arrangements (HRAs). The legal basis for ICHRA and QSEHRA.
Verified Jul 8, 2026
IRC Section 162(l)Section 162(l) of the Internal Revenue Code
Tax deduction for self employed individuals who pay premiums for qualified health insurance coverage, including ACA Marketplace plans. Does not cover supplemental indemnity products.
Related:26 USC 36BVerified Jul 8, 2026
IRC Section 9831Section 9831 of the Internal Revenue Code
Tax code section that excludes qualified small employer HRAs from group health plan rules under ERISA and the ACA employer mandate.
Related:IRC Section 105Verified Jul 8, 2026
CFR
26 CFR 1.36B26 CFR Section 1.36B (Premium Tax Credit regulations)
Treasury regulations implementing the Premium Tax Credit. Details the SLCSP definition, household income calculation, and reconciliation on Form 8962.
Verified Jul 8, 2026
26 CFR 54.4980H26 CFR Section 54.4980H (Employer Shared Responsibility)
The employer mandate regulations. Defines Applicable Large Employer status, affordability, and minimum value for employer plans.
Verified Jul 8, 2026
26 CFR 54.9801-626 CFR Section 54.9801-6 (HIPAA special enrollment)
Treasury regulations implementing HIPAA special enrollment rights when group coverage ends or an issuer exits a market, including the 60 day election window.
Verified Jul 8, 2026
45 CFR 146.13645 CFR Section 146.136
Regulation implementing mental health parity requirements for nonquantitative treatment limitations in group and individual health coverage.
Related:MHPAEAVerified Jul 8, 2026
45 CFR 147.10245 CFR Section 147.102
ACA regulation limiting permissible premium rating factors to age (3:1 cap), tobacco (1.5:1 in most states), geography, metal tier, and family enrollment. Health status is excluded.
Related:42 USC 18022Verified Jul 8, 2026
45 CFR 147.10645 CFR Section 147.106
Regulation governing issuer withdrawal from an individual or small group market, including notice requirements and continuity of coverage obligations.
Verified Jul 8, 2026
45 CFR 147.13645 CFR Section 147.136
Regulation implementing PHSA Section 2719 utilization review standards, including prior authorization response timelines for urgent and non urgent requests.
Verified Jul 8, 2026
45 CFR 155.22045 CFR Section 155.220
ACA regulation governing agents and brokers on the Federally Facilitated Marketplace, including registration, training, and compensation disclosure.
Verified Jul 8, 2026
45 CFR 155.30545 CFR Section 155.305
ACA regulation setting Marketplace eligibility standards. Explicitly includes lawfully present immigrants as an APTC eligible category.
Verified Jul 8, 2026
45 CFR 155.31545 CFR Section 155.315
Regulation listing acceptable documents for verifying immigration status during Marketplace enrollment and APTC eligibility.
Verified Jul 8, 2026
45 CFR 155.41045 CFR Section 155.410
Regulation setting the ACA Open Enrollment Period dates and eligibility for enrollment in a Qualified Health Plan.
Verified Jul 8, 2026
45 CFR 155.42045 CFR Section 155.420
Regulation defining Special Enrollment Periods (SEP), qualifying life events, and the 60 day windows for enrollment outside of OEP.
Related:45 CFR 155.410Verified Jul 8, 2026
45 CFR 155.50545 CFR Section 155.505
ACA regulation establishing the Marketplace eligibility appeals process, including filing deadlines and notice requirements.
Verified Jul 8, 2026
45 CFR 155.52045 CFR Section 155.520
Regulation allowing interim APTC continuation while a Marketplace eligibility appeal is pending, if the enrollee requests it.
Verified Jul 8, 2026
45 CFR 155.54545 CFR Section 155.545
Regulation covering appeal hearing procedures and resolution timelines for Marketplace eligibility determinations.
