By 2014, all health insurance plans offered in the Exchange or out must abide by a new essential benefit package standard. Grandfathered plans will be exempt (see more below). The essential benefit package will provide a comprehensive set of benefits, including Ambulatory patient services (i.e. outpatient services), 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). In addition, an essential benefit package must cover 60 percent of the actuarial value of the covered benefits and limit annual cost-sharing to the current law HSA limits ($5,950/individual and $11,900/family).

There are four levels of coverage: Bronze, Silver, Gold, and Platinum. Each level requires the plan pay for a specified percentage of costs: Bronze (60% actuarial value), Silver (70%), Gold (80%), Platinum (90%). Secretary of Health and Human Services may issue regulations under which employer contributions to a health savings account may be taken into account in determining the level of coverage for a plan of the employer.

There is no bare-bones policy under the new law effective 2014. Unless you have a grandfathered plan, all other individuals must carry a health insurance policy that meets the requirements of essential minimum benefits package. However, individuals under 30 years and not using the tax credit to obtain coverage can enroll in a catastrophic plan to satisfy the individual responsibility requirement. The catastrophic plan is not minimum essential coverage and thus cannot be offered by an employer to meet health coverage requirements. A catastrophic plan must cover essential health benefits and at least 3 primary care visits, but must require cost-sharing up to the Health Savings Account out-of-pocket limits. Also, if an insurer offers a qualified health plan, it must offer a child-only plan (under 21) at the same level of coverage in the individual market.

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