Beginning January 1, 2014, individual health insurance plans in South Carolina will have to meet the standards of a Qualified Health Plan (QHP). QHP’s cannot refuse coverage or charge higher premiums due to preexisting conditions. In addition, QHP’s will have to cover a comprehensive package of items and services, known as essential health benefits.
2014 Health Plans – Essential Health Benefits
Below is a brief summary of the 10 Essential Health Benefits that all metal plans must offer:
Ambulatory patient services (such as doctor visits and other care you receive as a “walk-in” as opposed to services a person receives as an “inpatient” at a hospital or other care facility)
Emergency services – These include care received in an Emergency Room
Hospitalization – These services include medically-necessary surgeries and other inpatient procedures.
Maternity care and newborn care
Mental health services & substance use disorder services – These services include counseling as well as behavioral health treatment for alcohol abuse and drug abuse
Drug coverage – This applies to prescription medication and not over-the-counter drugs
Rehabilitative and habilitative services and devices – Rehabilitation covers services such as relearning to speak after an aneurysm while habilitative services involve learning a new skill such as managing diabetes through various behaviors
Laboratory tests and services (for example, X-Rays)
Preventive and wellness services as well as the management of chronic diseases
Pediatric medical services (including both oral care and vision care)
2014 Health Plans – Classifications
In order to minimize confusion, QHP’s will be classified as “metal plans” designated by how comprehensive the plan benefits are. Plan designations, in order from highest to lowest are as follows: platinum, gold, silver, bronze, & catastrophic. For South Carolina residents that qualify for subsidies, the subsidy amount will be based on the 2nd lowest cost silver plan.
Each county in South Carolina will have different rates. In addition, every county in SC will have either 27 or 32 Qualified Health Plans available. It is worth noting that there are no platinum plans offered on the Federal Marketplace in South Carolina.
Questions about Qualified Health Plans? Contact us today!