Qualified Health Plans and the Exchange

Under the PPACA health insurance plans will begin being sold through state health insurance exchanges. Pennsylvania has opted to allow the federal government to establish and build the PA State Health Insurance Exchange. When you purchase a plan through the exchange, by law, it must be a qualified health plan (QHP).

You as an individual or a business owner may decide to enroll in the exchange through a "navigator" website, or with the help of an agent or a broker.  

Qualified health plans will offer a certain standardized package of benefits and meet other requirements so that they can be sold in an exchange, the regulated marketplace in each state where people can compare plans and shop for coverage.

Qualified health plans must meet exchange standards for provider networks, marketing, accreditation, and other health plan factors. In order to shop in an exchange, people must: be residents of the area served by the exchange; be citizens, nationals, or lawfully present; and not be incarcerated. Federal law does not prohibit insurers from offering plans, including qualified health plans, outside of an exchange. 

However, it is possible that some states will require individual and/or small group health insurance be sold through an exchange as the only marketplace.If people enroll in a plan through the exchange and verify their incomes, low- and moderate-income individuals and families who meet income requirements and do not have other affordable coverage options may receive premium tax credits and cost-sharing assistance for use with a qualified health plan. They will not receive that assistance if they enroll in plans outside of the exchange.

Ask your broker or contact us if you have any additional questions.

Edward T. MacConnell CBC, CHRS
www.emabenefits.com