Three goals: wider access, Medicaid expansion, lower-cost care delivery.

Guaranteed issue = no health underwriting, no preexisting condition exclusion.

Enrollment is still limited to open and special enrollment periods.

OEP = yearly window; no life change needed.

SEP in California: 60 days from the triggering event.

Losing coverage for nonpayment is NOT a triggering event.

Lost Medi-Cal: 90 days; Medi-Cal enrollment: any time.

Adults 19–64: up to 138% FPL.

Children under 19: up to 266% FPL.

138 = 133 + 5% disregard; 266 = 261 + 5%.

MAGI looks at income only; no asset test.

APTC: income up to 400% FPL (outline).

Calculated by Covered California; paid to the insurer.

Benchmark = second lowest cost Silver plan; usable with any tier.

Only for a QHP bought through the Exchange; reconciled on Form 8962.

CSR lowers cost sharing, not the premium.

138%–250% FPL (outline); Silver plan through the Exchange only.

Plan share rises to 94 / 87 / 73%.

QHP = Exchange-certified + EHB package + licensed issuer.

Issuer: at least one Silver and one Gold; same rate in every channel.

Every QHP is MEC; Medicare Part A is MEC but not a QHP.

Stand-alone dental (excepted benefit) is not MEC.

10 EHB categories; dental and vision only for children.

EHB rule: individual and small group, inside or outside the Exchange.

Bronze 60, Silver 70, Gold 80, Platinum 90.

California: actuarial value within plus or minus 2%.

Premium tax credits: QHP bought through Covered California only.

CCSB: up to 50 employees (outline).

Agents: complete Covered California agreements and certification first.

Dependent children: covered to the 26th birthday.

Before 26: no marriage, student, residency or support tests.

Disabled child: incapable of self-support AND chiefly dependent.

Aging out = COBRA for up to 36 months.

MLR = share of premium spent on care and quality improvement.

Outline: individual 80%, group 85%.

Miss it: pro rata rebate by September 30 of next year, market by market.