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Key Provisions About Coverage

Purchasing Coverage Through an Exchange

• Coverage is available to everyone, regardless of health status or preexisting conditions.
• Young adults up to age 26 can be covered under their parents’ plans.
• Individuals and small businesses can purchase health care coverage through the DC Health Benefits Exchange.
• Lifetime policy limits have been banned and annual limits will be phased out by 2014.
• Medicare has been strengthened, offering seniors better coverage and closing the prescription drug coverage donut hole.
• Medicaid has been expanded to provide more assistance for low-income families.
• Plans are required to offer coverage for certain essential benefits.
• Individuals are required to have minimal essential coverage.
• Employers with 50+ FTEs are required to offer coverage or pay a fine (effective Jan. 1, 2015).
• Small businesses with less than 25 employees may be eligible for tax credits when they provide coverage for employees.
• Coverage has been expanded for early retirees.

An individual will be eligible for enrollment in a “qualified health plan” (QHP) through an Exchange if he or she:

• Is a citizen, national or non-citizen lawfully present in the United States, and is reasonably expected to remain so for the entire period for which enrollment is sought;
• Is not incarcerated; and
• Resides in the state covered by the Exchange.

Regardless of whether an individual is eligible for the insurance affordability programs, he or she will still be eligible to enroll in a QHP through the Exchange as long as the basic eligibility requirements are met.

What This Means For Employers

Employees who meet the basic eligibility requirements for purchasing coverage through an Exchange will generally be permitted to waive employer-sponsored coverage and, instead, enroll in coverage through an Exchange. This is true regardless of:

• The employee’s household income;
• The employee’s employment status (full-time or part-time); or
• Whether the employee is eligible for other minimum essential coverage (such as coverage under a government-sponsored program or an eligible employer-sponsored plan).

An employee who is not eligible for the affordability programs may still be eligible to enroll in a QHP through an Exchange. However, this would not result in an employer mandate penalty for the employer.


For Immediate Release: Wednesday, November 13, 2013

Richard Sorian:

Mahlori Isaacs:

DC Residents, Businesses Show Strong Demand for Affordable, Quality Health Insurance

More than 1100 Account Holders Have Chosen Coverage for 2014
(Washington, DC) — The DC Health Benefit Exchange Authority today released new data showing strong interest by people and businesses in the District of Columbia in affordable quality health insurance. Between October 1 and November 13, DC Health Link had more than 84,272 unique visitors and 19,706 accounts were created to shop, compare, and choose a health insurance plan that meets ones needs and budgets. To date, 696 employer accounts have been created.