Starting Oct. 1, 2013, California based individuals and small business owners will be able to consider the california health insurance exchange. The Patient Protection and Affordable Care of 2010 (PPACA) created the option to establish a state run health insurance exchange. The California program will be known as â€œCovered California.â€
Estimates are that more than 5 million Californians will be eligible for Covered California with about half, or more than 2.5 million, eligible for subsidies. The remaining individuals are expected to partake in the offered health plans as well.
There will be 5 plans: Platinum, Gold, Silver, Bronze, and Catastrophic. The PPACA mandates that all plans must provide for Essential Health Benefits (EHB) as outlined by 10 categories with each state determining the benefit and services. The EHB’s are
1. Ambulatory patient services.
2. Emergency services.
4. Maternity and newborn care.
5. Mental health and substance abuse disorders/behavioral treatment.
6. Prescription drugs.
7. Rehabilitive & habilitative services/devices.
8. Laboratory services.
9. Preventive & wellness services and chronic disease management.
10. Pediatric services, including oral and vision care.
PPACA requires that the EHB’s have no annual or lifetime limits, include 100% of preventive care coverage, and that all expenses (ie: copays, coinsurance, etc) count towards out of pocket maximum.
There is no specific requirement for anyone to purchase health insurance from the exchange. Companies offering health plans in California will also meet these minimum requirements. If you choose to stay outside of Covered Calfiornia and purchase through an agent you’ll will get the guaranteed benefits as well.