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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


Will the SHOP and Individual Exchange Offer the Same QHPs?

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Question: Have you heard if the SHOP will offer the same qualified health plans as the individual exchange?

Answer: The Exchange Board is currently considering how closely aligned the Qualified Health Plans (QHPs) should be between the two Exchanges. Two general issues arise from the alignment question - one is the alignment of insurers and the other the alignment of benefit plans. It looks like the Exchange will go with “partial” alignment in both cases.

The following options are available for alignment of insurers between exchanges:

  • Option A1: Full alignment: Health plan issuers submit qualified health plan applications for participation in both individual and SHOP exchanges in the same geographic coverage regions, and contracts are only awarded to issuers that can serve both markets.
  • Option A2: Partial alignment: Health plan issuers submit applications for participation in both the individual and SHOP exchanges. However, the Exchange would permit health plans that only want to participate in one exchange on an exception basis.
  • Option A3: No required alignment: Health plans may participate in either Exchange.

The following options are available for the alignment of benefit plan offerings between exchanges:

  • Option B1: Full alignment: Benefit plan offerings would be identical in both exchanges.
  • Option B2: Partial alignment: Benefit plan offerings would generally be consistent in both exchanges, with the possibility of some differences to meet the needs of Individual and Small Group enrollees.
  • Option B3: No required alignment: Benefit plan offerings are unique to each Exchange.

The Exchange staff and consultants have made their preliminary recommendation to pursue partial alignment for both plans and benefit design (A2 and B2).

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