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% |