BEST PRACTICES: Patient Protection and Affordable Care Act Compliance 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 state and local government employers review federal health-care benefit requirements for ACA compliance?
At least quarterly.
What is the primary purpose of the ACA for employers?
Changing how healthcare benefits are provided, ensuring specified levels of health-care benefits to certain employees or face financial penalties.
What expertise is needed for staff monitoring health-care benefit requirements?
Appropriate levels of expertise and coordination with external experts like insurance brokers, attorneys, consultants, and actuaries.
What communications are required by the ACA for employers to issue to employees?
New Health Insurance Marketplace Coverage Options and 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?
Coverage for essential benefits with no lifetime or annual limits, elimination of preexisting condition exclusions, and coverage of 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?
Expansion of Medicaid coverage and examining prescription drug plan design and coverage for retirees to maximize subsidies under Medicare Part D.
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.
How should state and local government employers use state exchanges under the ACA?
To determine whether paying penalties for some or all full-time employees to purchase health-care coverage through an exchange might produce a better financial outcome than continuing to provide health benefit plans.
