Covered California Standard Benefit Plans

Why Standardize Benefit Plans?

Standardization lets consumers shop from one insurance company to the next knowing the benefits are the same and there will be no surprises or tricks. Covered California is leading the way for consumers to make apples-to-apples comparisons when choosing health coverage.

4 Coverage Tiers

The Covered California health insurance marketplace will offer four tiers of coverage options - platinum, gold, silver, and bronze - often referred to as the metals plans for obvious reasons. These options are based on the percentage of full actuarial value of benefits the plan is designed to provide, and are as follows: platinum 90%, gold 80%, sliver 70%, and bronze 60%. Additionally, a Minimum Benefit Plan is offered to those under 30 years of age. The chart below highlights some of the benefits in each of the 4 metal tiers.

2 Coverage Designs

Each metal plan will offer a choice of Copay Plan or Coinsurance Plan. Covered California Copay Plans are analogous to HMO plans, while Coinsurance Plans are PPO plans.

Overall Design Themes

• Simplicity: Consumers understand and prefer copays to coinsurance, so Covered California tried to substitute copays for coinsurance cost-sharing even within the coinsurance plans where possible (doc visits, emergency room, urgent care).
• Prevention: In addition to a free (0 copays, deductible waived) annual doctor visit for preventive care, Covered California has added one doctor visit per year to treat an injury or illness for copay only with deductible waived. The deductible is waived for the first 3 visits per year in the Catastrophic Plan.
• Transparency: In addition to the substantial transparency improvements afforded by the ACA, Covered California will make out-of-network benefits for Coinsurance Plans much more predictable than they are today.