Health Insurance in Brentwood will change in 2014 with implementing the Health Insurance Exchange Program. We, the Health Insurance Agent will still be able to help you choose the suitable plan, and we expect that the exchange will create a more competitive market and with more transparency.
Health Insurance Exchange
The most anticipated element of health reform, state-based Exchanges, will play a significant role in transforming the healthcare marketplace. And while California’s Exchange Board is still being formed and many decisions have yet to be made, Blue Shield is already busy understanding requirements to participate in this new environment.
What is the Exchange?
In 2014, the Exchange creates a new marketplace where individuals and small groups compare and purchase health plans from various carriers – all in one place. As a result, competitive pricing and comparable benefits will be huge driving factors in buying coverage through an Exchange; consumers will be encouraged to make decisions based on cost and quality.
The Exchange offers a variety of qualified health plans, and provides premium subsidies for individuals with incomes between 134%-400% of the Federal Poverty Level (FPL).
Small Group Exchange
The Small Business Health Options Program (SHOP) offers the competition and variety found in the individual Exchange, in addition to assisting with enrollment.
How it works
Five different levels of coverage will be offered on and off the Exchange, although the rules around how many of the products we’ll need to offer will differ whether on or off the Exchange. Levels of coverage are as follows:
Bronze – 60% Actuarial value
Silver – 70% Actuarial Value
Gold – 80% Actuarial Value
Platinum – 90% Actuarial Value
This plan must cover the essential health benefits, plus three primary care visits per year. No benefits (beyond the primary care and free preventive care visits) will be provided until the individual meets the cost-sharing limits.
The Catastrophic Plan may only be sold in the individual market to:
- Persons under age 30
- Persons exempt from the individual mandate as a result of low income or hardship
Small group and individual plans (both on and off the Exchange) also must:
- Be offered on a guaranteed issue basic
- Impose no pre-existing condition exclusions
- Not vary rates based on health factors
- Comply with major mandates such as no lifetime limits, preventive care with no member cost-sharing, extended dependent coverage, etc.
How the Exchange will collect premiums and administer all other necessary tasks, such as enrollment and plan payment for small businesses, is all still to be determined. Specifics of how individuals and small businesses will access the Exchange are also still being determined. We expect guidance from Health & Human Services in the fall of 2011.
We hope this small overview is helpful and we will keep you posted of any changes in the Health Insurance Industry in California and locally in Brentwood.