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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 (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.
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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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