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1.
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The Affordable Care Act
Remember that each provision of the ACA may apply to different market segments i.e. individual (consumer) v small group v large group (ALEs).
Due to the volume of information, it's best if you search for your topic by doing a word search.
Timeline chart http://www.healthcare.gov/law/timeline/
http://healthreform.kff.org/timeline.aspx
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2.
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-Grandfather v Grandmother Plan Status
-Nursing Mothers mandate
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3.
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Small Business Tax Credit
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4.
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-Annual/ Lifetime dollar limit prohibition
-Dependent to 26 coverage
-Emergency services covered in network
-External Review Standards - Appeals
-Non-discrimination or prohibition in favor of Highly Compensated Individuals
This new prohibition applies to fully insured plans and is on hold
-Pre-existing condition limitation prohibition for persons under age 19
-Premium Rate Review
-Preventive Care Services without cost sharing includes Women's Contraceptive -Primary Care Physician (PCP) selection
-Rescission prohibition (Rescission means retroactive termination)
-Wellness
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5.
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What are the requirements regarding Medical Loss Ratios (MLR) expenditure and refunding ?
How is this affected by the PACE act whereby some states elected to define small group as 1-100 in 2016 ?
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6.
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Is there a requirement for employers to report the total premium cost of health benefits on the W-2?
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7.
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Is there a change to the tax penalty for using HSA funds for other than qualified medical expenses ?
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8.
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Is there a limit to employee funding of an FSA ?
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9.
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Is there a change to the definition of an eligible medical expense with regards to OTC (over the counter) drugs ?
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10.
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The CLASS Act (long term care funding) has been repealed under the January 1, 2013 Fiscal Cliff deal.
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11.
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What are the Summary of Benefits and Coverage and Uniform Glossary (SBC) requirements ?
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12.
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Fees and Taxes
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13.
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What is the change to the medical expense tax deduction limitation ?
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14.
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What is the latest regarding Exchanges (now known as the Health Insurance Marketplace) ?
http://kff.org/health-reform/state-indicator/state-health-insurance-marketplace-types/?currentTimeframe=0
STATE based exchange info may be found here
https://www.cms.gov/CCIIO/Resources/Data-Resources/sbm-puf.html
As of January 2018
12 State-based exchanges
5 State-based exchanges using the federal platform
28 Federally facilitated marketplaces
6 State Partnership exchanges
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15.
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What Rating Methodology applies to the individual and small group markets?
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16.
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What is the size definition and determination of "small group plan" ?
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17.
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What are the available premium tax credits a/k/a subsidy/ subsidies ?
APTC (Advanceable Premium Tax Credits)
Who is eligible for Catastrophic coverage?
The Basics and Who is Eligible IRS FAQ here
https://www.irs.gov/affordable-care-act/individuals-and-families/questions-and-answers-on-the-premium-tax-credit
See the IRS Publication 974 here for helpful information:
https://www.irs.gov/pub/irs-pdf/p974.pdf
Reporting life changes
https://www.healthcare.gov/how-do-i-report-life-changes-to-the-marketplace/
Kaiser FAQ http://khn.org/news/what-are-the-penalties-for-not-getting-insurance/
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18.
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When did all pre-existing condition limitation exclusions end ?
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19.
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What are Essential Health Benefits ?
Who is subject to them?
Maximum Out of Pocket rules.
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20.
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Coverage for persons eligible for Clinical Trials.
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21.
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What is the Medicaid expansion ?
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22.
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What is the maximum probationary or waiting period that is permitted?
The 90 day maximum rule
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23.
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Are employers mandated to provide coverage ?
Due to the volume of information within this topic, it's best if you search for your topic by doing a word search.
The following categories related to the Employer Shared Responsibility (ESR) / Play or Pay will be covered in this FAQ section.
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Basics of the Employer Shared Responsibility Provisions: Intro 1
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Which Employers are Subject to the Employer Shared Responsibility Provisions: Questions 2-3
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Determining Group Size
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Identification of Full-Time Employees: Questions 4-11
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AND Measuring Variable Hour and Seasonal Employees
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Liability for the Employer Shared Responsibility Payment: Questions 16-17
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#18 covers Affordability
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Making an Employer Shared Responsibility Payment: Questions 19
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NOW EXPIREDTransitional Relief for 2015: Questions 23-24
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Resources: Question 25
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24.
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Is there an Individual Responsibility "mandate" ?
Although the actual mandate is still in place, the Federal penalty has been reduced to zero as of January 1, 2019.
Note that NJ, MA, VT and the District of Columbia have enacted laws that include a penalty for not having coverage in place.
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25.
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The "Free-Choice" Voucher provision was eliminated.
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26.
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Are Wellness programs mentioned in the law ?
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27.
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What are the criteria for establishment of SIMPLE Cafeteria Plans for Small Businesses ?
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28.
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How are Self-Funded plans impacted ?
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29.
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What is the meaning of "culturally and linguistically appropriate manner" ?
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30.
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What are the Information Reporting Rules for Employers, Plans and Carriers under PPACAs IRC Codes 6055 and 6056?
Also known as 1094 / 1095 reporting.
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31.
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Where can I find more information ?
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