Health plans, rates for Delaware Health Insurance Marketplace announced

The Delaware Department of Insurance announced Sept. 19 the companies that will participate in the Delaware Health Insurance Marketplace and the 19 qualified health plans being offered to uninsured Delawareans. There are three companies offering coverage in the individual marketplace and two companies offering coverage in the small business health options program. Also, three companies will be offering dental coverage in Delaware.

Beginning Oct. 1, Delawareans will be able to go to the health insurance marketplace website and see the plans available to them and the pricing for each plan. They will also be able to determine their eligibility and amount of tax credit or federal subsidy and calculate the net cost of coverage.

Insurance Commissioner Karen Weldin Stewart said, “The Delaware Department of Insurance, The Delaware Department of Health and Social Services and the insurance companies participating in our marketplace have worked extremely hard to create a robust market that includes many options at affordable rates.”

Coverage under the plans begins Jan. 1, 2014, and the open enrollment period runs from Oct. 1, 2013 through March 31, 2014. The companies offering plans in the individual market in Delaware through the health insurance marketplace are Coventry Health Care, Coventry Health and Life, and Highmark Blue Cross/Blue Shield of Delaware.

For the SHOP, businesses will be able to select from 11 qualified health plans. Businesses with less than 25 employees may take advantage of the 50 percent premium tax credit, as long as 50 percent of the premium is paid by the small employer. The companies participating in the SHOP marketplace are Coventry Health Care and Highmark Blue Cross/Blue Shield of Delaware. The companies offering dental coverage in the Delaware marketplace are Delta Dental, Dentegra and Dominion.

The Delaware Health Insurance Marketplace will offer an array of plans from which to choose: bronze, silver, gold, platinum and catastrophic. As the level of coverage increases, consumers will pay smaller deductibles but larger monthly premiums. The plans will include the essential health benefits mandated in the Affordable Care Act and benefits contained in the benchmark plan selected by The Delaware Healthcare Commission.

For the first time, Delawareans will be able to purchase coverage without concern of being denied due to preexisting medical conditions. Also, consumers will not have to be concerned with running out of benefits based on annual and lifetime benefit limits placed on them from insurance carriers. People who purchase on the individual market will have the opportunity to make the cost of coverage more affordable by utilizing the premium tax credit, known as the federal subsidy. This tax credit is available to those who are between 138 percent and 400 percent of the federal poverty level.

Premiums cannot exceed 9.5 percent of the individual’s adjusted gross income. Also, those between 138 percent and 400 percent of the federal poverty level may be eligible for cost-sharing reduction. Cost-sharing reductions are deductibles, coinsurance, and copays.

The Department of Insurance will be responsible for assuring the companies are in compliance with all the certification standards adopted for the Delaware marketplace.

To learn more about the qualified health plans, the rates being offered in the Delaware health insurance marketplace, and examples and scenarios of premium rates including the advanced payment tax credits, go to www.delawareinsurance.gov/health-reform/DE-QHP_Ind_and_SHOP_PlanYear2014Overview.pdf