Module 10 Flashcards
Another term for “other employee benefit plans” under ERISA
Welfare plans
This regulation requires minimum standards for health plan: providing plan information, exercising fiduciary responsibilities in plan administration, establishing a grievance and appeal process, and allowing participants the right to sue
ERISA
A law requiring parity with respect to aggregate lifetime and annual dollar limits for mental health benefits
Mental Health Parity and Addiction Equity Act of 2008
A law requiring health plans to provide mastectomy, prosthetic device, and reconstructive surgery coverage
Women’s Health and Cancer Rights Act of 1998
A law requiring most group health plans to provide temporary continuation of group health coverage that may otherwise be terminated
COBRA
The maximum % amount that an employer may require a COBRA participant to pay for coverage
102%
Entities that do not have to offer COBRA
Federal government, churches, ERs with less than 20 EEs
A common benefit not subject to being offered in COBRA continuation
Life or disability insurance
The maximum period of COBRA continuation coverage offered based on employee termination or reduction in hours
18 months
Upon the employee divorcing, dying, or qualifying for Medicare, the spouse and dependent child may obtain COBRA for up to how many months?
36 months
This legal provision allows additional opportunities to enroll in a group health plan when coverage is lost, the participant gets married, or a new dependent is added
HIPAA
HIPAA nondiscrimination rules stipulate that employees and their family members cannot be denied eligibility or benefits based on what?
Health factors
Starting in 2010, the ACA prohibited plans from imposing this exclusion.
Pre-existing condition exclusions
The decision in National Federation of Independent Business v. Sebelius Supreme Court precluded the federal government from ________.
Withholding all Medical federal funding if the state fails to accept/comply with ACA Medicaid expansion requirements
Under the ACA, the 10 core benefits that must be covered such as ambulatory patient services, prescription drugs, and laboratory services are considered what? ____________.
Essential health benefits
The ACA designation for the types of coverage that qualify for satisfying the shared responsibility provision for individuals and employers.
Minimum essential coverage
Under the ACA, tax credits are offered to those with incomes of ________________.
100% to 400% of the poverty line
Another name for the shared responsibility mandate under the ACA
Employer mandate or the “play or pay provision”
An IRC section requiring applicable large employers to offer health coverage to full-time employees or pay a penalty
4980H
For employers to avoid having to make a shared responsibility payment to the IRS, the minimum essential coverage must be both “affordable” and _______.
Provide minimum value
The # of hours an employee must work to be considered a full-time employee under employer shared responsibility provisions
30 hours per week or 130 hours per month
Those who don’t have employer-sponsored insurance or who don’t qualify for government programs such as Medicare or Medicaid can purchase insurance through a __________.
Health Insurance Marketplace
The threshold for FTEs that makes an employer be considered an ALE (applicable large employer)
50
Employers with 50 or fewer employees can purchase health insurance coverage for their employees through the _____________.
Small Business Health Options (SHOP) Marketplace
