California Healthcare Foundation: Individual Coverage Under the ACA: California vs. Federal Provisions

Since passage of the federal Affordable Care Act (ACA) in 2010, California has enacted implementing state legislation in key areas, including establishment of a state-administered exchange, health insurance premium rate review, benefit standards and cost-sharing limits, and detailed rules for the offering and sale of private coverage to individuals and small groups. California developed ACA implementing legislation in the context of pre-existing state laws and programs, requiring policymakers to analyze and reconcile state and federal standards.

This overview compares California law and the ACA affecting the offer and sale of individual health insurance effective January 1, 2014. The following key topics are covered in the comparative table:

  • Availability of coverage including guaranteed issue, prohibited eligibility factors, prohibited exclusions and limitations, and exceptions to guaranteed issue
  • Enrollment periods including open enrollment, special enrollment, and coverage effective dates
  • Renewal of coverage including guaranteed renewability
  • Rates and rating factors including risk pooling and regulatory rate review
  • Limited benefit and special programs including excepted benefits and guaranteed issue programs
  • Consumer protections including marketing prohibitions, notice of coverage options, notice of grandfathered plan status, and other issuer disclosures
  • Monitoring and oversight including regulatory reports and review, and state contingencies

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  • LAAAC is managed by St. Barnabas Senior Services; Funded, in part, by Archstone Foundation.
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