Qualified Health Plans
California state law established the Covered California health insurance marketplac and directed it to “selectively contract with carriers so as to provide health care coverage choices that offer the optimal combination of choice, value, quality, and service” and to establish and use a competitive process to select the participating health plans.
Covered California QHP
A Qualified Health Plan (QHP) is a Covered California selected plan that offers an essential health benefits package and meets all other ACA requirements. Additionally, Cover California will strive for the ideal mix of health plans that best meet the Exchange’s goals of providing an appropriate range of high quality choice to participants at the best available price. There are a number of additional evaluation principles that Covered California will consider, including:
- Affirm that bid includes one of the standard plan designs for each metal tier.
- Confirm actuarial value for each plan submitted.
- Confirm geographic service area and rating region.
- Encourage delivery system reforms such as patient-centered medical homes, ACO, proven chronic disease management programs, effective quality and patient safety initiatives.
Covered California QHP Selection Benchmarks
- Evaluation and selection of winning responses by 3/30/2013
- Discussion and negotiation of final contract terms, conditions, and premium rates by 5/31/2013
- Execution of contracts with the selected QHP issuers 6/1/2013
Standardized Benefit Plan Designs Summary of Benefits and Coverage
Covered California has conducted discussion among health plan issuers, providers and consumer representatives about the details of the preliminary standardized benefit plan designs. The Exchange has created Co-Pay and Co-Insurance standard plans and restructured deductible types to accommodate HMO-capitated, delegated model operations. Designs consistently prefer co-pays over co-insurance to simplify consumer comparison even in the coinsurance plan. Standard benefit plan designs are ” platform neutral” which allows HMO bids for co-insurance if desired. Alternate benefit plan designs will be considered (one per issuer only), and will be closely scrutinized.