Qualified Health Plan (QHP) Law & Legal Definition


Qualified health plan (QHP) is a type of health insurance plan under which a self-insured employer elects to set up its own managed care program. QHP offers high quality medical care and timely access to medical services. Service under QHP is provided by the health care providers from a list of health-care providers participating in the employer's QHP.

Following is an example of a federal statute defining the term qualified health plan. Pursuant to 42 USCS § 18021 (a) (1) qualified health plan is a health plan that:

(A) has in effect a certification (which may include a seal or other indication of approval) that such plan meets the criteria for certification described in section 1311(c) [42 USCS § 18031(c)] issued or recognized by each Exchange through which such plan is offered;

(B) provides the essential health benefits package described in section 1302(a) [42 USCS § 18022(a)]; and

(C) is offered by a health insurance issuer that:

(i) is licensed and in good standing to offer health insurance coverage in each State in which such issuer offers health insurance coverage under this title;

(ii) agrees to offer at least one qualified health plan in the silver level and at least one plan in the gold level in each such Exchange;

(iii) agrees to charge the same premium rate for each qualified health plan of the issuer without regard to whether the plan is offered through an Exchange or whether the plan is offered directly from the issuer or through an agent; and

(iv) complies with the regulations developed by the Secretary under section 1311(d) [42 USCS § 18031(d)] and such other requirements as an applicable Exchange may establish.