New Essential Plan Variant: Essential Plan 200-250

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New Essential Plan Variant: Essential Plan 200-250


As of April 1, 2024, we began offering a new variant of the Essential Plan called Essential Plan 200-250. This is in addition to the existing Essential Plans 1-4. The new variant is nearly identical to Essential Plan 1; the only difference is the member’s maximum out-of-pocket expense. See the updated 2024 Summary of Companies, Lines of Business, Networks, and Benefit Plans for details on the Essential Plan.

This variant expands Essential Plan eligibility to individuals who have an annual income of 200 – 250% of the Federal Poverty Level (FPL). Prior to April 1, 2024, this annual income level would have qualified someone for an individual and family plan with a cost-share reduction, but they would still have a monthly premium. All Essential Plan variations, including the new Essential Plan 200-250, have no monthly premium or deductible and low-to-no cost-shares!


What this means for our providers

  • More members using the Enhanced Care Prime Network.
  • Reimbursement will be consistent with Essential Plan 1 and 2.
  • Simple administration with no referrals.


Benefits for members

Please share this with your staff and any patients you think can take advantage of the features of this new variant:

  • No monthly premiums and annual deductibles.
  • $2,000 maximum out-of-pocket.
  • No referrals required.
  • Preventive care at no cost.
  • Robust network with top hospitals.
  • Telemedicine at no cost with Teladoc® Primary360.
  • Gym reimbursement. Eligible members can earn up to $200 in reimbursement per six-month period (Jan. 1 – June 30 and July 1 – Dec. 31) each calendar year if they complete 50 workouts each period.
  • Wellness program.
Provider Update