8.1 FEDERAL LAWS AND REGULATION OF BUSINESS

Question 1

WHAT IS THE PATIENT PROTECTION AND AFFORDABLE ACT? (PPACA)

Answer 1

AKA - AFFORDABLE CARE ACT
-THE PPACA PROHIBTS INSURANCE COMPANIES FROM DENYING COVERAGE ON GROUNDS OF PREEXISTING CONDITION,
- THE PPACA PROVIDES A TOTAL ANNUAL MAXIMUM FOR OUT-OF-POCKET EXPENSES. IN 2023 THE MAXIMUMS ARE 9.1K FOR INDIVIDUALS AND 18.2K FOR A FAMILY PLAN.
- ONCE THE INSURED REACHES THE OUT-OF-POCKET MAXIMUMS, ALL FUTURE COVERED COST WILL BE PAID BY THE INSURER.
- A COINSURANCE PAYMENT IS THE AMOUNT THE INSURED MUST PAY ON CLAIMS ON WHAT IS REMAINING FROM ITS OUT-OF POCKET DEDUCTIBLE

Question 2

WHAT ARE THE EMPLOYER RESPONSIBILITIES UNDER PPACA?

Answer 2

FOR APPLICABLE LARGE EMPLOYERS (ALE’S) THE PPACA IMPOSES 2 CHOICES

Question 3

HOW DO WE DETERMINE WHICH EMPLOYERS ARE ALE’S?

Answer 3

“AVERAGE OF AT LEAST 50 FULL-TIME EMPLOYEES”

PART TIME EMPLOYEE CALUCULATION = TOTAL HOURS WORKED IN A WEEK / 30

Question 4

HOW IS THE PENALTY COMPUTED FOR EMPLOYERS NOT OFFERING THE MINIMUM ESSENTIAL COVERAGE UNDER PPACA OR NOT OFFERING AFFORDABLE COVERAGE?

Answer 4

SEE SCREEN SHOT

OR THE LESSER OF 4,320 PER FULL TIME EMPLOYEE

Question 5

WHAT IS THE DEFINITION OF “MINIMUM ESSENTIAL COVERAGE?”

Answer 5

1) COVERS AT LEAST 60% OF THE COST OF BENEFITS
2) PROVIDES SUBSTANTIAL COVERAGE FOR INPATIENT HOSPITALIZATION AND PHYSICIAN SERVICE

*COVERAGE MUST BE OFFERED TO EMPLOYEES AND NONSPOUSAL DEPENDENTS
AND THE COVERAGE MUST COST LESS THAN 9.12% IN 2023 OF THE EMPLOYEES HOUSEHOLD INCOME WITH A SAFE HARBOR AMOUNT OF 9.5%

*EMPLOYEES WHO EXCEED THE SAFE HARBOR AMOUNT ARE ABLE TO TURN TO THE “MARKETPLACE EXCHANGE”

Question 6

WHAT IS THE FAIR DEBT COLLECTION PRACTICES ACT?

Answer 6

THE ACT PROHIBTS DEBT COLLECTORS FROM HARASSING DEBTORS, COLLECTORS ARE PERMITTED TO TAKE REASONABLE MEASURES TO,
1) LOCATE THE DEBTOR
2) CONTINUE TO CONTACT THE DEBTOR
3) PROVIDE WRITTEN NOTICE (WITHIN 5 DAYS OF THE FIRST COMMUNICATION WITH A DEBTOR)
4) FILE A LAWSUIT

Question 7

WHAT IS THE EMPLOYMENT RETIREMENT INCOME SECURITY ACT?

Answer 7

ERISA APPLIES TO EMPLOYERS WHO HAVE CHOSEN TO PROVIDE PENSION BENEFITS TO EMPLOYEES.

Question 8

WHAT IS THE COMPREHENSIVE ENVIRONMENTAL RESPONSE, COMPNESATION, AND LIABILITY ACT? (CERCLA)

Answer 8