Related:45 CFR 155.505Verified Jul 8, 2026
45 CFR 156.13045 CFR Section 156.130
Regulation setting actuarial value calculation rules for QHPs. This is where the +/- 2 percentage point tolerance around each metal tier is codified.
Related:42 USC 18022Verified Jul 8, 2026
45 CFR 156.15545 CFR Section 156.155
Regulation defining catastrophic plan eligibility, age exemptions, and hardship exemption rules for ACA Marketplace enrollment.
Related:42 USC 18022Verified Jul 8, 2026
45 CFR 156.23045 CFR Section 156.230
Regulation requiring QHP issuers to maintain accurate provider directories and update network listings on a regular schedule.
Verified Jul 8, 2026
45 CFR 156.27045 CFR Section 156.270
Regulation establishing the three month grace period for APTC enrollees who miss premium payments before coverage termination.
Verified Jul 8, 2026
45 CFR Part 14945 CFR Part 149 (No Surprises Act implementation)
CMS regulations implementing the No Surprises Act, including independent dispute resolution and patient protections from surprise bills.
Related:No Surprises ActVerified Jul 8, 2026
45 CFR Part 16445 CFR Part 164 (HIPAA Privacy and Security Rules)
The regulatory home of the HIPAA Privacy Rule and Security Rule. Governs how brokers may use and disclose Protected Health Information (PHI).
Verified Jul 8, 2026
Statutes
ACAPatient Protection and Affordable Care Act (2010)
The 2010 federal law creating the Marketplaces, essential health benefits, subsidies, and consumer protections. Formally titled Public Law 111-148.
Verified Jul 8, 2026
CAN-SPAM ActControlling the Assault of Non-Solicited Pornography And Marketing Act of 2003
Federal law setting rules for commercial email. Requires accurate headers, opt out mechanism, and physical address in every marketing email.
Verified Jul 8, 2026
ERISAEmployee Retirement Income Security Act of 1974
Federal law governing employer sponsored benefit plans, including group health plans. Preempts most state laws for self funded employer plans.
Related:26 CFR 54.4980HVerified Jul 8, 2026
HIPAAHealth Insurance Portability and Accountability Act of 1996
Federal law establishing standards for the privacy and security of Protected Health Information (PHI). Applies to brokers as business associates of health plans.
Verified Jul 8, 2026
HITECH ActHealth Information Technology for Economic and Clinical Health Act (2009)
2009 law that strengthened HIPAA enforcement, added breach notification requirements, and increased penalties for PHI disclosures.
Verified Jul 8, 2026
MHPAEAMental Health Parity and Addiction Equity Act of 2008
Federal law requiring comparable limits on mental health and substance use disorder benefits versus medical and surgical benefits in group health plans and ACA Marketplace coverage.
Verified Jul 8, 2026
No Surprises ActNo Surprises Act (Consolidated Appropriations Act, 2021)
2021 federal law protecting patients from surprise medical bills for out of network emergency care and certain non emergency services at in network facilities.
Verified Jul 8, 2026
PRWORAPersonal Responsibility and Work Opportunity Reconciliation Act of 1996
Federal welfare reform law that added the five year Medicaid waiting period for most new lawful permanent residents. Does not apply to ACA Marketplace APTC.
Verified Jul 8, 2026
IRS
Form 1095-AIRS Form 1095-A (Health Insurance Marketplace Statement)
Tax form issued by the Marketplace to enrollees. Reports the months of coverage, monthly premium, SLCSP, and APTC received. Required to complete Form 8962.
Related:Form 8962Verified Jul 8, 2026
Form 8962IRS Form 8962 (Premium Tax Credit)
Tax form used to reconcile Advance Premium Tax Credit (APTC) received during the year with the actual Premium Tax Credit owed at tax time.
Verified Jul 8, 2026
IRS Publication 974IRS Publication 974 (Premium Tax Credit)
IRS official guide to the Premium Tax Credit. Contains worksheets, examples, and rules for household income calculations, alternative calculations for marriage, and repayment limits.
Verified Jul 8, 2026
