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heath care reform
life CE
| Question | Answer |
|---|---|
| Patient Protection and Affordable Care Act of 2010 (PPACA) | The act was signed into law by President Barack Obama on March 23, 2010. |
| Health Care and Education Reconciliation Act of 2010 (HCERA) | modified the PPACA. Senate approval followed, and the President signed HCERA into law on March 30, 2010. |
| intent of (PPACA) and (HCERA) | improve our country’s health care delivery system, and at the same time, expand coverage and control health-care costs. 1 all Americans have quality, affordable health ins 2. |
| how would these health care reforms affect different financial classes of people? | aimed at reducing the cost of health care for the middle class, ensuring health security to seniors, and providing tax credits to small businesses and individuals to further reduce the overall cost of health coverage. |
| What specifically will the health care legislation do? | 1. mandate most U.S. residents to obtain health ins 2. create benefit exchanges so ppl can get subsidies to lower ins cost 3. expand medicaid elig 4.tax ins plans c high prem 5.change fed tax code 6.change medicare & medicaid |
| when are all indiv expected to have health care coverage | by the Jan 1, 2014 |
| what happens if your employer does not offer health care? | purchase coverage through insurance exchanges with premium and cost-sharing credit available to those who need financial assistance |
| where will small businesses purchase coverage? | through separate exchanges |
| what happens if employees buy their health care through an exchange instead of through an employer? | The employer will be penalized - THERE IS AN EXCEPTION FOR SMALL BUSINESSES |
| T OR F •Regulations on all health plans will preclude health insurers from denying coverage for any reason, including pre-existing conditions, and from charging higher premiums based on health status and gender | TRUE |
| what happens if indiv do not have health care cov by Jan 1, 14? | they will have to pay a penalty each year they go without |
| who are exempt from purchasing health care? | 1. financial hardship 2. reilg pref 3. American Indians 4.uninsured less than 3 mo. 4. certain low income indiv. |
| health insurance exchanges | states will create these. can be accessed by us citizens and legal immigrants |
| what is the criteria for a small business to purchase insurance through a small business exchange? | 100 or less employees |
| what are the 4 different plan levels for ins? | gold, silver, bronze, platinum |
| what does each level pay of the expenses? | Platinum - 90 % Gold - 80% Silver - 70% Bronze - 60% |
| how long will young adults be able to remain on their parents plan? | till the age of 26 |
| how long will the waiting period for health care contracts be? | no longer than 90 days |
| T OR F plans will be required to eliminate annual and lifetime limits on coverage | TRUE |
| CHIP | Children’s Health Insurance Program |
| how long will medicaid and CHIP continue at their current levels? | until September 30, 2019. |
| T OR F As opposed to the current law, undocumented immigrants will be eligible for Medicaid. | FALSE |
| grandfathered plans | If coverage was provided by a group health plan or by a group or individual health insurance issuer in which an individual was enrolled on March 23, 2010—the date of the act’s enactment—the coverage is grandfathered. |
| what are grandfathered plans exempt from? | elimination of cost sharing for preventive care, annual limits, elimination of pre-exis. condit exclusions, availability of a stand. appeals, limitation on prem variations, •guaran avail of cov, •guaran renewal of cov, no discrim based on health stat |
| t or f lifetime limits are prohibited on all plans after sept 23, 2010 | true |
| what doe essential health benefits include? | ambulatory patient, emerg, hospitalization, maternity & newborn, mental health and substance use disorder, incl behav hlth tx, prescrip drugs, rehab, lab svcs, preven & wellness svcs & chronic disease mgmt, pediatric svcs, incl oral and vision care |
| what restricted annual benefits can a new or grandfathered plan have prior to 9/23/10? | 750k/yr before 09/23/10, 1.25m/yr after 09/23/11 but before 09/23/12 and 2m /yr for on or after 09/23/12 but before 01/01/14 |
| rescission | cancelation of coverage that has a retroactive effect. cancelation of coverage that has only prospective effect, or a retroactive cancelation of coverage that is effective only to the extent of the failure to pay a premium, is not a rescission |
| if a rescission is deemed to be justified, how long does the company need to give the client in order to appeal the rescission or to find new insurance? | 30 DAYS |
