Mental health & substance abuse coverage

All Marketplace insurance plans cover mental health and substance abuse services as an essential health benefit.

Mental and behavioral health services are essential health benefits

Health insurance plans available in the Marketplace must cover 10 categories of essential health benefits. One of these categories is mental health and substance abuse services. (Substance abuse is also known as substance use disorder.)

These services include behavioral health treatment, such as psychotherapy and counseling. They also include mental and behavioral health inpatient services and substance use disorder treatment.

Your specific behavioral health benefits will depend on the state you live in and the particular health plan you choose. You’ll see a full list of what each plan covers when you compare plans in the Marketplace.

Mental and behavioral health and pre-existing conditions

Marketplace plans can’t deny you coverage or charge you more just because you have a pre-existing condition. This includes mental health and substance use disorder conditions.

Coverage for treatment of pre-existing conditions begins as soon as your Marketplace coverage starts.

There’s no waiting period for coverage of these services.

No lifetime or yearly dollar limits for mental health services

Marketplace plans can’t apply yearly or lifetime dollar limits on coverage of essential health benefits. This includes benefits for mental health and substance use disorder services.

Parity protections for mental health services

Marketplace plans must provide certain “parity” protections between mental health and substance abuse benefits on the one hand, and medical and surgical benefits on the other.

This means that in general, limits applied to mental health and substance abuse services can’t be more restrictive than limits applied to medical and surgical services. The kinds of limits covered by the parity protections include:

  • Financial, like deductibles, copayments, coinsurance, and out-of-pocket limits
  • Treatment, like limits to the number of days or visits covered
  • Care management, like being required to get authorization of treatment before getting it

Breastfeeding benefits

The health care law requires most health insurance plans to provide breastfeeding equipment and counseling for pregnant and nursing women.

You may be able to get help with breastfeeding at no cost

Health insurance plans must provide breastfeeding support, counseling, and equipment for the duration of breastfeeding. These services may be provided before and after you have your baby.

These rules apply to Health Insurance Marketplace plans and all other health insurance plans, except for grandfathered plans.

Coverage of breast pumps

Your health insurance plan must cover the cost of a breast pump – and may offer to cover either a rental or a new one for you to keep.

Your plan may have guidelines on whether the covered pump is manual or electric, how long the coverage of a rented pump lasts, and when they’ll provide the pump (before or after you have the baby).

But it’s up to you and your doctor to decide what's right for you.

Your doctor’s breastfeeding recommendations

In many cases, your insurance plan will follow your doctor’s recommendations on what is medically appropriate. Some insurance plans may require pre-authorization from your doctor to ensure the proper services are provided. Talk to your doctor to find out what this means for you.

Contact your insurance plan for questions about your breastfeeding benefits.

Birth control benefits

Plans in the Health Insurance Marketplace must cover contraceptive methods and counseling for all women, as prescribed by a health care provider.

These plans must cover the services without charging a copayment or coinsurance when they’re provided by an in-network provider. This is true even if you haven’t met your deductible.

Covered contraceptive methods

All Food and Drug Administration-approved contraceptive methods prescribed by a woman’s doctor are covered, including:

  • Barrier methods (used during intercourse), like diaphragms and sponges
  • Hormonal methods, like birth control pills and vaginal rings
  • Implanted devices, like intrauterine devices (IUDs)
  • Emergency contraception, like Plan B® and ella®
  • Sterilization procedures
  • Patient education and counseling

Plans aren’t required to cover:

  • Drugs to induce abortions
  • Services related to a man’s reproductive capacity, like vasectomies

For more information about specific contraceptive services your plan covers, check your plan’s materials or ask your employer or benefits administrator.

Birth control benefits rules for employer-provided coverage

If you work for a religious employer

Health plans sponsored by certain exempt “religious employers,” like churches and other houses of worship, don’t have to cover contraceptive methods and counseling. If you work for an exempt religious employer and use contraceptive services, you may have to pay for them out-of-pocket. Contact your employer or benefits administrator for more information.

If you work for a non-profit religious organization

Some non-profit religious organizations (like non-profit religious hospitals and institutions of higher education that certify they have religious objections to contraceptive coverage) don’t have to contract, arrange, pay, or refer for contraceptive coverage.

