What is the difference between Covered California On-Exchange, Off-Exchange and Off-Off-Exchange Health Insurance Plans?

What is the difference between Covered California On-Exchange, Off-Exchange and Off-Off-Exchange Health Plans?
1) On-Exchange plans are offered by the official Covered California Exchange to consumers and small businesses. They have the following characteristics:
• 4 Standardized Metallic Tiers of plans called: Platinum, Gold, Silver and Bronze.
• There also offer a Catastropic level plan to 18 to 30 year olds only.
• Each Metallic Level plan may be offered by several of the carriers in each county, e.g. Anthem Blue Cross, Blue Shield, Kaiser and Health Net.
• On-Exchange Plans may be purchased online, through a licensed and certified Agent or through a CEC (certified enrollment counselor).
• You may apply for a federal Subsidy (or Premium Assistance) at the time that you make you application for enrollment.
• Most On-Exchange plans have reduced or limited networks of providers.

There are 2 kinds of Off Exchange Plans:
2) Off Exchange plans that “mirror” the Metallic Level plans and are identical to them. These plans usually have different names than the metallic plans.• Rates are the same between the On Exchange plans and the Off Exchange “Mirror” plans.
• They offer the same 4 metallic level plans, although under different names.
• Subsidies are not offered on Off Exchange plans.
• Off-Exchange plans may have either full or limited provider networks.

3) Off-Off Exchange Plans that are not standardized and are different from any of the On Exchange or Off-Exchange “Mirror” plans.
• Rates and Benefits are different than On Exchange plans.
• No Subsidies are offered for these Off-Off Exchange plans.
• Off-Off Exchange plans are more likely to offer full provider networks in addition to limited provider network plans.

On Exchange plans (1) are identical to Off Exchange plans (2). The only difference is that one may apply for a subsidy if they purchase an On Exchange plan. No subsidy are available on Off Exchange plans. On the Individual Exchange, one may apply for an individual subsidy based on income. On the SHOP Exchange, small business employers may apply for a tax credit to help pay for premiums on employee plans.

With On Exchange plans, each metallic level may offer a choice of multiple carriers to their employees simultaneously, like Anthem and Kaiser, or Blue Shield and Kaiser. While Off Exchange plans may be purchased only from one carrier at a time.
Off-Off Exchange plans (3) may offer many plan designs not available under the 4 standardized metallic levels.
Off-Off Exchange plans are more likely to offer larger provider networks than On-Exchange plans.

Phil Lee

Health Care Reform (ACA) Implementation Jan. 1st, 2014 – California Updates

Latest Updates

Individuals and Families
• Insurance Carriers are expected to release their health plan offerings for 2014 on Oct. 1st.
• The major carriers offering Individual/Family plans in the Bay Area will be Anthem Blue Cross, Blue Shield, Health Net and Kaiser.
• Individual & Family purchase mandates and penalties will go into effect on Jan. 1st. Large Employer Group (50+ Employees) mandates and penalties, however, have been postponed to 1/1/2015.

Small Employer Groups (50 or fewer employees)
• Model Notices — All Employers are required to give “Model Notices” to all their employees by Oct. 1st, and to new hires within 14 days of hire. This is a Dept. of Labor mandated notice, that talks about employees’ and dependents’ options, under ACA, to employer and individual health coverage, Exchanges, subsidies and tax credits.
• Previously, this Model Notice law carried a penalty to Employers of $1,000 per employee for non-compliance. Last week, the Dept. of Labor announced a waiver of the penalty for non-compliance. But they still want employers to send out those notices.
• Anthem Blue Cross will not be offering any Small Group health plans within the Covered California Exchange. But they will be offering a wide selection of non-standardized plans outside of the Exchange.

Large Employer Groups (50+ employees)
• Model Notices — Penalties waived, see above.

Medicare Individuals
If you are on Medicare, you are mostly unaffected by the implementation of ACA on Jan. 1st.

Phil Lee


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