are the tiers you point out.....the only tiers, in that, the only coverage allowed?
follow the trail....
the law provides a tax penalty for persons who do not have "acceptable health care coverage"....
Page 167
18 ‘‘SEC. 59B. TAX ON INDIVIDUALS WITHOUT ACCEPTABLE
19 HEALTH CARE COVERAGE.
20 ‘‘(a) TAX IMPOSED.—In the case of any individual
21 who does not meet the requirements of subsection (d) at
22 any time during the taxable year, there is hereby imposed
23 a tax equal to 2.5 percent of the excess of—
1 ‘‘(1) the taxpayer’s modified adjusted gross in2
come for the taxable year, over
3 ‘‘(2) the amount of gross income specified in
4 section 6012(a)(1) with respect to the taxpayer.
acceptable health care coverage is defined as...
Page 171
21 ‘‘(A) QUALIFIED HEALTH BENEFITS PLAN
22 COVERAGE.—Coverage under a qualified health
23 benefits plan (as defined in section 100(c) of
24 the America’s Affordable Health Choices Act of
25 2009).
1 ‘‘(B) GRANDFATHERED HEALTH INSUR2
ANCE COVERAGE; COVERAGE UNDER GRAND3
FATHERED EMPLOYMENT-BASED HEALTH
4 PLAN.—Coverage under a grandfathered health
5 insurance coverage (as defined in subsection (a)
6 of section 102 of the America’s Affordable
7 Health Choices Act of 2009) or under a current
8 employment-based health plan (within the
9 meaning of subsection (b) of such section).
10 ‘‘(C) MEDICARE.—Coverage under part A
11 of title XVIII of the Social Security Act.
12 ‘‘(D) MEDICAID.—Coverage for medical as13
sistance under title XIX of the Social Security
14 Act.
15 ‘‘(E) MEMBERS OF THE ARMED FORCES
16 AND DEPENDENTS (INCLUDING TRICARE).—
17 Coverage under chapter 55 of title 10, United
18 States Code, including similar coverage fur19
nished under section 1781 of title 38 of such
20 Code.
21 ‘‘(F) VA.—Coverage under the veteran’s
22 health care program under chapter 17 of title
23 38, United States Code, but only if the cov24
erage for the individual involved is determined
25 by the Secretary in coordination with the
8 ‘‘(G) OTHER COVERAGE.—Such other
9 health benefits coverage as the Secretary, in co10
ordination with the Health Choices Commis11
sioner, recognizes for purposes of this sub12
section.
private insurance needs to fit into A)QUALIFIED HEALTH BENEFITS PLAN
a qualified health benefits plan is defined
Page 13
4 (20) QUALIFIED HEALTH BENEFITS PLAN.—
5 The term ‘‘qualified health benefits plan’’ means a
6 health benefits plan that meets the requirements for
7 such a plan under title I and includes the public
8 health insurance option.
so, what are the requirements for such a plan under Title I....Title I begins at page 14 and continues through page 71
everything on pages 14 through 71 must be in every insurance policy sold..whether inside the exchange or outside the exchange.
private companies are not required to participate in the exchange, but if they wish to sell insurance in the exchange it must comply exactly to the essential benefits. Any policies sold outside the exchange must have the essential benefits plus additional benefits. Page 25
essential benefits are defined starting on page 26
deductible is set at $5k on page 29
copayments for the basic plan (30%) are on page 30
enhanced (15%) and premium (5%) plans are defined on page 33
thus, all of the above is required for every insurance policy....
