Individual Coverage Under the ACA: California vs. Federal Provisions
December 2, 2013
Kelch Policy Group
Since passage of the federal Affordable Care Act (ACA) in 2010, California has enacted implementing state legislation in key areas, including establishment of a state-administered exchange, health insurance premium rate review, benefit standards and cost-sharing limits, and detailed rules for the offering and sale of private coverage to individuals and small groups. California developed ACA implementing legislation in the context of pre-existing state laws and programs, requiring policymakers to analyze and reconcile state and federal standards.
This overview compares California law and the ACA affecting the offer and sale of individual health insurance effective January 1, 2014. The following key topics are covered in the comparative table:
Availability of coverage including guaranteed issue, prohibited eligibility factors, prohibited exclusions and limitations, and exceptions to guaranteed issue
Enrollment periods including open enrollment, special enrollment, and coverage effective dates
Renewal of coverage including guaranteed renewability
Rates and rating factors including risk pooling and regulatory rate review
Limited benefit and special programs including excepted benefits and guaranteed issue programs
Consumer protections including marketing prohibitions, notice of coverage options, notice of grandfathered plan status, and other issuer disclosures
Monitoring and oversight including regulatory reports and review, and state contingencies
The complete table is available as a Document Download.