On December 13, 2011, HHS published a final rule to implement the Consumer Operated and Oriented Plan (CO–OP) program, which was mandated by the Affordable Care Act (ACA) to provide loans to encourage the creation of consumer-governed, private, nonprofit health insurance issuers. CO-Ops will offer qualified health plans to individuals and small businesses through new Affordable Insurance Exchanges (and outside of Exchanges) beginning January 1, 2014. The ACA set aside $3.8 billion to support loans under the CO-OP program, with the goal of having at least one CO-OP in each state. Organizations may apply for two types of low-interest loans under the program: start-up loans to support development of a CO-OP, and solvency loans to help meet state reserve requirements. The final rule: (1) establishes eligibility standards; (2) establishes certain loan terms; and (3) provides basic standards that organizations must meet to participate, including governance requirements. HHS anticipates making initial CO-OP awards in January 2012, and additional applications will be accepted quarterly through December 31, 2012.