A TRUSTED INDEPENDENT HEALTH INSURANCE GUIDE SINCE 1999.
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Featured

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13 qualifying life events that trigger ACA special enrollment
Outside of open enrollment, a special enrollment period allows you to enroll in an ACA-compliant plan (on or off-exchange) if you experience a qualifying life event.

Latest News & Topics

Latest News & Topics

Featured

Featured
Finalized federal rule reduces total duration of short-term health plans to 4 months
A finalized federal rule will impose new nationwide duration limits on short-term limited duration insurance (STLDI) plans. The rule – which applies to plans sold or issued on or after September 1, 2024 – will limit STLDI plans to three-month terms, and to total duration – including renewals – of no more than four months.
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formulary

What is a formulary?

healthinsurance.org health insurance glossary

What is a formulary?

A formulary is a list of all the drugs covered by a health insurance plan. Health plans have different formularies, which means that a particular drug might be covered by one plan in your area, but not by another. Rebates from drug manufacturers to health plans’ pharmacy benefits managers can also affect which drugs end up on the formulary and into which drug tier they’re placed.

 
However, the ACA imposed some minimum standards on all new individual and small-group plans in an effort to ensure that their formularies are robust and non-discriminatory:
  • The formularies must include at least one drug in every United States Pharmacopeia (USP) category and class, OR the same number of drugs in each USP category and class as the state’s benchmark plan.
  • And since 2017, the formulary creation process has been required to be guided by the recommendations of a pharmacy and therapeutics committee.

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