Health Care – Are You Covered?

Ainer & Fraker , LLP – By 2014, each state must establish an exchange to help individuals and small employers obtain coverage.  Benefit options will be in a standard format and a single enrollment form used for all policies.

Plans offered through an exchange must provide essential health benefits, limit cost sharing, and provide specified accrual benefits (i.e., the percentage amount paid the insurer).  Out-of-pocket deductibles are limited to caps for Health Savings Accounts and further limited to $2,000 ($4,000 for families) in the small group market.

Plans in the individual and small group markets use a metallic designation for the accrual benefits provided:

  • Bronze 60%
  • Silver 70%
  • Gold 80%
  • Platinum 90%