Private Health Plans Under the ACA: In Brief

Summary

This report provides short descriptions of health plans that may be offered inside and outside of exchanges:

qualified health plans;

child-only plans;

multi-state plans;

health cooperatives;

catastrophic and other high deductible health plans;

stand-alone dental plans;

nongroup, small group and large group plans;

grandfathered plans;

self-funded (self-insured) plans;

union plans;

retiree-only plans; and

vision plans, ancillary insurance products, and limited-benefit plans.

In addition, this report indicates the applicability of select ACA market reforms to private health plans. The following market reforms are discussed in this report:

prohibition on lifetime dollar limits;

coverage of preventive health services with no cost-sharing;

extension of dependent coverage;

minimum medical loss ratio (MLR);

essential health benefits (EHBs);

minimum actuarial value (AV);

prohibition on annual dollar limits;

non-discrimination based on health status;

guaranteed issue and guaranteed renewability;

coverage of preexisting health conditions; and

rating restrictions.