Exchange-Health Insurance Marketplace

PUBLIC EXCHANGE REQUIREMENTS                                 

Every Plan must be certified as a qualified Health Plan (QHP)

• This Means
  • Plan must offer at least a uniform benefits package, called Essential Health Benefits (EHB)
  • Be licensed by the State
  • Have a sufficient network
• Each Exchange will offer four levels of coverage While the scope of benefits will be the same among the plans, the value of those plans. The value of those benefits will vary by actuarial values.
  • Bronze: Benefits equivalent to 60% of the full actuarial value of plan benefits                     Mary Jo Gisewhite
  • Silver: benefits actuarially equivalent to 70% of full value
  • Gold: benefits actuarially equivalent to 80% of full value
  • Platinum: benefits actuarially equivalent to 90% of full value

*Actuarial Value: The percentage of total average costs for covered benefits that a plan will cover.
 
For example: If a plan has an actuarial value of 70%, on average, you will be responsible for 30 of the costs of all covered benefits.
Starting in 2014, actuarial value will be used to categorize health plans sold in the individual and small group markets into coverage tiers.

Call Mary Jo with all your Affordable Healthcare Act questions today!