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Healthcare Reform

Healthcare Reform, the Affordable Care Act

How it affects Individuals and Businesses

It takes constant dedication to keep up with the newest health care reform regulations. SPC has the training and resources necessary to keep you informed of all of the latest changes to ensure you are prepared, especially when it comes to the most recent healthcare reform, the Affordable Care Act (ACA)

The ACA, also known as OBAMA CARE is currently being implemented and is probably the nation’s most significant change in the laws that govern healthcare. 

Below you will find some (but certainly not all) highlights of the new law and how it may impact employers and individuals under 65.  

 

Highlights of the ACA

For Individuals and Businesses

Tax Penalties

Employers who have more than 100 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. In 2016, the mandate applies to employers who have 50 or more full-time equivalent employees.

Individuals must now obtain qualifying coverage either through an individual policy or through their employer or face a potential penalty.

New Approval Guidelines

No pre-existing clause. 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 in determining rates.

Renewal rates are the same as new business rates.

Waiting period should not exceed 90 days.

Open Enrollment Period

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.

Qualifying Coverage

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.” CLICK HERE FOR A LIST OF THE ESSENTIAL BENEFITS

Premium Tax Credits

Business and Individuals who purchase their health insurance through the new Health Insurance Marketplace and/or SHOP may be eligible for tax credits which are applied as a discount on your monthly insurance premium. To see if you are eligible for a tax credit (premium subsidy), please click the appropriate link below.

Individuals click here
Businesses click here

Related Resources

To help you with Healthcare Reform

The consultants at SPC are continually educating themselves to stay abreast of new laws, regulations and legislation within the healthcare and healthcare insurance industries.  We can help you stay compliant, while reducing costs.

Contact Us for More Info

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