Insurance3

Question 1

ACA

Answer 1

■ Also known as PPACA, Obamacare, and Heath Care Reform
■ Signed in 2010 with some reforms
■ Additional reforms began January 2014
Grandfathered—existed before ACA
Nongrandfathered—existed after ACA

Question 2

Individual Mandate

Answer 2

■ U.S. citizens and legal residents are required to have qualifying health care coverage.
■ There is a tax penalty if they do not have coverage (with some exceptions)

Question 3

EHB

Answer 3

■ Health plans must be qualified to fit ACA standards.
■ QHPs, Medicaid state plans, and insurance on the health exchange must meet requirements.

Question 4

Emergency Medical Services

Answer 4

■ No pre-authorization required
■ In-network or out-of-network
■ Normal cost-sharing requirements

Question 5

Primary Care Provider

Answer 5

■ Every insured and dependent must have a PCP.

Question 6

Prohibition on Lifetime/Annual Limit

Answer 6

■ On all EHBs (except for grandfathered plans)
■ Limits allowed on non-EHBs

Question 7

Metal Tiers

Answer 7

■ Four levels of coverage; each must cover minimum EHBs.
■ Tiers represent average portion of expected costs.
■ Percentages represent how much plan will pay.

Question 8

Free Preventative Care

Answer 8

■ Take care of yourself now to prevent costly, future, chronic conditions.

Question 9

Pre-existing conditions

Answer 9

■ Health plans can no longer exclude pre-existing conditions (except for grandfathered plans).

Question 10

Coverage of Children to Age 26

Answer 10

■ Up to, not including, age 26
■ Children can remain if:
–– married;
–– not living with parents;
–– attending school;
–– not financially dependent; or
–– eligible to enroll in employer’s plan.
■ Past age 26 if unmarried, financially dependent, and have physical or mental impairment

Question 11

Eligibility

Answer 11

■ Depends on:
–– Income
–– Employment status
–– If you have coverage through employer

Question 12

Guaranteed Issue

Answer 12

■ Must be offered to any individual or employer in the state
■ Subject to rules

Question 13

Health Benefit Exchanges/Marketplaces

Answer 13

■ Required
■ Operated by state or federal government
■ Annual open enrollment and special enrollment depending on qualifying events

Question 14

QHPs

Answer 14

■ Provide EHBs
■ Only available on the exchange
■ Only plan that provides tax credits and cost sharing

Question 15

SHOP

Answer 15

■ Online application to compare health plans
■ 50 or less full-time employees

Question 16

Subsidies

Answer 16

■ A sum of money given by the federal government
■ Advanced premium tax credits (APTC)
■ Cost-sharing (only available in Silver tier)

Question 17

Navigators

Answer 17

■ Funded by government through federal grants
■ CANNOT sell insurance or provide advice
■ Help determine eligibility for public assistance

Question 18

Employer Responsibilities

Answer 18

■ Employer notification responsibilities
–– Required to let employees know their rights to affordable coverage
■ Employer mandate—employer shared responsibility
–– For employers with 50 or more employees
–– Penalty if not followed

Question 19

Health Care Tax Credit for Small Employers

Answer 19

■ Maximum credit
–– 50% of premiums paid for small business employers
–– 35% of premiums paid for small tax-exempt employers
–– Eligible for two years