Healthcare Reform

Information for Individuals and Families

The healthcare reform law, known as the Affordable Care Act (ACA), can be somewhat confusing; especially when it comes to determining what changes will impact you and/or your family.

At SummaCare, we want to help you understand your options when it comes to health insurance. Our goal is to provide you with the resources and tools you need to choose health insurance coverage that is right for you, your family, your needs and your budget.

Quality Coverage Focused On You

SummaCare has already implemented numerous provisions of the ACA, including:

  • Coverage of adult dependents up to age 26 (under federal and state law). 
  • Coverage of certain preventive services at 100 percent including mammograms, immunizations and well-child care visits
  • Coverage of additional women’s preventive services at 100 percent (effective for new and/or renewing members as of August 1, 2012)
  • Elimination of lifetime limits of coverage
  • Regulation of annual limits of coverage
  • Distribution of Summary Benefits of Coverage documents (SBCs) to help you better understand your benefit plan 
  • To ensure that consumers have adequate coverage, all non-grandfathered health plans in the individual and small group market (groups up to 50 employees) must cover 10 categories of essential health benefits (EHBs) as created and defined by the ACA. Consumers will have access to these benefits on their effective or renewal date on or after January 1, 2014. The 10 categories are:
  • 1. Ambulatory patient services 
    2. Emergency services 
    3. Hospitalization 
    4. Maternity and newborn care 
    5. Mental health and substance use disorder services, including behavioral health treatment 
    6. Prescription drugs 
    7. Rehabilitative and habilitative services and devices
    8. Laboratory services 
    9. Preventive and wellness services and chronic disease management 
    10. Pediatric services, including oral and vision care
Important Information about Individual Coverage
  • On October 1, 2013 the Health Insurance Marketplace opened as an option for shopping and purchasing health insurance. SummaCare offers individual health insurance plans on the Health Insurance Marketplace. 
  • SummaCare has a shopping site - www.MySummaCare.com - that makes it easy for individuals to get a quote, view plan options and apply for financial assistance in the form of a subsidy.  Our shopping site is integrated with the Health Insurance Marketplace, making it a one-stop destination for shopping and purchasing individual coverage.
  • Also under the ACA, all individuals will be required to have health insurance or pay a tax penalty. Individual health insurance plans are effective through the end of a calendar year.  This means you must shop for and purchase individual health coverage each year during the open enrollment period.
  • The enrollment period to shop for and purchase individual health insurance coverage is November 15, 2016 through January 31, 2017. This means that in order to secure coverage for 2017, you must purchase a plan within this enrollment period.
  • Between February 1 and November 14, you can only enroll in a plan if you have a qualifying event that creates a Special Enrollment Period (SEP). Learn more about qualifying life events that create a special enrollment period here.

Please check www.healthcare.gov for updates and news regarding ACA mandates that may impact how you shop for and purchase health insurance coverage. 


The information contained in this section is provided for informational purposes only. 

Learn more about health insurance by watching Health Insurance Explained: The YouToons Have it Covered, written and produced by the Kaiser Family Foundation.