Does Your Health Insurance Qualify Under ACA?
|By Wayne Greene, Tulsa World, Okla.|
Unfortunately, there's no telling, and
Starting in 2014, Americans must report on their income tax returns whether they have qualified health insurance. If they don't, they have to pay the higher of
The maximum penalty is
So every Oklahoman with health insurance has an interest in what health insurance qualifies under the law.
The Affordable Care Act broadly defines 10 areas that all health insurance must cover, but it leaves specifics within those areas to be determined on a state-by-state basis.
Defining qualifying health insurance is part of the process of setting up a state health insurance exchange, and
State Deputy Insurance Commissioner
That exchange will choose a benchmark health insurance program that reflects a typical employer plan in the state. The benchmark can be one of the three largest small-group plans in the state, one of the three largest state-employee health plans, one of the three largest federal health plans or the largest HMO plan offered in the state.
If the federal government sets up the state's exchange, the
The benefits and services included in the benchmark health insurance plan would be the state's essential health benefits package. Plans could modify coverage within a benefit category so long as they do not reduce the value of coverage.
The federal law also specifies other standards for qualifying plans, including that they all must be licensed by the state insurance department and that they all must offer four graded steps of coverage -- bronze, silver, gold and platinum -- reflecting how much of health-care costs are covered by the plan.
For example, if you had a bronze plan, the insurance company would pick up 60 percent of the cost, but a platinum plan would cover 90 percent.
For insurance plans created after
There are many exceptions to those mandates -- including an exemption for plans in effect before
Under the Affordable Care Act, all health insurance will include all of the following general categories:
--Ambulatory patient services
--Maternity and newborn care
--Mental health and substance-use disorder services, including behavioral health treatment
--Rehabilitative and habilitative services and devices
--Preventive and wellness and chronic disease management
--Pediatric services, including oral and vision care
Source: Affordable Care Act
(c)2012 Tulsa World (Tulsa, Okla.)
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|Source:||McClatchy-Tribune Information Services|