  • If your health plan is sponsored or arranged by this type of organization, an insurer or third party administrator will make separate payments for contraceptive services that you use.
  • You’ll have access to contraceptive services without a copayment, coinsurance, or deductible when they are provided by an in-network provider.

Contact your employer or health plan for more information.

Dental coverage in the Marketplace

In the Health Insurance Marketplace, you can get dental coverage 2 ways: as part of a health plan, or by itself through a separate, stand-alone dental plan.

You can buy a dental plan through the federal Marketplace only when you enroll in a health plan.

Dental coverage is available 2 ways

  • Health plans that include dental coverage. In the Marketplace, dental coverage is included in some health plans. You can see which plans include dental coverage when you compare them.

    If a health plan includes dental coverage, you’ll pay one monthly premium for everything. The premium shown for the plan includes both health and dental coverage.

  • Separate, stand-alone dental plans. In some cases separate, stand-alone plans are offered. You may want this if the health coverage you choose doesn’t include dental coverage, or if you want different dental coverage.

    If you choose a separate dental plan, you’ll pay a separate, additional premium.

Adult and child dental insurance in the Marketplace

Under the health care law, dental insurance is treated differently for adults and children 18 and under.

  • Dental coverage for children is an essential health benefit. This means if you’re getting coverage for someone 18 or younger, dental coverage must be available as part of a health plan or as a stand-alone plan. While it must be available to you, youdon’t have to buy it.

  • This is not the case for adults. Insurers don’t have to offer adult dental coverage.

Under the health care law, most people must have health coverage or pay a fee. But this isn’t true for dental coverage. You don’t need to have dental coverage, even for children, to avoid the penalty.

Coverage for pre-existing conditions

Essential health benefits for pre-existing medical conditions are covered under all Marketplace plans.

  • No insurer can reject you, charge you more, or refuse to pay for essential health benefits for any medical condition you had before your coverage started.
  • This coverage includes pregnancy. If you get pregnant and then enroll in a Marketplace plan during Open Enrollment or with a Special Enrollment Period, care for your pregnancy and childbirth is covered when your new plan begins.
    Learn more about coverage for pre-existing conditions.

What Marketplace health plans cover

All private health insurance plans offered in the Marketplace offer the same set of essential health benefits. These are services all plans must cover.

The essential health benefits include at least the following items and services:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization (such as surgery)
  • Pregnancy, maternity, and newborn care (care before and after your baby is born)
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services

Additional benefits

Essential health benefits are minimum requirements for all plans in the Marketplace. Plans may offer additional coverage. You will see exactly what each plan offers when you compare them side-by-side in the Marketplace.

Additional benefits include:

Catastrophic health insurance plans

People under 30 and people with “hardship exemptions” may buy a "catastrophic" health plan. This type of plan has lower monthly premiums and mainly protects you from very high medical costs.

Protection from worst-case scenarios

A catastrophic plan generally requires you to pay all of your medical costs up to a certain amount, usually several thousand dollars. This limit is known as a deductible. After you reach your deductible, costs for essential health benefits are generally paid by the catastrophic plan.

Catastrophic plans usually have lower monthly premiums than a comprehensive plan. But they cover your costs only after you’ve used a lot of care. These plans basically protect you from worst-case scenarios like serious accidents or illnesses.

Catastrophic plans cover prevention and some primary care

In the Marketplace, catastrophic plans cover 3 primary care visits per year at no cost, even before you’ve met your deductible. They also cover free preventive services.

If you buy a catastrophic plan in the Marketplace, you can’t get premium tax credits or lower out-of-pocket costs based on your income. Regardless of your income, you pay the standard price for the catastrophic plan.

Catastrophic plans with a hardship exemption

  • People 30 and over with a “hardship exemption” may buy a catastrophic plan. Hardship exemptions from paying the fee are granted to people based on income or other factors that prevent them from getting coverage. Learn about the 14 types of hardship exemptions.
  • If you had an individual insurance plan that was cancelled and you believe other Marketplace plans aren't affordable, you may qualify for a hardship exemption. If you do, you can buy a catastrophic plan.

