Network Adequacy

A health plan certified by a health insurance exchange as meeting ACA standards and offered through that exchange. — A Qualified Health Plan is a health plan that is certified by an exchange — in California, Covered California — as meeting the standards of the Affordable Care Act, and that is offered through that exchange. Certification requires the plan to cover the essential health benefits, meet actuarial value requirements, and comply with network adequacy, rate, and consumer protection standards. Only exchange-certified QHPs make the purchaser eligible for premium tax credits. Employer self-funded plans, Medicare Advantage products, and short-term policies are regulated under different frameworks and are not QHPs sold on the exchange.

National insurance concept

A plan certified by the exchange as meeting ACA standards, covering essential health benefits, and offered through the marketplace — A qualified health plan (QHP) is a health plan that is certified by an exchange (in California, Covered California) as meeting the ACA's standards for coverage. A QHP must cover the essential health benefits, comply with cost-sharing and actuarial-value limits, and be offered through the marketplace. Certification is what makes the plan 'qualified' and eligible to receive premium tax credits on behalf of enrollees. QHPs may be offered at the Bronze, Silver, Gold, or Platinum metal levels. A QHP must also comply with the exchange's network adequacy, marketing, and transparency requirements, and only enrollees in a QHP may receive premium tax credits and cost-sharing reductions.

National insurance concept