COVERED CA Plans
There will be four basic levels of coverage through Covered California: Platinum, Gold, Silver, and Bronze. With a Platinum policy you choose to pay a higher monthly premium, but when you need medical care you pay less to the doctor. Inversely, with a Bronze policy you choose to pay a lower monthly premium, but when you need medical care you pay more to the doctor. The choice is yours as your premium assistance is the same across all metal tiers. Platinum plans have the highest premium, yet pay 90% of covered health care expenses. Bronze plans have the lowest premium, but pay only 60% of covered health expenses. The chart below will illustrate how much you will pay for covered services under each standard Bronze 60, Silver 70, Gold 80, and Platinum 90 plan.
Covered CA Enhanced Silver plans – There are also non-standard Enhanced Silver plans available to individuals and families that meet certain age and income requirements. These Enhanced Silver options vary from 73, 87, and 94 plans which essentially correlate to the percentage of expenses that the insurance carrier will cover. These plans are comparable with either the Gold or Platinum policies with respect to deductibles and benefits, but come at a fraction of the cost.
Under the new Affordable Care Act, all newly sold health plans must meet a set of certain standards.
- Rate Increase Rules – The insurers must justify premium increases. Insurance companies are required to spend 80% of premium dollars on quality health care, not administrative costs like salaries or marketing.
- No Lifetime Limits – Insurers are not allowed to set a maximum dollar amount they will pay for key health benefits during your lifetime.
- Preventive Care – All new health plans must cover preventive care and medical screenings like mammograms, and colonoscopies, as well as women’s services such as breast-feeding support, contraception and domestic violence screening. Insurer’s cannot charge co-payments, coinsurance or deductibles for such services.
- Essential Health Benefits – Newly sold health plans must cover services that fall into these 10 categories of Essential Health Benefits.
- Ambulatory patient care
- Emergency service
- Maternity and newborn care
- Mental health and substance abuse disorder treatment
- Prescription drugs
- Rehabilitation and habilitation services and devices
- Lab services
- Preventive and wellness services and chronic disease support
- Pediatric services, including dental and vision care
The Department of Labor recently released their inflation-adjusted penalties for ERISA, the Family Medical Leave Act, and the Genetic Information Nondiscrimination Act.
With healthcare premiums continuously increasing year over year, many employers are searching for options to help reduce their benefit costs.
The Employee Retirement Income Security Act (ERISA) oversees group benefit plans, and with the onset of the Affordable Care Act, the ERISA Summary Plan Description (SPD) requirements are in the spotlight.