The Affordable Care Act an Overview

The Affordable Care Act will bring with it many changes to the ways in which health care coverage can be accessed by both individuals and companies. Changes will also be seen to the quality and structure of many health care plans. Consumers will enjoy more rights, including having the ability to file complaints or appeal decisions made by their carrier, such as a denial of coverage for certain treatments. Insurance companies will be required to continue to provide an internal appeal process, but if not successful, consumers will then be eligible to participate in an external appeal process through a local consumer assistance program who will review the case. Consumer assistance programs also help to guide consumers on choosing health care plans.

There will be also be changes to health care plans, such as the removal of annual or lifetime dollar limits, the inclusion of many preventative care services, and plans will also be required to cover pre-existing conditions. Insurance companies will not be able to increase premium costs without clear justification and consumers will be protected from losing coverage due to honest mistakes, such as those made on insurance applications. Prescription costs will also be made more accessible to senior citizens who are currently receiving Medicare, and younger adults will be eligible to remain on their parent’s coverage. The Affordable Care Act also provides support to primary care physicians and healthcare facilities by investing money in training, scholarships, new research, and ensuring that health care resources are available in places which need them the most.

The impact of the Affordable Care Act will affect companies differently depending on the size of the business. For example, companies which employ 50 employees or fewer are considered to be small companies. Companies which employ up to 25 employees and which meet other criteria may be eligible for tax credits to help them continue to provide health care coverage. The types of plans which companies are required to offer their employees vary depending on the state, and companies should be familiar with these. Insurers must charge the same premium for all employees within the group insurance plan regardless of their health status, gender, or age. Small business health option programs or SHOP, provide a market place for small businesses, making it easier for companies to choose the most appropriate plans for their employees. Insurance plans will continue to be offered by private insurance companies, but the content of these plans, including what is covered will be more readily available and easy to understand. This will allow small companies to compare plans before purchasing these.

Large companies are those with employ 50 employees or more. These companies will not have access to public exchanges initially, and those which do not provide health coverage after 2014 may be required to pay a penalty if they meet other criteria.

To navigate the current changes, many companies are choosing to work with consulting companies who can help them to choose the best options for purchasing health care insurance, including implementing these and administrating these efficiently within the company. Ensuring that there are effective software solutions in place to support benefit administration, is an equally important part of the benefit process.

Get Started

Learn more about our Benefits Solutions

Contact Us