Ever since the Affordable Care Act was implemented, there have been several new provisions created.
Here are some of the following newly implemented ACA provisions that can affect your business:
Medical Loss Ratio – Effective January 1, 2011, Health insurance issuers offering coverage must report on the share of premium dollars spent on health care and provide consumer rebates for excessive medical loss ratios annually
- LARGE: Must spend at least 85% of premiums on medical care
- SMALL: Must spend at least 80% of premiums on medical care
Health Insurance Exchange – Since 2014, it has been required that each state must have a health insurance exchange where individuals & small businesses can shop for affordable health insurance.
- LARGE: 51+ employees & must employ at least one employee on the first day of the plan year
- SMALL: <50 employees & must employ at least one employee on the first day of the plan year
Nondiscrimination Reforms – Effective 2014, the ACA requires that all health plans must comply with the new set of nondiscrimination reforms
- LARGE: May NOT discriminate against individuals with respect to plan eligibility, May NOT discriminate against individuals with preexisting conditions or refuse to renew coverage
- SMALL: May NOT charge higher rates due to health status or gender
- No preexisting conditions
- Refuse to renew coverage
Limits on Cost-Sharing: Only applies to health plans effective prior to 2014, Non-grandfathered group health plans are subject to limits on out of pocket expenses.
- BOTH LARGE & SMALL: Out of pocket expenses may not exceed the amount applicable to coverage related to HSAs
