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Qualified Health Plans (QHP)

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Marketplaces will offer only health insurance plans that are certified as qualified health plans, or QHPs. These QHPs must be licensed and accredited, and must meet certain requirements for transparency. To become certified, a QHP must meet a minimum set of criteria, including the following: 

  • Coverage, at a minimum, of a comprehensive package of benefits, known as essential health benefits, or EHB
  • Benefit design standards, including non-discrimination requirements and limits on cost-sharing and out-of-pocket costs
  • Network adequacy standards


Essential Health Benefits

The Affordable Care Act requires that health plans offered in the individual and small group markets, both inside and outside of the Marketplaces, offer a comprehensive package of services, known as essential health benefits, or EHB. EHB include items and services within 10 benefit categories that are highlighted on the next page. The Affordable Care Act requires that EHB:

  • Reflect appropriate balance among the 10 EHB categories
  • Do not discriminate based on age, disability or expected length of life
  • Take into account the health care needs of diverse segments of the population

For plan years 2014 and 2015, each state was asked by HHS to select a specific health plan’s set of benefits as its “EHB-benchmark plan,” equivalent to a typical employer health plan. If the state did not choose a plan, the EHB-benchmark plan was determined by HHS. The EHB in each state will be measured against the state’s EHB-benchmark plan. Because states elected their EHB-benchmark plans from existing state plans that included state-specific benefits, the EHB package will vary from state to state. Starting in 2014, QHP issuers will need to ensure that every QHP offered in the Marketplace is substantially equal to the EHB-benchmark plan in the state where the QHP is offered.

Essential Health Benefit Categories

  • Ambulatory Services such as Doctor Visits
  • Hospitalization
  • Mental Health and Substance Use Disorder Services, Including Behavioral Health
  • Rehabilitative and Habilitative Services and Devices
  • Laboratory Services
  • Emergency Services
  • Maternity and Newborn Care
  • Presciption Drugs
  • Preventative and Wellness Services and Chronic Disease Management
  • Pediatric Services, including oral care, offered as part of a QHP package or as a stan-alone plan

Next Topic: Levels of Coverage

Agents and Brokers are required to be trained to assist consumers with the application and decision making process. Using an Agent to enroll in a ObamaCare Health Plan will be the primary choice of many americans. After all agents have the inside track on companies and their promptness to handle claims and pay benefits in atimely fashion.

Our Agents are available 7 days a week.

We offer a free consultation which entails speaking one on one with a knowledgable Agent that has been state licensed and trained to answer your questions.

Next Topic: Coverage Basics

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*ExploreObamacare.com is not affiliated with any government agency. All information provided is for informational purposes only and no guarantee of the accuracy is hereby implied. The information was the product of researching the Affordable Care Act Bill and is subject to change.
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