Healthcare Reform A look into the Affordable Care Act (ACA) and what it means to you. Presented by Bill Scuorzo President & CEO. About BCG Advisors. ACA Overview.
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The 2,407 page Patient Protection and Affordable Care Act (H.R. 3590), also known as the Senate bill, was signed March 23, 2010. It was amended by the 153 page Health Care and Education Affordability Reconciliation Act of 2010 (H.R. 4872), commonly known as the Reconciliation Bill, signed March 30, 2010.
The law builds upon our current employer based health insurance model that covers 83% of Americans today and hopes to add coverage for 30 million uninsured individuals. This will be accomplished by providing financial assistance through subsidies or tax credits for low income individuals and small businesses, and by expanding Medicaid. The Congressional Budget Office, the CBO, said that as a result 94% of Americans will have access to health care.
Coverage for Pre-Existing Conditions
Fees & Taxes on Group Plans
Small Business Tax Credits
Employer MandateMajor provisions affecting employers who offer group health benefits
Dependents covered to age 26
Medical Loss Ratio
Waiting Period Maximum
Minimum Essential Coverage
Elimination of Pre-Existing Conditions
A MLR of 85% applies to large group plans and 80% for individual and small group plans (100 and below).
Maximum Waiting Period
Effective 1-1-2014, waiting periods in excess of 90 days are prohibited for all size group health plans.
Dependents covered to age 26
The DU26 provision became effective with the first benefit period after 9-23-2010 which is six months after the enactment date of the law signed 3-23-2010.
Limits cost sharing for such coverage; and
Provides either bronze, silver, gold or platinum level of coverage (i.e., benefits that are actuarially equivalent to Bronze 60%, Silver 70%, Gold 80% or Platinum 90% (respectively) of the full actuarial benefits provided under the plan.
Effective January 1, 2014, all in-network out-of-pocket amounts (deductible, copayments, and coinsurance) will accumulate to the annual Out-of-Pocket maximum.
Annual Maximums on DeductiblesMinimum Essential CoverageThe tem “essential benefits package” means, with respect an health plan, coverage that:
Your insurance company can't turn you down or charge you more because of your pre-existing health or medical condition like asthma, back pain, diabetes, or cancer. Once you have insurance, they can't refuse to cover treatment for your pre-existing condition.
Preventive Care Coverage
Fees & taxes on group plans
Health Insurance Provider Fee
Transitional Reinsurance Fee
Individual and Group (SHOP)
Shop is the Small Business Marketplace
Created by private industry such as insurance carriers & Brokers
Can you claim the credit?
The employer mandate fee (officially called an Employer Shared Responsibility Payment) is a per employee fee for employers with over 50 full-time equivalent employees who don't offer health coverage to full-time employees.