60.06 Applicable benchmark plan (ABP)81

In general. The ABP helps determine the total amount of premium assistance. The ABP is the QHP from which the product of the applicable percentage and household income is subtracted to obtain the subsidy amount 77 Examples to illustrate the rules of this subsection can be found at 26 CFR § 1.36B-3(c)(6). 78 26 CFR § 1.36B-3(d). 79 Examples to illustrate the rules of this subsection can be found at 26 CFR § 1.36B-3(d)(2). 80 26 CFR § 1.36B-3(e). 81 26 CFR § 1.36B-3(f). Eligibility-and-Enrollment Procedures Part 7 – Page 34 (Sec.60.00, Sub.60.06) that will be provided on behalf of the qualified individual. Except as otherwise provided in this subsection, the ABP for each coverage month is the second-lowest-cost silver plan offered to the tax filer’s coverage family through VHC for: Self-only coverage for a tax filer: (i) Who computes tax under § 1(c) of the Code (unmarried individuals other than surviving spouses and heads of household) and is not allowed a deduction under § 151 of the Code for a tax dependent for the benefit year; (ii) Who purchases only self-only coverage for one individual; or (iii) Whose coverage family includes only one individual; and Family coverage for all other tax filers. (b) Family coverage. The ABP for family coverage is the second-lowest-cost silver plan that would cover the members of the tax filer's coverage family (such as a plan covering two adults if the members of a tax filer's coverage family are two adults). (c) Silver-level plan not covering pediatric dental benefits. [Reserved] (d) Family members residing in different locations. If members of a tax filer’s coverage family reside in different locations, the tax filer’s benchmark plan premium is the sum of the premiums for the ABPs for each group of coverage family members residing in different locations, based on the plans offered to the group through the Exchange where the group resides. If all members of a tax filer’s coverage family reside in a single location that is different from where the tax filer resides, the tax filer’s benchmark plan premium is the premium for the ABP for the coverage family, based on the plans offered through the Exchange to the tax filer’s coverage family for the rating area where the coverage family resides. (e) Single or multiple policies needed to cover the family Policy covering a tax filer’s family. If a silver-level plan or a stand-alone dental plan offers coverage to all members of a tax filer’s coverage family who reside in the same location under a single policy, the premium (or allocable portion thereof, in the case of a stand-alone dental plan) taken into account for the plan for purposes of determining the ABP under paragraphs (a), (b) and (c) of this subsection is the premium for this single policy. Policy not covering a tax filer’s family. If a silver-level QHP or a stand-alone dental plan would require multiple policies to cover all members of a tax filer’s coverage family who reside in the same location (for example, because of the relationships within the family), the premium (or allocable portion thereof, in the case of a stand-alone dental plan) taken into account for the plan for purposes of determining the ABP under paragraphs (a), (b), and (c) of this subsection is the sum of the premiums (or allocable portion thereof, in the case of a stand-alone dental plan) for self-only policies under the plan for each member of the coverage family who resides in the same location. (f) Plan not available for enrollment. A silver-level QHP or a stand-alone dental plan that is not open to enrollment Eligibility-and-Enrollment Procedures Part 7 – Page 35 (Sec.60.00, Sub.60.07) by a tax filer or family member at the time the tax filer or family member enrolls in a QHP is disregarded in determining the ABP. (g) Benchmark plan terminates or closes to enrollment during the year. A silver-level QHP or a stand-alone dental plan that is used for purposes of determining the ABP under this subsection for a tax filer does not cease to be the ABP for a benefit year solely because the plan or a lower cost plan terminates or closes to enrollment during the benefit year. (h) Only one silver-level plan offered to the coverage family. [Reserved] (i) Examples82