Qualified Health Plan

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A qualified health plan is a type of health insurance plan that meets certain standards and requirements set by the Affordable Care Act (ACA). To be considered a qualified health plan, a plan must:

  • Offer a set of essential health benefits, which include coverage for things like hospitalization, prescription drugs, and preventive care
  • Limit out-of-pocket costs for essential health benefits
  • Meet certain standards for cost-sharing, such as deductibles and copayments
  • Be offered through the ACA’s Health Insurance Marketplace (also known as the “exchange”) or be a grandfathered health plan

Qualified health plans are required to cover a minimum percentage of the costs of covered benefits, and they must provide a Summary of Benefits and Coverage (SBC) that clearly explains the plan’s benefits, coverage, and costs. Qualified health plans may be offered by insurance companies, employer group plans, or other organizations, and they may be available to individuals, families, and small businesses.

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