Learn if you qualify for a catastrophic plan in the Marketplace

After you fill out a Marketplace application you'll get an eligibility notice. It will tell you what programs and savings you’re eligible for, including catastrophic plans. If you’re eligible to enroll in a catastrophic plan, you’ll see these plans listed when you compare your coverage options.

You can then choose to enroll in a catastrophic plan or any other plan available to you.

How to find health care provider information

Many tools are available to help you search, compare, and assess providers, hospitals, and other care facilities so you can make better decisions.

Comparing Care Providers

  1. Compare Providers: Search for and compare physicians and other health professionals. You can see information on medical specialty, clinical training, foreign languages spoken, and more.
  2. Compare Hospitals: Compare the quality of care that hospitals deliver. You can see a list of U.S. hospitals that includes hospital demographics (location, hospital type) and 44 quality-of-care measures. You can also find data on some Department of Veterans Affairs medical centers.
  3. Compare Nursing Homes: Compare the quality of care in nursing homes. You can see a list of U.S. nursing homes, demographics (location and type of facility), ratings, health inspection reports, staffing data, and quality measures.
  4. Compare Home Health Agencies: Compare the quality of care provided by home health agencies. You can see a list of U.S. home health agencies, including demographics, services provided, and quality measures.
  5. Compare Dialysis Facilities: Use this tool to help you compare the quality of care in dialysis facilities. It provides a list of U.S. dialysis facilities, services provided, quality measures, and resources.

How to choose Marketplace insurance: Type of plan and provider network

There are different types of health insurance plans that meet different needs. Some examples include HMOEPOPPO, and POS plans.

Different plan types provide different levels of coverage for care you get inside and outside of the plan’s network of doctors, hospitals, pharmacies, and other medical service providers. There are other differences between plan types too.

When comparing your options in the Marketplace, you’ll see health plan details. Make sure to note the type of each plan you’re considering.

To get details about the plan you can also view a summary of benefits, a plan brochure, a provider directory, and a list of covered drugs. If staying with your current doctors is important to you, check to see if they're included in the provider directory before choosing a plan.

You can find quality information about doctors, hospitals, and other care providers by using our quality compare tools.

How to choose Marketplace insurance: Out-of-pocket costs

It’s important to know how much you have to pay out of your pocket for services when you get care. You pay these out-of-pocket costs in addition to your monthly premiums.

The category of plan you choose affects how much you spend on out-of-pocket costs. Generally, Bronze and Silver plans have lower monthly premiums, but you’ll pay higher out-of-pocket costs when you need care. Gold and Platinum plans generally have higher premiums but lower out-of-pocket costs.

The maximum out-of-pocket costs for any Marketplace plan for 2015 are $6,600 for an individual plan and $13,200 for a family plan. This means when the amount you’ve paid in deductibles, copayments, and coinsurance reaches these limits, the insurance company pays 100% of your costs for covered care. Even if you choose a catastrophic coverage planyour out-of-pocket costs shouldn’t exceed this limit.

Savings on out-of-pocket costs with a Silver plan

If you qualify for lower out-of-pocket costs based on your household size and income and choose a Silver plan, you can save more. This called a “cost-saving reduction.”

With a cost-sharing reduction, you’ll pay lower deductibles, copayments, and coinsurance. You'll basically get the lower out-of-pocket costs of a Gold or Platinum plan while paying a Silver plan premium. You can choose any category of plan, but you get these savings on out-of-pocket costs only if you enroll in a Silver plan.

If you make $11,670 to $29,175 for individuals or $23,850 to $59,625 for a family of 4, you may be eligible for a cost-sharing reduction. The lower your income within these ranges, the more you’ll save on out-of-pocket costs.

Get more information about cost sharing reductions for American Indians and Alaska Natives.

How to choose Marketplace insurance: Monthly premiums

Monthly premiums are important, but they’re not all you need to think about. Picking a plan only because its premium is low may not be the best decision for you.

  • If your plan has a lower monthly premium, your out-of-pocket costs may be higher when you need care.

  • If your plan has a higher premium, your out-of-pocket costs may be lower when you need care.

Generally speaking, the lower your monthly premium the higher your out-of-pocket costs will be. It’s important to keep this in mind when you compare plans.

