The Affordable Care Act – What Does It Mean For Group Health Plans?

affordable care act

The Affordable Care Act (ACA) adds many protections to group health plans. For example, it prohibits the exclusion of pre-existing conditions from coverage, and it requires plans to provide a simple, easy-to-understand summary of coverage and benefits. It also requires coverage of certain preventive care, including cancer screenings, without cost-sharing. It also mandates that insurers cover emergency care in hospitals that aren’t part of the plan network.

Since the Affordable Care Act took effect, the number of uninsured people has dropped dramatically. Today, the uninsured rate is the lowest it has ever been. According to the Department of Health and Human Services, more than 16 million people gained health coverage through the law, including more than half of them since the end of 2013. Thousands of young adults also gained coverage before the law’s implementation, thanks to the option to stay on a parent’s plan until they are 26.

However, the Affordable Care Act has faced many challenges. Some states, like the State of Minnesota, have chosen to scale back the expansion of coverage, citing concerns over premium cost. One recent case was a legal challenge in the U.S. Supreme Court in NFIB v. Sebelius, which found that the act was coercive. However, states were still free to continue with their current eligibility levels.

Another key aspect of the Affordable Care Act is that it requires health plans to implement an effective appeals process. This means that consumers can file a complaint and appeal if they are not satisfied with the plan’s services. In addition, the Act requires insurers to provide emergency and preventive care services. It also sets forth standards for primary care providers and removes referral requirements for gynecological care. Finally, it requires the Secretary of Health and Human Services to award grants to states for consumer assistance programs.

Another important provision of the Affordable Care Act is the definition of essential health benefits. The law requires the Secretary of Health and Human Services to develop guidelines for what constitutes a minimum level of coverage. These benefits must cover emergency, preventive, and wellness services, prescription drugs, and maternity care. It also mandates that health insurers must reduce maximum limits on out-of-pocket expenses for people with incomes of 100% or below 400 percent of the federal poverty line.

Another key part of the Affordable Care Act is its mandate on employers to provide health insurance coverage to employees. Under the Act, large employers must automatically enroll new employees in a health care plan unless they opt out. Large employers must also provide employees with notice of their right to opt out of the plan, and must provide premium assistance if necessary.

Individuals with incomes between 100% and 400% of the federal poverty level may receive federal subsidies for premiums purchased through the ACA exchange. The regulations set forth formulas to determine the amount of these credits.