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Frequently Asked Questions

 

What is private exchange?
An exchange is an online tool for individuals and families to purchase health insurance and other products. It permits easy comparison of price, benefits and services for plans in your area.

 

How long will this take?

The exchange is designed to make shopping and enrolling a quick process. Most individuals can complete their health insurance purchase in 10 minutes or less (excludes eligibility check for subsidy plans). The steps are outlined under “Getting Started”.

What is the difference between subsidy and non-subsidy plans?
Subsidyplans allow individuals to potentially receive financial help with their health insurance premiums and a cost share reduction for copays, deductibles and out-of-pocket expenses. You must complete an eligibility check to validate, however, you will receive an estimate of subsidy based on the household size and income you enter during the quoting process.

Non-Subsidyplans will not reflect reduced premium or other reduced costs and do not require an eligibility check in order to enroll.

 

Both plan types are qualified health plans and meet all the affordable care act requirements. It is possible to see carriers or plans available in one type but not the other.

 

How do I know if I am eligible for a subsidy plan?

Individuals eligible for a subsidy (cost sharing reduction) must have a household income between 100-250% of the federal poverty level. You can select subsidy plans and enter your household income and size for an estimate of subsidy amount. Refer to the Subsidy page under Medical to determine if you may be eligible for assistance before making this selection.


When is the open enrollment period for the exchange?
The open enrollment period for will be held annually from November 1st – December 15th. These dates are subject to change.

Is the open enrollment period the only time individuals can enroll in a health plan?
No. If you experience a qualified life event such as loss of job, marriage, birth of a child, you will have a 60-day special enrollment period to enroll in healthcare. However, to avoid penalties for not enrolling in coverage, it is important to do so during the open enrollment period.

 

For a complete list of QLEs and SEPs rules, please visit www.healthcare.gov.

What are metal tiers?

Plans in each category pay different average of total costs of an average person’s care..

  • Bronze: Your health plan pays 60% on average. You pay about 40%.
  • Silver: Your health plan pays 70% on average. You pay about 30%.
  • Gold: Your health plan pays 80% on average. You pay about 20%.
  • Platinum: Your health plan pays 90% on average. You pay about 10%.
  • Catastrophic: Catastrophic coverage plans pay less than 60% of the total average cost of care on average. They’re available only to people who are under 30 years old or have a hardship exemption.

If I have questions regarding benefits, who should I call?

Please contact the insurance carrier directly if you have questions regarding benefits or subsidy eligibility. Click here for a complete listing.

 

If I have a question regarding the quoting platform who should I contact?

Click here for a shop, compare and enrollment tutorial.

 

How will I know my coverage is in effect?

The insurance carrier will notify you when your coverage is approved. To verify benefits we encourage you or your provider to contact the insurance carrier directly. Click here for complete listing.

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     Getting Started

Purchasing insurance on this exchange can be done in a few simple steps:

1.  Select desired Insurance Types and complete the quote request form.

2.  Add spouse, child and other dependent information.

3.  Review product(s) plans, rates and details and make your selections.

4.  Accept Terms & Conditions and enroll.

 

Note:  For Subsidy plans, you will need to complete an eligibility check before you can complete step 4.

 

You will also be asked what portion of your APTC (subsidy) you want to apply towards your premium.  You may select 0 or up to the full amount.  Unused portions may be claimed as a tax credit.  

 

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