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Health Insurance Glossary

Definitions for common health insurance terms

qualified health plan

DEFINITION: Under the ACA, the designation of qualified health plan (QHP) is given to health insurance plans that are sold in the marketplace (exchange).  The same basic rules apply to plans sold both in and out of the exchanges:  they must be guaranteed issue, follow the ACA’s cost-sharing guidelines, and cover “essential health benefits” with no lifetime or annual maximums.

But in order to be sold in the exchanges, a health plan must also be certified by the exchange as a qualified health plan.  In the spring of 2013, health insurance carriers in each state submitted plan designs and pricing to the exchanges – the ones that were approved are considered QHPs.  The QHP label is basically an extra layer of consumer protection, one that makes shopping in the exchanges a good idea even for people who don’t qualify for subsidies.