Affordable Care Act Compliance (ACA)
Remaining ACA compliant requires individual, employer, and association health plans to meet all preventive service coverage rules. Importantly, preventive services play a key role in meeting ACA standards for both individual and group health plans. Therefore, all plan types must include required preventive services to maintain compliance with the ACA.
Preventive Services and Affordable Care Act Compliance:
The ACA emphasizes preventive care as essential to comprehensive health coverage. Therefore, it requires health plans to cover specific preventive services.
Moreover, plans must offer these services without deductibles, copayments, or coinsurance to ensure affordable access.
Requirement for Small and Large Employer Groups:
Employer group health plans, both small and large, must comply with the Affordable Care Act (ACA) requirement of providing coverage for preventive services without cost-sharing. However, there is a distinction in the specific preventive services that must be covered:
- Small Group Health Plans: Small group health plans, covering 1–50 employees, must cover USPSTF-recommended preventive services without cost-sharing. Specifically, they must include all preventive services rated “A” or “B” by the USPSTF.
- Large Employer Group Health Plans: The ACA emphasizes preventive care as essential to comprehensive health coverage. Therefore, it requires health plans to cover specific preventive services. Moreover, plans must offer these services without deductibles, copayments, or coinsurance to ensure affordable access.
Coverage for 100% Wellness and Preventive Services:
The ACA requires that certain preventive services be covered with no cost-sharing. This applies to individual ACA plans and extends to employer group health plans, including small and large groups. The coverage of wellness and preventive services without cost-sharing includes a range of screenings, immunizations, counseling services, and preventive medications.
Remaining ACA Compliant:
To ensure ACA compliance, employer group health plans and association health plans should consider the following:
- Understand the Requirement: First, employers and associations must clearly understand ACA preventive service rules and know which services require no cost-sharing. Then, they should stay updated on any changes to these service requirements.
- Check Recommended Guidelines: Employers and associations should refer to the recommendations of the USPSTF and HRSA for the list of specific preventive services that must be covered.
- Review Plan Documents: First, employers and associations should review plan documents, contracts, and agreements to confirm preventive services have no cost-sharing. Next, they must ensure coverage aligns with ACA preventive care requirements.
- Educate Employees: It is important to inform plan participants about the availability of preventive services without cost-sharing. Employers and associations should communicate the importance of accessing preventive care as a part of a comprehensive health plan.
- Consult with Insurance Carriers: Employers and associations should consult with their insurance carriers or third-party administrators to ensure compliance with the ACA’s preventive services requirement.
By staying proactive, employers and associations maintain ACA compliance and support participants’ well-being through cost-free preventive care. Additionally, consult experts like Enrollment First, Inc. to ensure your health plan fully complies with preventive service requirements.
Sources:
[1] ACA Preventive Services: https://www.healthcare.gov/coverage/preventive-care-children/
[2] Small Business Health Options Program (SHOP) Marketplace: https://www.healthcare.gov/small-businesses/employers/coverage/
[3] Healthcare.gov: Preventive Services Covered by Private Health Plans: https://www.healthcare.gov/coverage/preventive-services-adults/
[4] Regulations.gov – Final Rules on Preventive Services Coverage: https://www.regulations.gov/document?D=EBSA-2018-0009-6252
[5] United States Preventive Services Task Force: https://www.uspreventiveservicestaskforce.org/recommendations.htm
[6] Health Resources and Services Administration: https://www.hrsa.gov/womens-guidelines/index.html