Passed in 2010, the Affordable Care Act is a new health care law designed to give people more ways to get health insurance. There are five important parts of the new law:
If you already have health insurance, you may not experience any changes. Or, you may find insurance that covers additional benefits. If you do not have health insurance because of a pre-existing condition or for financial reasons, you will find there are more affordable options available to you.
Under the new law, most individuals will be required to have health insurance in 2014. If you do not have it, you may have to pay a penalty on your federal income tax return.
Premium tax credits assist with up-front payments to offset the monthly cost of health insurance. Individuals and families with incomes between 100% and 400% of the Federal Poverty Level (FPL) who purchase coverage in the newly established Health Insurance Marketplace may qualify.
Advance payments are made directly to the insurance company that the individual chooses, with individuals responsible for the remaining premium. The credits are delivered in advance so that individuals do not have to pay the full premium and wait to be reimbursed.
Yes. Under the Affordable Care Act, health plans like Community will offer health coverage, regardless of pre-existing medical conditions, starting in January 2014.
Yes. Your adult children can be covered under your plan until they are 26 years old or can apply for coverage on their own.
Community Health Choice will include benefits considered to be essential to good health. The Affordable Care Act defines these as essential health benefits. Essential health benefits include:
A full list of Community Health Choice plan benefits and rates are available under the Benefits and Coverage section.
You have 30 days from when you first sign up for your plan to make your first payment. You can expect to receive your first invoice 3-5 business days after you sign up for your plan.
You do not have coverage until you make this first payment.
If you do not make your first payment within 30 days, you will be dis-enrolled from your health plan.
Your premium is due before the first of each month. After that, it is considered late. This payment is for the upcoming month of coverage.
For example, a payment that you make on February 28th is for March coverage.
A deductible is the amount you must pay for health care expenses before insurance covers any costs. If your plan has a deductible, it must be met each year before coverage begins.
For Members with Bronze deductible plans, Community offers three visits to a Primary Care Physician (PCP) at the plan’s copay cost before the deductible is met.
A fixed fee that you pay for health care services and products (such as doctor visits and pharmaceutical prescriptions).
The amount you must pay for health care expenses before insurance covers the costs. Sometimes, a health insurance plan will have a yearly deductible that you must meet before coverage begins.
The amount you must pay for health care expenses after your deductible has been met. Coinsurance amounts are shared amounts between the health insurance carrier and you. Your portion of the coinsurance is paid until your out-of-pocket maximum is met for the year.
Example: Joe has insurance that pays 80% of medical expenses. Joe has a doctor visit. The visit cost is $100. Joe pays $20 (coinsurance amount) and his insurance pay $80.
This is the maximum amount you will pay out of your own pocket in a year for covered health care expenses. Typically, after your out-of-pocket maximum expense limit is met, the plan pays 100% of all covered services for the remainder of the year.
A specified period of time when you can enroll in an insurance plan.
A Provider who is contracted with the health plan to provide services to plan Members for specific, pre-negotiated rates.
A Provider who is not contracted with the health plan.
A health care condition that existed before insurance coverage begins
A health care professional (usually a physician) that is responsible for monitoring your overall health care needs.
A health care professional who specializes in one area of medicine. For example, a cardiologist is a doctor who specializes in heart conditions.