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ACA Changes Associated with Group Health Insurance
Click on each section below to learn how Health Care Reform affect these different segments of Group Health Insurance.
Grandfathered vs. Non-Grandfathered
If your plan was in place prior to March 23rd, 2010 and you have made no significant changes to benefits (decrease of more than 15%) or employee contributions (decrease more than 5%), your plan may be Grandfathered.
The Health Care Reform Law affect these two types of plans differently. As you read through the rest of the reforms, we will mention whether they apply to Grandfathered, Non-Grandfathered, or both types of plans.
Each reform provision applies differently, so we will break it down for you below.
Applies to: Non-Grandfathered Plans Only
Effective: New or renewing policies on or after September 23rd, 2010.
All non-grandfathered policies, group and individual, have 100% preventive coverage for defined services for plans written or renewing after September 23rd, 2010.
Services are defined by the United States Preventive Service Task Force’s A & B category services. (USPSTF List)
Examples of Services Classified as Preventive
$1· Blood Pressure Screening
$1· Cholesterol Screening
$1· Colorectal Cancer Screening for adults over 50
$1· Type 2 Diabetes screen for adults with high blood pressure
$1· Immunization such as Flu shots, Pneumonia, tetanus and others
$1· Obesity Screening
$1· STD prevention and counseling for adults at high risk
$1· Tobacco Use screening and cessation interventions
Children’s Preventive Services
Children have a separate list of preventive services. Below is a partial list of those services.
$1· Autism screening for children at 18 months and 24 months
$1· Behavioral assessment for children of all ages
$1· Developmental screening for children under age 3
$1· Depression screening for adolescents
$1· Hearing screening for newborns
$1· Immunizations including but not limited to Hepatitis A & B, Flue shot, Measles, Mumps, Rubella, Pneumonia
$1· Obesity Screen
$1· Vision Screening
Women’s Preventive Services: Added Effective August 1st, 2012
Included in women’s preventive coverage is…
$1· Breast cancer screening every 1 to 2 year for women over 40
$1· Breastfeeding support and counseling as well as access to breastfeeding supplies
$1· Cervical cancer screen
$1· Sexually Transmitted Infections counseling
$1· Well Women’s visits
$1· Certain contraceptive drugs and sterilization procedures no including abortifacient drugs.
HSA & FSA Changes
Affects: All policy types, Grandfathered & Non-Grandfathered
Health Savings Account/HSA Changes
Effective January 1st, 2011
Effective January 1st, 2011, the following provision were changed in regards to Health Savings Bank Accounts.
$1· Withdrawals from and HSA bank account for non-qualified medical expenses will face a 20% tax penalty as opposed to the 10% that was previously assessed
$1· Over the counter medications were removed from the list of qualified medical expenses
Flexible Spending Account/FSA Changes
Effective January 1st, 2013
The limit for the medical expense portion of the FSA was set at $2,500 per employee. Before this limit was legally set, it was up to the employer to limit contributions.
Note: This does not limit the contribution to the Childcare or POP plans