We have already seen so many changes in the United States due to the enactment of the Affordable Care Act. The new law enforced numerous changes that affected everyone who wanted or has health insurance. Today we have seen only a fraction of the true impact of healthcare reform.
Many in the small business community took advantage of the early renewal program that many carriers offered to their clients in 2013, which provided clients the opportunity to move their renewal date to December 1st. This in turn provided clients another year to “stall” the implementation of an ACA plan.
In a turn of events, President Obama had to reorganize with insurance carriers to allow employers the ability to keep their coverage that was in existence prior to January 1, 2014. Therefore, in 2014, employers have the ability to keep the coverage they had prior to 1/1/2014 or move to an ACA compliant plan.
Our goal is to highlight a few changes that you need to be made aware while reviewing your renewal.
- Under an ACA Compliant plan, co-payments, deductibles and coinsurance will apply towards the out-of-pocket maximum.
- ACA compliant plans, under the “small group market (under 50 lives)) have a deductible limit of $2,000 and the out-of-pocket max cannot exceed $6350.
- Some carriers have structured the prescription drug card under ACA compliant plans to be less affordable as there is an additional cost to the insured if generic prescriptions are available, but a brand name drug is purchased instead.
- There are limited plans which mean less mitigation techniques to help lower increases.
- The rate structure for small groups (less than 50 lives) have age-banded rate tables in lieu of composite rates (tiered: Employee; Employee/Spouse; Employee/Child(ren) or Family.
- Pediatric dental and vision services are included under the “small group” ACA compliant plans.
- ACA prohibits health plans from imposing pre-existing condition exclusions.