Qualified Health Plans (QHP) for Health Exchanges

Qualified Health Plans (QHP) for Health Exchanges

A “qualified health plan” is a health plan that

  • Agrees to charge the same premium whether the plan is sold through the Exchange or outside the Exchange
  • Agrees to offer at least one silver plan and one gold plan
  • Complies with other requirements of the Secretary and the Exchange
  • Is certified by each Exchange through which it is offered
  • Is offered by an issuer that is
  • Licensed and in good standing in each state in which it is offered
  • Provides the essential benefits package

A qualified health plan may offer coverage through a primary care medical home plan

A qualified health plan may vary premiums by rating area

A reference to a qualified health plan is also a reference to a Co-Op plan and a Multi-State plan

Minimum Coverage delivered by Qualified Health Plans (QHPs)

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance abuse disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

How can we Help?

We are committed to help QHPs with turn-key, 2 in 1 Technology + Services solutions to catch-up with Oct 1 dead-line around

  1. Enrollment & Eligibility
  2. Premium Billing & Collection
  3. Claims Admin & Adjudication
  4. Actuarial & Analytics
  5. Call Center


Manish K. Jaiswal



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425 Washington Blvd., Jersey City,
New Jersey 07302, USA

Phone: +1 201.258.4704 / 201.258.4704
Fax: +1 201.604.3480