For Individuals & Families

What is it?

Insurance companies can no longer deny people health coverage because they have health problems (pre-existing conditions).

How does it work?

• Health insurance applications can no longer have questions about your health
• Everyone can get insurance regardless of their health
• Medical underwriting, the process of asking health questions to determine the "risk" for providing health insurance, has gone away

What is it?

Health insurance coverage guidelines to ensure there is adequate coverage and the same basic services are covered.

How does it work?

All new health plans must provide the following:

• 10 essential health benefits
  • Ambulatory patient services (outpatient)
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care
• No annual limits or lifetime dollar limits on the essential health benefits
• Preventive care and annual checkups at no out-of-pocket costs
• Certain coverage levels based on how much financial protection the health insurance policy will cover; coverage levels are bronze, silver, gold, and platinum

Type of Plan	What It Covers	You Pay	Premium Cost
Bronze	60 percent of the medical costs	40 percent of the medical costs	Lowest
Silver	70 percent of the medical costs	30 percent of the medical costs	Medium
Gold	80 percent of the medical costs	20 percent of the medical costs	High
Platinum	90 percent of the medical costs	10 percent of the medical costs	Highest

What is it?

A set time called Open Enrollment Period in which you must make your health insurance purchase.

How does it work?

• During open enrollment, you can make a plan change if you already have insurance, or you can enroll in a plan for the first time
• If you don't enroll during the annual Open Enrollment Period, you won't be able to have health insurance coverage until the next Open Enrollment Period. Unless a change occurs in your personal life, such as getting divorced or married or losing your employer coverage (called a qualifying event)
• The next Open Enrollment Period is Nov. 15, 2014, through Feb. 15, 2015

Special Enrollment Period

What is it?

If you did not enroll during the annual Open Enrollment Period, you may still be able to enroll in a plan if you have a qualifying event.

How does it work?

• Special Enrollment Period (SEP) is the period of time when Open Enrollment is closed.
• Qualifying events are changes that occur in your life, like getting married, moving, or losing your health insurance coverage
• In 2015, the Special Enrollment Period will begin February 16. Read more about the details of SEP.

What is it?

If you use tobacco, it will cost you more to buy health insurance.

How does it work?

• Insurance companies can charge people who use tobacco up to 50 percent more for health insurance
• If you use tobacco four or more times a week, you are considered a tobacco user; for example, smoking four cigarettes a week is considered tobacco use
• Tobacco use means all types of tobacco, including smokeless tobacco
• If you are eligible for a tax credit, you won't receive additional money because you use tobacco, which means your premiums will cost you more
• Programs are available to help you become tobacco-free with no out-of-pocket costs
• You won't be charged the surcharge after being tobacco-free for six months