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HealthCare Reform Basics

The Basics

The Affordable Care Act, the law commonly known as health reform, passed in 2010 and aims to make health care available to all Americans.

  • Everyone, with a few exceptions, is required to have health insurance. Health insurance is based on the idea of sharing costs across a large group of insured people.
  • People who choose not to buy health insurance must pay a penalty, or fee, each year. They must also pay for the costs of all their health care.
  • Most health insurance plans include certain essential benefits, like preventive care with no cost-sharing and coverage for pre-existing conditions.

Coverage Level Requirements

Plan coverage requirements are identified by four “metallic” benefit coverage levels:

Bronze – Silver – Gold – Platinum

These designations indicate the relative value of the covered benefits, from Bronze (lowest) to Platinum (highest). All plans must meet standard requirements for affordability, essential health benefits and consumer protections

Essential Health Benefits

Coverage must provide for an Essential Health Benefits (EHB) package in 10 benefit categories. Plans are required to cover pediatric dental and vision services, not generally covered previously under most typical small group employer plans.

90-day Waiting Period

Employers will need to offer new employees health benefit coverage on or before day 90 of their employment. The 90 day waiting period limits apply to all group health plans, grandfathered and non-grandfathered, for the plan year on or after Jan. 1, 2014.

Preventive Care

Most health plans now must cover preventive care. If you go to a doctor in your plan’s network, you don’t have to pay anything for preventive services. No copay. No coinsurance. There is no charge to you even if you have not met your plan’s deductible.

The U.S. government defines what must be covered under preventive care. The list includes:

  • Recommended vaccines for children
  • Screening tests for some conditions
  • Certain women’s health services, including birth control