There are a number of major changes for comprehensive health insurance plans effective January 1, 2014. These include the following:
Insurers must sell a health insurance policy to any person who applies for coverage, except in cases where fraudulent information is provided by the applicant.
Insurers are prohibited from excluding or limiting coverage for a preexisting condition.
Plans will be required to offer “essential health benefits.”
Plans in the small group and individual market will be categorized into one of four different metal tiers. Consumers will know the level of coverage expected by a plan based on the metal tier assigned to it. The percentages attached to each metal tier represent the average portion of expected costs a plan will cover for the average individual. Plans with a higher percentage of coverage will have more expensive premiums. The metal tiers include:
Bronze plans covering 60%;
Silver plans covering 70%;
Gold plans covering 80%; and
Platinum plans covering 90%.
Plans in all markets (individual, small group, and large group) will be required to limit in-network out-of-pocket expenses to $6,250 for self-only coverage.
Plans in the small group market cannot have deductibles that exceed $2,000 for individual coverage or $4,000 for family coverage.