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No Gimmicks, No Surprises - Standard Benefits

SACRAMENTO, Calif., Feb. 13, 2013 /PRNewswire/ -- Californians who must pay for their own health insurance are getting their first detailed look at what health care reform will truly offer. Covered California, the state run program that oversees implementation of the Affordable Care Act, is releasing the standards for benefit plans that will be made available to California citizens who do not rely on employer provided insurance or Medi-Cal for health care coverage.

"The most important aspect of these benefits is they are standardized and they are adjusted according to income to lower costs for those with lower incomes," said Peter V. Lee, Executive Director of Covered California. "Standardization is a game changer. It lets consumers shop from one insurance provider to the next, knowing that the benefits are the same. This is about removing barriers to care; about changing the focus of health insurance on prevention and on taking care of the sick."

"Covered California is leading the way for consumers to make apples-to-apples comparisons when choosing health coverage," said James Guest, President and CEO of Consumers Union. "Not only can consumers no longer be denied due to pre-existing conditions, they know there will be no surprises or gimmicks, and the benefits are the same from one carrier to the next."

Consumers have four levels of plans from which to choose – Bronze, Silver, Gold and Platinum. Households earning less than 250 percent of the federal poverty level can receive financial help if they enroll in a Silver plan; the less income they earn, the more financial assistance they can receive. For example, individuals earning between 150 to 250 percent of the federal poverty level can expect to pay $20 to see their primary care physician, while those earning 100 to 150 percent would pay $4.

" California has clearly learned from our experience. Massachusetts launched its health insurance exchange without standardizing benefits, but changed course after recognizing that allowing consumers to make apples-to-apples comparisons among plan options is critical to their ability to make informed decisions about what health plan satisfies their needs and meets their budget," said Jean Yang, Executive Director of Massachusetts Health Connector.

To be eligible for financial support, consumers must purchase plans from Covered California's marketplace.  The State of California is leading the health care innovation process by requiring that all carriers offer these same standard designs to all individuals and small businesses – whether inside or outside of Covered California. While higher income individuals choosing one of these plans would not be eligible for financial help, they would be assured that the plan contains the same essential health benefits offered, and the exact same benefit design so they can make true comparisons.

Examples of benefits, their costs, and typical premium costs are available on the newly launched Covered California website, The website will deliver up-to-date information for consumers, and access to resources during the lead up to the open enrollment period this fall for coverage that starts January 1, 2014. The website currently includes seven fact sheets, in both English and Spanish, and additional fact sheets are soon to be added, as well as translation of the material in 11 more languages.

Covered California also announced it has launched a social media presence on Facebook, Twitter, YouTube and Google+.

Critical next steps in the launch of Covered California include the selection of insurance carriers that will be allowed to participate in Covered California, and determination of the plan pricing.  

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