If you make $11,670 to $46,680 for individuals or $23,850 to $95,400 for a family of 4, you may qualify for premium tax credits that can lower your monthly premiums. The lower your income is within these ranges, the bigger your tax credit and the more you save.

Marketplace insurance categories

The health plan category you choose determines how you and your plan share the costs of care. These categories have nothing to do with the quality or amount of care you get.

There are 5 categories or “metal levels” of coverage in the Marketplace. Plans in each category pay different amounts of the total costs of an average person’s care. This takes into account the plans’ monthly premiumsdeductiblescopaymentscoinsurance, and out-of-pocket maximums. The actual percentage you’ll pay in total or per service will depend on the services you use during the year.

  • Bronze: Your health plan pays 60% on average. You pay about 40%.
  • Silver: Your health plan pays 70% on average. You pay about 30%.
  • Gold: Your health plan pays 80% on average. You pay about 20%.
  • Platinum: Your health plan pays 90% on average. You pay about 10%.
  • Catastrophic: Catastrophic coverage plans pay less than 60% of the total average cost of care on average. They’re available only to people who are under 30 years old or have a hardship exemption.

What to consider when choosing a plan category

Think about your health care needs when choosing a category of Marketplace plan.

  • If you expect a lot of doctor visits or need regular prescriptions: You may want a Gold plan or Platinum plan. These plans generally have higher monthly premiums but pay more of your costs when you need care.

  • If you don’t expect to use regular medical services and don’t take regular prescriptions: You may want a Silver, Bronze, or Catastrophic plan. These plans cost you less per month, but pay less of your costs when you need care.

  • If you qualify to save on out-of-pocket costs: Silver plans may offer the best value. You may qualify for lower out-of-pocket costs based on your household size and income. If you do, you can get these out-of-pocket savings only if you enroll a Silver plan. If you make this choice you'll basically get the lower out-of-pocket costs of a Gold or Platinum plan while paying a Silver plan premium.

  • If you’re under 30 or have a hardship exemption and want low monthly premiums: You may want to choose a catastrophic plan designed to protect you from worst-case scenarios, like serious accidents or diseases.

Of course, it’s impossible to predict all your health care needs for the year ahead. Pick a plan that fits your budget and meets your and your family’s expected needs.

How to choose Marketplace insurance: Comparing health plans

Choosing a health plan can be complicated. There are a lot of things to take into account.

There are several important things to consider when you compare Marketplace plans.

How to find low-cost health care in your community

If you can't afford any health plan and don’t qualify for coverage through Medicaid and the Children’s Health Insurance Program (CHIP), you can get low-cost health care at a nearby community health center.

How much you pay depends on your income. Community health centers are located in both urban and rural areas. They provide:

  • prenatal care
  • baby shots
  • general primary care
  • referrals to specialized care, including mental health, substance abuse, and HIV/AIDS

Locate a community health center near you.

Free or low-cost coverage through Medicaid & CHIP

When you apply for health coverage in the Marketplace, you or some members of your household could be eligible for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).

This will depend on your household size and income, and on whether your state is expanding its Medicaid program to cover more people.

Learn more about Medicaid and CHIP coverage.

How Marketplace plans set your health insurance premiums

Five factors can affect Marketplace plan prices: location, age, family size, tobacco use, and plan category. Health status and gender don’t affect pricing.

Factors that can affect premium costs

Under the health care law, insurance companies can take into account only 5 things when setting premium costs.

  • Age: Older people can be charged up to 3 times more for premiums than younger people.
  • Geographic location: Where you live has a big effect on your premiums. Competition, local regulation, and cost of living in different areas account for this.
  • Tobacco Use: Insurers can charge tobacco users up to 50% more than those who don’t use tobacco.
  • Individual vs. family enrollment: Insurers can charge more for a plan that covers a spouse and/or dependents.
  • Plan category: Plans are available in five categories: Bronze, Silver, Gold, Platinum, and catastrophic. The categories reflect how you and the plan share costs. Bronze plans will likely have lower premiums and higher out-of-pocket costs. Platinum plans are likely to have the highest premiums and lowest out-of-pocket costs.

States may limit how much these factors can affect premiums.

All Marketplace health plans cover the same list of essential health benefits. Insurance companies may offer more benefits than the minimum, which could also affect costs.

