BEST PRACTICES: Complying with the Affordable Care Act Flashcards
State and local government employers that sponsor group health plans should implement a process for reviewing federal health-care benefit requirements at least quarterly to ensure that they are aware of any newly issued or soon-to-be issued regulations.
How often should government employers review federal health-care benefit requirements for ACA compliance?
At least quarterly.
What is the primary purpose of the ACA for employers?
To change how healthcare benefits are provided, ensuring specified levels of health-care benefits to certain employees or face financial penalties.
What should staff involved in monitoring health-care benefit requirements have?
Appropriate levels of expertise and coordination with external experts like insurance brokers, attorneys, and actuaries.
What types of communications are required by the ACA for employers to issue to employees?
New Health Insurance Marketplace Coverage Options, Your Health Coverage notice, and the Summary of Benefits and Coverage document.
What characterizes a grandfathered plan under the ACA?
Plans that were in existence on March 23, 2010, and have not been substantially modified since then.
What changes might be required for ACA compliance in health-care plans?
Including coverage for essential benefits with no lifetime or annual limits, eliminating pre-existing condition exclusions, and providing coverage for adult children until their 26th birthday.
How can retiree-only health-care plans benefit under the ACA?
They are exempt from many of the new ACA standards and provisions of HIPAA, allowing more design and pricing flexibility.
What should plan sponsors examine in terms of coverage options under the ACA?
The expansion of Medicaid coverage, and whether maximizing available subsidies under Medicare Part D is beneficial.
What are some of the ACA-associated fees and taxes plan sponsors need to prepare for?
Transitional Reinsurance Fee, Comparative Effectiveness Research Fee, Health Insurance Industry Fee, and the Cadillac excise tax.
What defines a full-time employee under the ACA?
An employee who works an average minimum of 30 hours per week.
