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Working Families & Individuals and Health Insurance Exchange

Benefits to help families and individuals obtain and keep health insurance coverage:

2011: Pertaining to individual plans, plans cannot:

  • Charge out of pocket costs for preventive services*
  • Cap lifetime benefits
  • Cancel or rescind a policy, except in the case of fraud
  • Refuse to cover a child's pre-existing condition*
  • Young adults may be covered on a parent's insurance plan until the age of 26, regardless of student, marital, residency, support, or tax status, unless the dependent has health insurance available through an employer
  • Young adults may be covered on a parent's health insurance plan until the age of 26, regardless of marital, student, residency, or tax status; only qualify if insurance is not offered by employee


  • Plans cannot refuse to provide coverage to those with pre-existing conditions
  • Plans must accept every employer and individual who applies for coverage (although they may create special enrollment periods)
  • Plans cannot require individuals to take a health questionnaire or deny them coverage because of their health condition
  • Individuals and families with household incomes below 400% of the federal poverty level may be eligible for subsidies to help buy coverage from their state's health insurance exchange, only if their employer does not offer coverage
  • Income based caps on out-of-pocket medical expenses take effect
  • Medicaid assistance will increase to serve those 133% and below of the federal poverty level
  • Those under the age of 30 purchasing on their own from the exchange, will have the option of purchasing a catastrophic coverage plan, designed specifically for their age group

Last Updated: Wednesday May 04 2011
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