How does a health plan become a state-qualified health plan?
A health plan becomes a state-qualified health plan when it is qualified by the state government, State Department of Insurance. To be considered for qualification by the state, the health plan must agree to four consumer protections specified in the Trade Act which created the HCTC. The four criteria are: 1. Guaranteed issue: qualifying individuals are guaranteed enrollment regardless of their medical status. 2. No preexisting condition exclusion: insurance companies must cover all of your illnesses. 3. Non-discriminatory premium: the health plan must have the same cost for all members, regardless of HCTC participation. 4. Same benefits for both HCTC and non-HCTC recipients. It is the state’s decision to qualify a plan. Even if a health plan meets the above criteria, a state may choose not to qualify it. Every state is different. For more detailed information visit the State Departments of Insurance page.