Factors that can’t affect premiums

  • Insurance companies can’t charge women more than men for the same policy.

  • They also can’t take health status into account when setting rates. All Marketplace policies must cover treatment for pre-existing conditions from the first day coverage begins.

How to save on out-of-pocket health care costs

When you enroll in coverage through the Marketplace, you may be able to save money on out-of-pocket costs, including deductibles, copayments, and coinsurance. This is sometimes called “cost-sharing reductions.”

Whether you qualify to save on out-of-pocket costs will depend on your household size and income.

Very important: You can get these savings on out-of-pocket costs only if you enroll in a plan in the Silver category.

The Marketplace cost-sharing reduction lowers the amount you have to pay for out-of-pocket costs like deductiblescoinsurance, and copayments. These are costs you have to pay when you get care.

When you apply for coverage in the Marketplace, you'll learn if you’re eligible for savings on out-of-pocket costs.

Savings depend on your income

If your household income falls between the following amounts, health insurance companies must lower how much you pay out of pocket when you get medical care. They do this only for Silver plans.

The lower your income within these ranges, the more you’ll save on out-of-pocket costs.

  • $11,670 to $29,175 for individuals
  • $15,730 to $39,325 for a family of 2
  • $19,790 to $49,475 for a family of 3
  • $23,850 to $59,625 for a family of 4
  • $27,910 to $69,775 for a family of 5
  • $31,970 to $79,925 for a family of 6
  • $36,030 to $90,075 for a family of 7
  • $40,090 to $100,225 for a family of 8

Incomes that qualify for cost-sharing reductions are higher in Alaska and Hawaii. See Alaska and Hawaii information.

Learn how to estimate your income and report on your household size.

If your income falls between the amounts shown, you also qualify forpremium tax credits that lower your monthly premiums.

Out-of-pocket savings apply only to Silver plans

Plans in the Marketplace are grouped into 4 categories: Bronze, Silver, Gold, and Platinum.Learn more about plan categories and what they mean.

If you qualify for out-of-pocket savings, you must choose a Silver plan to get the savings. You can choose any category of plan, but you'll get the out-of-pocket savings only if you enroll in a Silver plan.

Get more information about cost sharing reductions for American Indians and Alaska Natives.

Getting lower costs: How to save on monthly insurance premiums

When you buy health insurance coverage in the Marketplace, you may be able to get a premium tax credit that lowers what you pay in monthly premiums.

This will depend on your 2015 household size and income.

You can apply part or all of this tax credit each month to your premium payments. The Marketplace will send your tax credit directly to your insurance company, so you pay less for your premiums each month. This is called “advance payment of the premium tax credit.”

Savings depend on 2015 income and family size

If your 2015 income falls within the following ranges you'll generally qualify for a premium tax credit. The lower your income is within these ranges, the bigger your credit.

  • $11,670 to $46,680 for individuals
  • $15,730 to $62,920 for a family of 2
  • $19,790 to $79,160 for a family of 3
  • $23,850 to $95,400 for a family of 4
  • $27,910 to $111,640 for a family of 5
  • $31,970 to $127,880 for a family of 6
  • $36,030 to $144,120 for a family of 7
  • $40,090 to $160,360 for a family of 8

Incomes that qualify for tax credits are higher in Alaska and Hawaii. See Alaska and Hawaii information.

Savings at lower income levels

If your 2015 income falls below the amounts shown on the chart, you may qualify for coverage under your state’s Medicaid program. This is true if you live in a state that’s decided to expand Medicaid to cover more people.

But if ALL of the following apply, you can’t get premium tax credits when you buy a private insurance plan through the Marketplace:

  • Your income falls below the amounts shown on the chart
  • Your state is not expanding Medicaid
  • You don't qualify for Medicaid under your state's rules

Learn if your state is expanding Medicaid and what this means for you.

Income levels that qualify for lower health coverage costs

To learn if you qualify for lower costs on health insurance coverage, find your estimated 2015 household income and household size on the chart below.

The column on the left tells you if you may qualify for premium tax credits, lower out-of-pocket costs, or low-cost health care through Medicaid.

Quick Check: Do I qualify to save on health insurance coverage?

This health care savings chart shows if you may qualify for lower costs on coverage in the Health Insurance Marketplace based on your household income and family size.

