The plans in the Exchange will be offered in a tiered format. The tiers are named after metals:
- Platinum – 90% coverage
- Gold – 80% coverage
- Silver – 70% coverage
- Bronze – 60% coverage
Each tier will have several plans to choose from and will include essential health benefits. Bronze plans will have the lowest monthly premium, but cost shares will be more when health care services are provided. Platinum plans will have the highest monthly premium, but cost shares will be less.
All plans must include “essential health benefits” as defined by the health care reform law. Specifically, the plans must include items and services from at lease these 10 categories of care:
Ambulatory patient 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