| What is the new rule regarding emergency services | prohibit a plan or policy from requiring prior authorization or increased cost sharing for emergency services, whether in network or out |
| Under the new health reform laws, what is the maximum number of employees a small business can have and still purchase insurance coverage through a state health insurance exchange? | 100 |
| Under the new health-care reform laws, when can an insurer rescind coverage? | in instances of fraud |
| Access to state health insurance exchanges will be limited to whom? | to U.S. citizens and legal immigrants. |
| Beginning in what year will nearly all individuals in the U.S. be required to have health insurance? | 2014 |
| Failure to maintain coverage penalty | •the greater of $95 in 2014, $495 in 2015, and $750 in 2016 •up to 2 percent of income by 2016, up to a cap of the national average bronze plan premium Families will pay half the amount for children cap of $2,250 for the entire family |
| Employers with more than 200 employees have what responsibility? | be required to automatically enroll new full-time employees in coverage with proper notice and the opportunity for employees to opt out of any coverage. |
| what must employers tell employees if the employee opts for an exchange health care plan rather than the emplorers group plan? | they will lose the employer contribution, if any, to any health benefits plan offered by the employer and that such contribution may be excludable from income for federal tax purposes. |
| An employer with more than 50 full-time employees that does not offer coverage will be penalized how? | assessed a fee of $750 per full-time employee monthly, the comp must have at least 1 full time employee with prem assis tax credit |
| Reduced cost sharing | available for indiv in qual health plans. Standard out-of-pocket max limits will be reduced by 2/3 for those between 100 and 200 % poverty level, by 1/2 for those between 200 and 300 % of pov level, and by 1/3 for those between 300 and 400 % of pov level |
| who qual for small business employer? | < 25 employees and avg annual wages < $50k. |
| what are the tax credits sm business are elig for and when?q | wages of less than $50,000—are eligible for a tax credit on a sliding scale or full credit for employees who ear < $25K when they purchase health insurance for their employees |
| To qualify for the full small business tax credit, a small employer | must have 10 or fewer employees. |
| How many levels of health-care coverage will be available through state exchanges? | 4 |
| who is required to participate in state insurance health exchanges as a result of the Patient Protection and Affordable Care Act? | No individual, company, business, or nonprofit entity is required to participate in any federal health insurance program created under the act. |
| who will be responsible for determining whether an individual who is claiming a premium tax credit or reduced cost sharing meets the income and coverage requirements? | the HHS |
| Which of the following will be required to automatically enroll new full-time employees? | employers with more than 200 employees |
| Exchanges must be self-sustaining by when? | 2015 |
| The current CHIP program is authorixed how long? | has been reauthorized through September 30, 2015. |
| If a state requires benefits beyond the essential health benefits, which of the following will pay for these? | the state |
| Beginning in 2014, states will be required to use which of the following to determine Medicaid eligibility? | modified grossincome |
| small group market | The small group market is one in which a plan is offered by a small employer that employs 1 to 100 employees. |
| large group marke | he large group market is the market in which a plan is offered by a large employer that employs more than 100 employees. |
| essential health benefits package | covers essential health benefits, limits cost sharing, and has a specified actuarial value |
| individual and small group markets, essential health benefits | must be equal in scope to the benefits of a typical employer plan |
| t or f For all plans in all markets, limits greater than those for health savings accounts are prohibited. | true |
| t or f For the small group market, deductibles greater than $2,000 for individuals and $4,000 for families are prohibited. | true |
| when is a catastrophic-only plan uzed | individuals who are under the age of 30 or who are exempt from the individual responsibility requirement because coverage is unaffordable to them or because of a hardship |
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