[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-355241-105":53,"doc-detail-355241-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","marketplace-health-plans-template-assessment-tool-october-2014","Marketplace Health Plans Template Assessment Tool - October 2014","","Marketplace Health Plans Template Assessment Tool (October 2014) provides a step-by-step method to evaluate qualified health plans (QHPs) offered through state and federally run Marketplaces. It supports low-income individuals and service providers to compare premiums, cost-sharing, provider networks, inpatient and outpatient coverage, medications, specialty services, and overall affordability. It also equips advocates to monitor plan adequacy for vulnerable populations and to identify potential discriminatory insurance practices in ways that may violate the ACA, enabling flagging for monitoring and enforcement.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/marketplace-health-plans-template-assessment-tool-october-2014/355241/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/marketplace-health-plans-template-assessment-tool-october-2014/355241.png","ImageObject",442,249,{"name":88,"@type":89},"Elsa","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-22","2026-09-22",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",7,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What is the purpose of this assessment tool for qualified health plans (QHPs)?","Question",{"text":109,"@type":110},"The tool guides assessment of QHPs both to help consumers choose plans that fit care needs and affordability, and to help advocates evaluate adequacy for vulnerable populations and monitor potential ACA-related discriminatory practices.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"Which QHP elements does the tool analyze in a step-by-step way?",{"text":114,"@type":110},"It analyzes premium and cost-sharing requirements, outpatient services/provider networks, inpatient services, medications, specialty services, and potential discriminatory insurance practices.",{"name":116,"@type":107,"acceptedAnswer":117},"How do “metal” levels affect cost-sharing in Marketplace QHPs?",{"text":118,"@type":110},"Metal levels (bronze, silver, gold, platinum) correspond to expected percentages of healthcare costs covered by the plan versus the consumer, with higher metal levels generally covering a larger share and requiring less consumer cost-sharing.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},355241,1791259893,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":40,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":141},137455077381,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Marketplace Health Plans Template Assessment Tool  \nOctober 2014  \nBeginning in January 2015, state and federal Marketplaces (aka exchanges) will again offer a range of insurance plans called qualified health plans (QHPs) . As uninsured individuals begin to enroll in these plans in November 2014, it will be critical that each is able to select a plan that includes current health care providers and affordably meets his/her healthcare needs. This tool is designed to guide assessment of QHPs in two ways.  \nFirst, it aims to assist low-income individuals and their health and social service providers in selecting a QHP that best meets their care and treatment needs. This tool highlights areas of a QHP that will significantly affect access to and cost of care. QHPs are available on state Marketplace websites. For federally run Marketplaces, [visit](visit www.healthcare.gov to)[ ](visit www.healthcare.gov to)[www.healthcare.gov](visit www.healthcare.gov to)[ to](visit www.healthcare.gov to) find plan offerings.  \nSecond, this tool is meant to build capacity among advocates in assessing the adequacy of QHPs for vulnerable populations. In the past, private health plans have not met the needs of lowincome individuals and families, especially those living with complex chronic health conditions or disabilities. Now that more people with lower incomes and complex health conditions will join the private market, insurance companies will need to build plans that are somewhat different from the ones in the past. For example, although the Affordable Care Act (ACA) prohibits discrimination on the basis of health status, plans may still be designed to attract the healthiest consumers. To maximize the potential of QHPs to meet care and treatment needs, advocates will need to monitor new plans to ensure their adequacy for all consumers, especially those with more significant healthcare needs. To help advocates with monitoring, this tool highlights areas where a QHP may violate the ACA’s prohibition on discrimination. This is intended to help advocates identify discriminatory practices in plans in order to flag them for monitoring and enforcement by the state or federal government.  \nThis tool is designed to guide a step-by-step analysis of the following elements in any given QHP:  \n1. premium and cost-sharing requirements  \n2. outpatient services / provider networks  \n3. inpatient services  \n4. medications  \n5. specialty services  \n6. potential discriminatory insurance practices  \nBACKGROUND ON HEALTH INSURANCE PLANS  \nHealth insurance plans each have different provider networks and cover different health benefits. Plans also charge different monthly premiums and require consumers to pay different costs for healthcare services and treatments. These costs include co-pays, co-insurance, and deductibles, which can apply to provider visits, drugs, and procedures. The following terms are essential to understand as they determine the adequacy and affordability of a plan:  \n• Premium: monthly fee an insurance plan charges for plan membership  \n• Co-pay: a set fee a consumer pays for each provider visit, prescription refill, lab test, or other healthcare service (e.g., $10, $20, or more)  \n• Co-insurance: a percentage of the cost of the healthcare service that the consumer must pay (e.g., 30% of the cost of a provider visit or of a procedure)  \n• Deductible: a set annual amount of consumer spending the consumer must pay before the insurance plan pays for any of the costs of care (e.g., $2,500)  \n• Out-of-pocket (OOP) maximum: a limit on the total amount of money a plan can require the enrollee to pay for healthcare (in co-pays, co-insurance, and deductibles) during a single year  \n• Subsidy: money that the government pays directly to a health plan in order to reduce a consumer’s premiums and out-of-pocket costs  \n• Provider network: the healthcare providers that a health plan contracts with, making them available to provide care to the plan’s enrollees  \n•","cbCaiufrrm7nv7Yf","https://ap.wps.com/l/cbCaiufrrm7nv7Yf","pdf",194590,"English","# Step-by-Step QHP Assessment Approach\n## Goals: consumer support and advocate capacity building\n## Background on health insurance plan structure\n## Core terms for assessing affordability and adequacy\n## Premium and cost-sharing limits (metal levels)\n## Out-of-pocket maximums and subsidy context","[{\"question\":\"What is the purpose of this assessment tool for qualified health plans (QHPs)?\",\"answer\":\"The tool guides assessment of QHPs both to help consumers choose plans that fit care needs and affordability, and to help advocates evaluate adequacy for vulnerable populations and monitor potential ACA-related discriminatory practices.\"},{\"question\":\"Which QHP elements does the tool analyze in a step-by-step way?\",\"answer\":\"It analyzes premium and cost-sharing requirements, outpatient services/provider networks, inpatient services, medications, specialty services, and potential discriminatory insurance practices.\"},{\"question\":\"How do “metal” levels affect cost-sharing in Marketplace QHPs?\",\"answer\":\"Metal levels (bronze, silver, gold, platinum) correspond to expected percentages of healthcare costs covered by the plan versus the consumer, with higher metal levels generally covering a larger share and requiring less consumer cost-sharing.\"}]","Marketplace Health Plans Template Assessment Tool - October 2014 | PDF",1790117010,6]