Aka: ACA or Obamacare
Patient Protection and “Affordable” Care Act
Overview- Passed March 23, 2010 and affirmed by Supreme Court June 28, 2012. This law creates many provisions to regulate the insurance companies, employers, and individuals for the purpose to ensure everyone has affordable health insurance. Provisions of the law have various dates of compliance, many of which have already been enacted.
- HHS- Creation of Health and Human Services, CMS and many related entities that are charged with “filling in the details” of the law.
- Individual Mandate- that insurance must be purchased either through an employer, personal policy, government coverage, or through an exchange.
- Exchanges- the requirement for each state to create and run a health insurance purchase exchange to begin on Jan. 1, 2014. These policies will be offered with “guaranteed issue” or with no pre-existing condition exclusions and be required to have a minimum level of coverage established by each state.
- Small businesses up to 50 employees
- States can create their own or participate in a federal exchange
- States can allow purchases on and off the exchange or on the exchange only (DC and VT).
- Navigators- currently expected that non profit organizations will be set up to “guide” individuals to health insurance plans offered on the exchange.
- Brokers- may or may not be eligible to “sell” on the exchange depending on the state.
- MD – brokers will be able to offer both “on and off” exchange purchasing of health insurance for individuals and businesses
- Subsidies – offered if purchased from the exchanges- based on a graduating scale of income, both subsidies and maximum premiums are required. These IRS subsidies are to be offset by larger employers (50 FTE’s- full time equivalent employees) paying $2000 penalties for any employees who receive subsidies from the exchange.
- Minor provisions-
- Up to age 26 dependents- employment, student nor existing health insurance status does not restrict from going onto their parent or guardian’s plan.
- Contraceptive Mandate- free condoms
- Free preventive care- all plans- certain drugs and procedures were added to the “preventive” list of coverages.
- Medical Loss Ratio- requirements of carriers to issue credits back to business and individuals for “overpayment of premiums” for claims not made
- Unlimited Lifetime Benefits- this removed the insurance companies higher level limits of coverage.
- Monthly Income Reporting-Employers must report employee income monthly to establish subsidy amounts and taxes.
Disclaimer: Please note the purpose of this outline is to provide a general, and broad, overview for the above referenced topic and is not intended to be used for outside distribution or reference. Please contact your health insurance advisor or local government authority for additional materials and information.