Healthcare Reform Consulting
With nearly 2,700 original pages of healthcare bill and 41 amendments made since first passing in 2010, the Affordable Care Act is the most significant change in the laws that govern healthcare in the nation’s history. Some may interpret parts of the new law differently.
Below you will find some (but certainly not all) highlights of the new law and how it may impact employers and individuals under 65. Because of the complexities of the ACA, we urge you call us for more information and to be sure you are compliant with the new law.
Our consultants are PPACA (Patient Protection Affordable Care Act) trained and certified, and continually work to stay abreast of industry laws and trends.
- Employers who have more than 50 or more full-time equivalent employees must offer those employees and their families and dependents to age 26, benefits that pays for 60% of the minimum essential benefits, as established by the ACA, or face a potential penalty.
- Individuals must obtain qualifying coverage either through an individual policy or through their employer or face a potential penalty. UPDATE – the individual mandate has been repealed for 2019.
New Underwriting Guidelines
- Insurance companies can no longer increase rates or deny coverage because of a pre-existing condition.
- Dependents up to age 26 may be added to an insurance policy for both individuals and employer coverage.
- Gender is no longer a factor.
- Renewal rates are same as new business rates.
- Waiting period can’t exceed 90 days.
- Individuals must purchase their health insurance during the annual open enrollment period. Failure to do so may result in penalties and having to wait until the next open enrollment to purchase coverage. Employers are able to offer benefits year round or during their normal open enrollment as usual.
- To be in compliance with the new healthcare reform laws and avoid costly penalties, you must purchase insurance coverage that pays at least 60% of the costs of the following “essential benefits.”