Q: Are there any standards that health insurance companies in exchanges will have to follow, or will they be able to cover only what they want to?



All policies must cover “essential health benefits.” The law defines these benefits. They include a broad and comprehensive spectrum of health services, such as maternity care and prescription drugs. In addition, each state has selected a base plan for their exchange. This plan is intended to represent the most popular small group health insurance plan offered, and it will serve as the base model for all of the plans that will be offered in the exchange.

Higher tiered plans, such as Gold and Platinum, can offer additional benefits. These plans have different cost-sharing requirements for the insured individual.

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Linda V. Tiano

Member of the Firm at Epstein, Becker, and Green in Washington, DC and New York


David Randall

Senior Vice President of Strategic Planning and Business Development at the University of Alabama at Birmingham Health System.


Marti Lolli

Director of Health Care Reform at Priority Health in Michigan.

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