Individual Health Coverage
INDIVIDUAL ESSENTIAL HEALTH BENEFITS
- Ambulatory Patient Services
- ER Services
- Hospitalization
- Maternity and Newborn Care
- Mental Health and Substance Use Disorder Services, including Behavioral Health Treatment
- Prescription Drugs
- Rehab Services
- Lab Services
- Preventative Wellness Services
- Pediatric Services, including Oral and Vision Care
GUARANTEED ISSUE INDIVIDUAL MARKET (*Beginning January 1st, 2014 Individual NGF)
- All Individual policies will be guaranteed issue with no pre-existing waiting period for all Under 65 individual products.
- No declinations or exclusion riders.
- One annual open enrollment period, otherwise off open enrollment for qualifying events only.
- Rating will be based Community Rating, no Health Rating.
COMMUNITY RATINGS
- Family Size
- Geographic Location
- Smoker Status (1:1.50 Ratio or 50% Rate-Up)
- Age (3:1 Ratio) - No Rating for Health or Gender