Plans must meet coverage standards

Small group plans sold after Jan. 1, 2014, must include  benefits in 10 categories, including prescription drugs and mental health and substance abuse services. 

Plans are labeled to help you understand the level of coverage you are buying. 

  • Bronze - The plan must cover 60 percent of expected essential health benefit costs for the average individual 
  • Silver - The plan must cover 70 percent of expected essential health benefit costs for the average individual 
  • Gold - The plan must cover 80 percent of expected essential health benefit costs for the average individual 
  • Platinum - The plan must cover 90 percent of expected essential health benefit costs for the average individual 

Insurers can sell more than one plan in each of the categories, although Oregon requires all insurers to sell one standardized bronze plan, one standardized silver plan, and one standardized gold plan. These plans will have similar benefits, making it easier to compare different companies based on price, provide networks, customer service, and other factors.

Limiting out-of-pocket costs: Small employer plans sold or renewed in 2014 must limit consumers' annual out-of-pocket costs (such as co-pays) to approximately $6,350 for individual and $12,700 for families. These limits will be indexed to average premium growth in future years.

Health Savings Accounts (HSA): Health Savings Accounts (HSA) are still allowed.

Lifetime coverage limits: Insurance companies cannot place a dollar limit on how much they cover over the lifetime of a member.

Annual coverage limits: For nongrandfathered plans issued or renewed on or after Jan. 1, 2014, annual dollar limits on coverage of essential benefits is prohibited.

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cp.ins@state.or.us

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