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Preexisting conditions
You can’t be denied a health plan or charged more on HealthCare.gov because of a preexisting health condition or disability.
When deciding how much to charge, plans can only use your age, where you live, whether you smoke or use tobacco, and whether you're buying coverage for yourself or your family.
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Essential health benefits
Health plans must cover 10 categories of essential health benefits. Plans generally cover all care that’s considered medically necessary. TDI and federal regulators review these plans to make sure they offer the protection consumers expect.
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Financial protection
Plans have a maximum out-of-pocket limit that caps the amount you’ll pay if you need a lot of health care services.
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Children included
Children can stay on their parents' plans until age 26. They don't have to live at home, be in school, or be a dependent on their parents’ tax return. Children with disabilities can get coverage after age 26. Dependent grandchildren can get coverage up to age 25.
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How to appeal
Plans have a process to appeal if they deny a health care claim or preauthorization request for medical reasons. If you appealed with your health plan and you're not satisfied, you can request an external review.
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