Guest post by Annessa Traynor, The McCullough Agency
Many key provisions of the Affordable Care Act
Out-of-pocket maximums for essential health benefits – These limit out-of-pocket member liability for in-network EHBs to no more than $6,350 for individual coverage and $12,700 for family coverage. Generally, member liability that is considered part of the out-of-pocket maximum includes in-network deductibles, coinsurance, copayments and any other expenditure required by, or on behalf of, an enrollee for in-network EHBs, including out-of-network emergency services.
Actuarial value (metallic levels) – Non-grandfathered health insurance plans in the individual and small group market must meet actuarial value coverage requirements for EHBs. The metallic levels are Platinum (90% AV), Gold (80% AV), Silver (70% AV) and Bronze (60% AV). The percentages reflect the portion of expenses paid by the insurer.
Community rating – Health insurance issuers can only use the following rating factors: geographic area, family demographics, age and tobacco usage.
Guaranteed issue and renewability – Carriers will be required to offer all products approved for sale in a particular market and accept any individual or group that applies for any of those products. Plans and policies are guaranteed renewable.
Health insurer fee – Requires covered entities providing health insurance (health insurers) to pay an annual fee to the federal government. These fees are designed to support programs that will stabilize premiums and provide subsidies to qualified individuals to help them purchase coverage.
Reinsurance fee – The reinsurance fee was designed to pay for a temporary transitional reinsurance program that will run from 2014 -2016 and will be funded by reinsurance contributions (reinsurance fees) from health insurance issuers and self-funded group health plans.
Small Business Health Tax Credit – ACA increases small business health tax credit. Small group employers with 25 or fewer employees (with an average wage of less than $50,000 a year) may be eligible for a tax credit. The Small Business Health Tax CreditSmall Business Health Options Program (SHOP).
This information is current as of April 2014. It is subject to change based on subsequent federal and state laws, regulations and guidance. Please note that this information is not comprehensive and is for general informational purposes only. All clients are advised to consult qualified legal counsel and/or tax professionals to ensure compliance.