See a full-screen version of this chart.

View an accessible version of this chart.

Higher incomes qualify for lower costs in Alaska and Hawaii. See Alaska and Hawaii information.

If you’re applying for coverage for the rest of 2014 with a Special Enrollment Period (SEP), the figures will be slightly different. When you apply with an SEP, the Marketplace application will use the 2014 dollar amounts.

How to use this health care savings chart

  • Most people can use adjusted gross income to estimate 2015 income. When you fill out a Marketplace application a different figure, called modified adjusted gross income, is used. Learn more about estimating 2015 income.
  • Include in your 2015 household everyone you will claim as a dependent on your tax return and any children who live with you. Be sure to include their income when you estimate your household income. Learn more about who to include in your household.
  • If you’re married, you must file a joint tax return for 2015 in order to get lower costs on 2015 Marketplace coverage based on your income. Note: If you’re a victim of domestic abuse, read an important note by selecting the question "What if my spouse and I file taxes separately?" at the bottom of this page.
  • As the chart shows, if your state ISN’T expanding Medicaid, you have limited income, and you're not eligible for Medicaid under your state’s current rules, you don't qualify for any of the affordability programs under the health care law. Learn how you can get low-cost health care at a Community Health Center near you.
  • If your estimated 2015 income is too high to qualify for savings, learn about your options for buying coverage.

More on Marketplace costs and savings

Take Action: Keep or change your plan

  • See a quick list of 5 Steps to Staying Covered through the Marketplace (PDF).
  • Don’t know if you want to change plans for 2015? Preview 2015 plans and prices to compare available plans with your current coverage.
  • Determine if you have any changes to your income or household. It’s important to report not only changes you had in 2014, but changes you expect in 2015. You can update your 2015 Marketplace application with this information starting November 15, 2014.
  • Want some help? Find someone in your community who can help with your application and answer your questions.
  • Contact the Marketplace Call Center. Customer service representatives are available 24/7.
  • Learn about the fee you have to pay if you don’t have health coverage in 2015.
  • Didn’t get a notice from your insurance company, or have a question about your insurance company notice? Contact your insurance company, not the Marketplace.

Keep or change your plan: If you’ll be automatically enrolled

If you bought a health plan through the Marketplace in 2014, you’ll probably be automatically enrolled for 2015. If you don’t take any action, your coverage will start January 1, 2015. But you should update your income and household information to be sure you get the right amount of savings for 2015.

When you get your notice from your health insurance company, you’ll know if you’ll be enrolled automatically.

You can change plans for 2015 coverage, even if you’ll be automatically enrolled in your current plan or a similar plan. Preview 2015 plans and prices to compare available plans with your current coverage.

Enrollment in a similar plan

If your insurance company notice says you’ll be enrolled automatically, it will tell you if:

  • You’ll be enrolled in the same plan you had in 2014
  • You’ll be enrolled in a similar plan

If you’ll be automatically enrolled in a similar plan: Insurance companies sometimes decide to change which plans they offer in the Marketplace. This is a normal part of their business cycle. If you’re being automatically enrolled in a different plan, your company has decided not to offer your particular Marketplace plan to anyone in your area in 2015.

An insurance company can’t move you to a different plan based on your health or how much care you use. It can move you only if it’s no longer offering the plan you had to anyone in your area.

You can accept the automatic enrollment in the similar plan or change plans.

If you want to change, you must enroll in the new plan by December 15, 2014, for your new plan to start January 1, 2015.

Enrollment with or without your 2014 savings

If you will be automatically enrolled, your Marketplace notice will tell you if:

  • You’ll have the same premium tax credits and other savings you had in 2014
  • You won’t get any premium tax credits or other savings

If you will be enrolled without savings, here are two possible reasons:

  • Updated income information from the IRS shows you may not qualify for savings in 2015
  • When you filled out your 2014 Marketplace application, you didn’t allow the Marketplace to use your updated tax information for future years

IMPORTANT: You must report changes to the information you provided on your 2014 Marketplace application

You must update the information you provided on your 2014 Marketplace application, like your income, who’s in your household, and whether you can get coverage through a job. This is true even if you accept your automatic enrollment.

Learn more about reporting changes.

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