Policy for Removal from Covered California.
The Policy for Removal from Covered California (also known as '25/2/2’) is an accountability program that holds each contracted Qualified Health Plan (QHP) Issuer to a minimum clinical quality performance standard to ensure high-performing health plans are available to Covered California members. It is a contractually enforced selective contracting strategy that allows Covered California to remove QHP products that consistently underperform on clinical quality measures. This process prioritizes consumer access to high-quality health plans and ensures accountability among contracted QHP Issuers.
How Products are Assessed
Issuer products are assessed annually against a product-specific 25th national percentile composite benchmark for the CMS Quality Rating System (QRS) Clinical Quality Management Summary Indicator (also known as 'Getting the Right Care') measures. Products that fall below the composite benchmark are subject to a defined four-year accountability process.
Monitoring Period: Products that fall below the composite benchmark enters a two-year monitoring period.
Remediation Period: Products that fail to meet the composite benchmark during the monitoring period enter a two-year remediation period. QHP Issuers must submit a Minimum Performance Level Action Plan.
Decertification: Products that fail to improve across both periods may be decertified from Covered California.
Contractual Requirements: The 25/2/2 Program is governed by Articles 5.2.3 (Removal from Covered California) and 5.2.4 (Quality Improvement Plans and Minimum Performance Level Action Plans) of the 2026-2028 QHP Issuer Contract.
Transition Period: New products offered on Covered California are given a transition period before being subject to this policy, consistent with CMS eligibility criteria. An issuer product is subject to assessment after it meets the CMS eligibility criteria to report QRS measure scores and receive star ratings for a minimum of two years.
Data Source: Covered California uses CMS QRS Proof Sheets as the official data source for scoring health plan products.