Skip to main navigation Skip to main content Skip to footer
  • For Individuals & Families
  • For Medicare
  • For Providers
  • For Brokers
  • Search
  • For Employers:
  • For Employers:
  • Plans and Services

    Plans and Services

  • Who We Serve

    Who We Serve

  • Employer Resources

    Employer Resources

  • Log in to Employer Portal
  • Log in to Employer Portal
  • Plans and Services

    Plans and Services

  • Who We Serve

    Who We Serve

  • Why Cigna Healthcare
  • Employer Resources

    Employer Resources

  • Home Employers Industry Insights Informed on Reform Section 1332 Waivers

    Section 1332 Waivers

    State Relief and Empowerment Waivers

    Under Section 1332 of the Affordable Care Act (ACA), states can receive permission to waive key provisions of the law in order to implement innovative, alternate health coverage rules or programs while retaining basic consumer protections. States can apply for the five-year State Relief and Empowerment Waivers (previously called State Innovation Waivers) through the Department of Health and Human Services (HHS).

    What can and cannot be waived

    In the application, states can request to waive or modify any or all of the following ACA provisions.

    • Individual and/or employer mandate penalties*
    • Essential Health Benefits (EHBs) and cost-sharing requirements
    • Premium tax credits and cost-sharing reductions
    • Standards for Marketplaces
    • "Plan categories" (or metal levels) on Marketplaces
    • Waivers cannot be used to modify or eliminate other patient protections, such as prohibiting annual or lifetime limits or charging higher premiums for those with preexisting conditions.

    Waiver guardrails

    States seeking a 1332 waiver must demonstrate that its innovation plan stays within certain waiver "guardrails."

    • Comprehensiveness: The coverage must be as comprehensive as coverage available on the public Marketplaces.
    • Affordability: The coverage must provide protections against excessive out-of-pocket spending and be as affordable as coverage offered through the public Marketplaces.
    • Scope of coverage: Coverage must be accessible to at least as many people as the ACA would cover without the waiver.
    • Deficit neutral: The coverage must not increase the federal deficit.

    For more information on guardrails and principles used by HHS to review waiver applications, review the issued regulations and guidance.

    Federal funding

    As part of the application, states can request a subsidy pass-through equal to the total premium tax credits, cost-sharing reductions (CSRs) and small business credits that residents would otherwise have received from the Marketplace. Expenses above and beyond those amounts must be provided for at the state level.

    Approved waivers

    States with approved 1332 waivers to implement reinsurance programs

    To date, the majority of state applications have requested waiving the single risk pool requirement in order to implement reinsurance programs.

    • Alaska
    • Maine
    • Maryland
    • Minnesota
    • New Jersey
    • Oregon
    • Wisconsin

    Other approved 1332 waivers

    Only one state to date has applied to waive a different ACA provision.

    • Hawaii – Waives the Small Business Health Options Program (SHOP) requirement and related provisions that conflict with Hawaii's more comprehensive Prepaid Health Care Act.

    View Cigna Healthcare Company Names

    * The Tax Cuts and Jobs Act of 2017 includes permanent effective repeal of the individual mandate by zeroing out the penalty beginning in 2019.

    I want to...
  • Get an ID card
  • File a claim
  • View my claims and EOBs
  • Check coverage under my plan
  • See prescription drug list
  • Find an in-network doctor, dentist, or facility
  • Find a form
  • Find 1095-B tax form information
  • View the Cigna Healthcare Glossary
  • Contact Cigna Healthcare
  • Audiences
  • Individuals and Families
  • Medicare
  • Employers
  • Brokers
  • Providers
  • Secure Member Sites
  • myCigna member portal
  • Health Care Provider portal
  • Cigna for Employers
  • Client Resource Portal
  • Cigna for Brokers
  • The Cigna Group Information
  • About Cigna Healthcare
  • The Cigna Group
  • Careers
  • Newsroom
  • Investors
  • Suppliers
  • Third Party Administrators
  • International
  • Evernorth Health Services
  • Cigna Healthcare. All rights reserved.
  • Privacy
  • Legal
  • Product Disclosures
  • Company Names
  • Customer Rights
  • Accessibility
  • Report Fraud
  • Sitemap
  • Cookie Settings
  • Disclaimer

    Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of South Carolina, Inc., and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see a listing of the legal entities that insure or administer group HMO, dental HMO, and other products or services in your state). Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of The Cigna Group Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT); (ii) Life Insurance Company of North America (“LINA”) (Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY (“NYLGICNY”) (New York, NY), formerly known as Cigna Life Insurance Company of New York. The Cigna Healthcare name, logo, and other Cigna Healthcare marks are owned by The Cigna Group Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna Healthcare.

    All insurance policies and group benefit plans contain exclusions and limitations. For availability, costs and complete details of coverage, contact a licensed agent or Cigna Healthcare sales representative. This website is not intended for residents of New Mexico.

    Selecting these links will take you away from to another website, which may be a non-Cigna Healthcare website. Cigna Healthcare may not control the content or links of non-Cigna Healthcare websites. Details