Chapter 12: Obamacare - Patient Protection and Affordable Care Act Flashcards
The ____ ____ and ____ ____ _____ is a federal law signed by President Obama in 2010 as part of the United States health care reform. It is more commonly referred to as Obama Care. The purpose of the Act was to hold insurance companies accountable, lower health care costs, guarantee options for consumers, and provide better health care for all Americans.
Patient Protection and Affordable Care Act
TF: Some highlights of the PPACA include:
Guaranteed issue;
Community rating – insurers must charge the same premium to all applicants of the same age, sex and geographical location, regardless of preexisting conditions;
Medicaid eligibility is broadened – individuals and families whose incomes are up to 133% of the federal poverty line;
Small businesses are provided a tax credit to provide health coverage to employees;
Lower premium costs;
Competitive private health insurance market – via state exchanges; and
Children ages 18 to 26 can be covered under their parents’ health plans.
True
TF: The PPACA allows dependent children to remain on their parents’ insurance plan until age 26, even if they no longer live with their parents, are not a dependent on a parent’s tax return, and are no longer a student, or are married.
True
TF: The PPACA also provides guaranteed issue to children under the age of 19 and prohibits insurers from excluding preexisting medical conditions.
True
In order to reduce administrative costs and require insurers to spend a minimum percentage of premiums on eligible healthcare services, the PPACA established a ____ _____ ratio
Medical Loss
The medical loss ratio requires insurers to spend a certain percent of premium dollars on _____ _____
Eligible Expenses
Health insurance companies are mandated to spend _____ percent for every dollar collected on individual and small-group health plans and at least _______ percent of the premiums collected on large-group plans on health care as opposed to administrative costs.
If an insurer fails to meet this requirement, the insurer must issue a premium rebate to its policyholders.
80%
85%
TF: Obamacare eliminates pre-existing conditions; meaning that an individual cannot be charged more for or denied coverage based on pre-existing health conditions.
True
TF: All new health care plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance. Other covered preventive services include:
Alcohol Misuse screening and counseling
Blood Pressure and Cholesterol screening for adults of certain ages or high-risk
Depression screening for adults
Diabetes screening for adults with high blood pressure and Obesity screening and diet counseling
HIV screening
Immunizations
True
The PPACA regulations dictate that health plans may not establish ____ ____ on the dollar value of benefits for any participant or beneficiary or any unreasonable ____ _____
LIFETIME LIMITS
annual limits
Salary reduction contributions for health flexible spending arrangements (health FSAs) are specifically limited to _______(indexed for inflation) per year.
$2,500
TF: Salary reduction contributions to FSAs, HSAs, and MSAs are limited under PPACA to $2,500
False - only FSAs are limited to $2,500. MSAs and HSAs are not
TF: The PPACA includes a grandfather clause that keeps the new regulations imposed by the PPACA from applying to health plans that are “grandfathered” in.
True
TF: Grandfathered plans may continue in this exempt status until one of the following plan changes occurs:
Switch of carriers by a fully-insured plan;
Elimination of certain benefits to treat or diagnose a particular condition that is currently covered;
Any increase in coinsurance percentage;
Certain increases of copayments, deductibles or out-of-pocket minimums;
Certain decreases in employer contribution rate;
Changes to overall annual limitations;
Certain mergers, acquisitions and/or employee transfer from a grandfathered plan.
True
Both new and grandfathered plans can no longer rescind coverage of employees, except in the case of fraud, material misrepresentation, refusal to pay premiums, or termination of the plan. The ______ may occur only after prior written notice to the affected employee is given.
Rescission
In addition to providing Essential Health Benefits (EHBs), all non-grandfathered health insurance plans must meet specific actuarial values, or AVs:
60% for a bronze plan
70% for a silver plan
80% for a gold plan
90% for a platinum plan
This are referred to as _____ _____
Metal Levels
TF: Metal Levels will assist consumers in comparing and selecting health plans by allowing a potential enrollee to compare the relative payment generosity of available plans. Taken together, EHB and AV will significantly increase consumers’ ability to compare and make an informed choice about health plans.
true
TF: The PPACA will require most Americans to have insurance. Every state is required to create a Small Business Health Options Program, also called SHOP exchanges, designed to help small employers access affordable insurance for their employees.
True