The Affordable Care Act (ACA) contains several requirements for insurers which are aimed at standardizing health insurance plans. These requirements will make it easier for consumers to compare benefits across several different plans and make an informed decision. They will also prevent insurance companies from attempting to insure only very healthy people. Insurance companies must adhere to these regulations if they wish to participate in a state or federal Health Insurance Exchange.
The regulations set forth by ACA call for four levels of healthcare coverage, labeled Bronze, Silver, Gold, and Platinum. Companies do not have to offer plans that fit within all four levels, but must offer one Silver and one Gold plan.
In order to qualify for each level, insurance plans must provide a certain amount of coverage for Essential Health benefits in the following ten categories:
• Hospitalization
• Prescription drugs
• Emergency services
• Outpatient services
• Maternity and newborn care
• Preventive, wellness, and chronic disease services
• Pediatric services, including oral and vision care
• Mental health and substance use disorder services
• Rehabilitative and habilitative services and devices
• Laboratory services
While all of these benefits must be addressed by each plan, the value of benefits will vary according to the plan levels. Bronze plan premiums will be the lowest, but these plans will offer the lowest amount of coverage and therefore carry greater out-of-pocket expenses for the insured individual. Meanwhile, Platinum plans will carry the highest premiums, but will include lower deductibles and co-pays. Plans will be designated as Bronze, Gold, Silver, or Platinum according to their “actuarial values”, or the percentage of health care costs covered by that plan.
Steve Amante is the President and CEO of Amante & Associates Insurance Solutions, Inc. To learn more about Healthcare Reform contact Steve Amante or Frank Faldmo the firm’s Employee Benefits Advisor at (951) 676-8800 or visit: www.amanteandassociates.com
