Things To Keep in Mind About ACA Regulations
It has been nearly five years since the Affordable Care Act was passed and it still has the power to confuse people. This is because it is one of the most comprehensive employee benefit plans in recent years. Because it is so comprehensive and because it aims to cover all possible aspects of employee benefits, the ACA regulations aren’t so easy to understand. This article has a very brief overview of the ACA regulations to help you better understand the law.
What is ACA?
Often referred as Obamacare, the Patient Protection and Affordable Care Act was passed to ensure that as many people as possible would receive health insurance coverage in the United States. The aim is to reduce the rising healthcare costs and make sure that everyone could afford good quality insurance cover. To date, there has been a significant rise in the number of formally uninsured people who gained access to insurance.
With some exceptions, the government requires everyone to have health insurance cover, including healthy people. If you don’t, you can invite penalties under ACA regulations. The act also requires employers to offer their full-time employees and their dependents, health insurance cover.
The Responsibility of the Employers
- ACA regulations state that employers with more than 50 full time employees need to offer them and their dependents insurance coverage.
- This insurance should cover the essential health benefits with no maximum benefit for those essential items.
- Insurance should also offer the least minimum value of 60%. This means that at least 60% of the medical benefits must be covered by the insurance companies.
- The employees should also receive the Form 1095 C from their employers by the 31st of January.
- The employees will file this form with the IRS to prove that they have adequate insurance coverage.
The ACA Regulation Terms
Here are the common ACA terms explained in brief. This would help you understand what the law says in detail:
- Full Time Employee – According to this Act, a full time employee is someone who works for 30 hours or more during the week and 120 days of the year. The equivalent of part-time employees also needs to be covered.
- Dependents – The members of the family of the employees under the age of 26 are considered. This usually includes children, whether biological or adopted. Spouses and domestic partners can also be considered dependents. In rare cases, elderly parents might be considered too.
- Essential Health Benefits – Essential health benefits include 10 critical heath expenses, including pregnancy and new born care, prescription medication, rehabilitation, etc.
- Maximum Benefit – Before the ACA regulations were put in place, there was a cap on the amount of money that a health insurance company could pay during the insured’s lifetime. The insurance provider could refuse offering coverage if that limit was crossed. That’s no longer the case.
Pre-Existing Medical Conditions
Before the ACA regulations were implemented, the insurance providers could deny applicants with pre-existing medical problems. For example, if you had asthma, your insurance premium would be higher or certain illnesses might not be covered. The ACA removes that condition. Now, only your age, place of living, and your use of tobacco is considered.
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