The Patient Protection and Affordable Care Act (ACA) establishes four levels of coverage based on the concept of “actuarial value,” which represents the share of health care expenses a plan covers for a typical group of enrollees. As plans increase in actuarial value – bronze, silver, gold, and platinum – they would cover a greater share of enrollees’ medical expenses overall, though the details could vary across plans.

Since NCMS Plan coverage is available exclusively outside the Exchange, the metal-tier plan levels are not directly relevant. However, as members hear such terms as they relate to the Exchange, understanding how such plans correspond to their coverage in the NCMS Plan is important to compare apples to apples, so to speak.

Below you will find each NCMS Plan health product and its corresponding Actuarial Value. In addition, we have included a chart showing the metal-tiers and their corresponding Actuarial Value ranges. With this additional information, you can approximate the value of your NCMS Plan coverage in terms of a metal-tier.

If you have questions about the ACA and the NCMS Plan, please contact your agent consultant or our office at (800) 662-7917.

Updated on 5/12/2014

Product Name Est. Actuarial Value
PPO 750-80 81%
PPO 1000-80 79%
PPO 1500-80 76%
PPO 2000-80 73%
PPO 2500-80 71%
PPO 3500-80 69%
PPO 1750-70 71%
PPO 2500-70 68%
PPO 2000-60 68%
PPO 5000-60 68%
PPO 5000-90 61%
PPO 2500-60 66%
PPO 1-2-3 1000 78%
PPO 1-2-3 1500 75%
PPO 1-2-3 2000 69%
PPO 1-2-3 2500 68%
PPO 1-2-3 3500 67%
PPO Select 1000 76%
PPO Select 1500 73%
PPO Select 2500 69%
PPO Select 3500 68%
HDHP 1500-100 83%
HDHP 2700-80 66%
HDHP 2700-100 74%
HDHP 3500-100 69%
HDHP 5000-100 61%
HDHP 6350-100 56%
HRA 2500-100 78%
HRA 2700-80 66%
HRA 2700-100 74%
HRA 5000-100 66%
HRA 3500-50 64%
HRA 6350-100 58%

ACA Metal-Tier Actuarial Value Range
Bronze 58-62%
Silver 68-72%
Gold 78-82%
Platinum 88-92%