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1. Qualified health plans (QHP)

The exchange will certify, re-certify and de-certify qualified health plans. A QHP is a plan that meets certain criteria including, but not limited to, providing essential benefits and complying with certain deductible and out-of-pocket restrictions.
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2. Metal levels of QHP

Various so-called metal tiers of QHPs will be offered through the exchange. Health insurance plans in the exchange have to meet distinct levels of coverage — each metal tier corresponds to an actuarial value.

  • •tBronze plan: Required to have an actuarial value of 60 percent. Covered individuals would be expected to pay 40 percent through deductibles, co-pays and other cost-sharing features.

  • •tSilver plan: Required to have an actuarial value of 70 percent. Covered individuals would be expected to pay 30 percent through deductibles, co-pays and other cost-sharing features.

  • •tGold plan: Required to have an actuarial value of 80 percent. Covered individuals would be expected to pay 20 percent through deductibles, co-pays and other cost-sharing features.

  • •tPlatinum plan: Required to have an actuarial value of 90 percent. Covered individuals would be expected to pay 10 percent through deductibles, co-pays and other cost-sharing features.

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3. Quality and price rating

The exchange will assign a quality and price rating to each QHP. That will give consumers an apples-to-apples comparison when it comes time to choose a plan.
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4. Standardized consumer information

Employees will also be provided standardized consumer information about the QHP.
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5. Electronic calculator

The calculator will include the ability to show any discount available after government assistance.
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6. Consumer assistance

Consumer assistance is also available through a toll free number or a website showing comparative data among plans offered, as well as certain financial information related to the plans. Consumers will be assisted with eligibility, enrollment, program specifications, and general education, with a goal of informing the public about the availability of the exchange.
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7. Consumers enrolled in eligible programs

The exchange will determine eligibility for, and assist the consumer in enrolling in, available programs such as government-provided premium assistance or Medicaid.
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8. Exemptions from individual mandate

Finally, the exchange will determine exemptions from the individual mandate.

  • •tA member of a religious sect that is recognized as conscientiously opposed to accepting any insurance benefits

  • •tA member of a recognized health care sharing ministry

  • •tA member of a federally recognized Indian tribe

  • •tAn individual whose household income falls below the minimum threshold for filing a tax return

  • •tAn individual who experiences a short gap in coverage of less than three consecutive months during the year

  • •tAn individual who incurs a hardship, as certified by an exchange, which makes him/her unable to obtain coverage

  • •tAn individual who cannot afford coverage because the premium cost exceeds 8% of his/her household income

  • •tAn individual who is incarcerated

  • •tAn individual who is not a U.S. citizen or a U. S. national, nor an alien lawfully present in the U.S.
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