Provide refundable and advanceable premium credits and cost sharing subsidies to eligible individuals and families with incomes between 133-400% FPL to purchase insurance through the Exchanges.
Require qualified health plans to meet new operating standards and reporting requirements.
Allow states the option of merging the individual and small group markets. (Effective January 1, 2014)
Permit states the option to create a Basic Health Plan for uninsured individuals with incomes between 133-200% FPL who would otherwise be eligible to receive premium subsidies in the Exchange.
Require the Office of Personnel Management to contract with insurers to offer at least two multi-state plans in each Exchange. At least one plan must be offered by a non-profit entity and at least one plan must not provide coverage for abortions beyond those permitted by federal law.
Create an essential health benefits package that provides a comprehensive set of services, covers at least 60% of the actuarial value of the covered benefits, limits annual cost-sharing to the current law HSA limits ($5,950/individual and $11,900/family in 2010), and is not more extensive than the typical employer plan.
Limit any waiting periods for coverage to 90 days.
Limit deductibles for health plans in the small group market to $2,000 for individuals and $4,000 for families unless contributions are offered that offset deductible amounts above these limits.
Reduce the out-of-pocket limits for those with incomes up to 400% FPL to the following levels:
- 100-200% FPL: one-third of the HSA limits ($1,983/individual and $3,967/family);
- 200-300% FPL: one-half of the HSA limits ($2,975/individual and $5,950/family);
- 300-400% FPL: two-thirds of the HSA limits ($3,987/individual and $7,973/family).
Create state-based American Health Benefit Exchanges and Small Business Health Options Program (SHOP) Exchanges, administered by a governmental agency or non-profit organization, through which individuals and small businesses with up to 100 employees can purchase qualified coverage.