The Affordable Care Act (ACA)

Obamacare(the ACA) has completely dominated headlines since the new health insurance marketplace opened for business. With some of the many changes that have been made, the biggest changes relate to health insurance plans offered to individuals. The new regulations, starting early this year, state that when employers have 50 or more employees, they’re required to provide coverage for essential health benefits.

Tiers of Coverage

Now just in case you weren’t aware, under the Affordable Care Act (ACA) there are four tiers of coverage for health insurance plans. There are the bronze, silver, gold, and platinum plans. Each plan is based on its values and percentages of healthcare expenses that are paid by the plan. Bronze has 60%, silver 70%, gold 80%, and platinum 90%. The higher the plan, the higher the pay will be toward your healthcare. Keep in mind that there are still monthly premiums so the higher you go in plans, the higher your monthly premiums will be.

ACA Health Plans

The Affordable Care Act ensures health plans offered in the individual and small group markets, both inside and outside of the Health Insurance Marketplace, offer a comprehensive package of items and services. Offered health plans must cover a minimum of the following;

Ambulatory patient services- This is the care that’s received without being admitted to a hospital. For example, care at a clinic, physician’s office, or same-day surgery center.

Emergency services- This is the care for conditions that, if not immediately treated, could lead to a serious disability or death.

Hospitalization– Care you receive as a patient in a hospital, such as room and board, care from doctors and nurses, tests and drugs administered during your stay.

Maternity and newborn care- This is the care that’s provided to women during pregnancy and during and after labor as well as care for newly born children. There are about 4 million babies born a year in the US. The average cost for an uncomplicated pregnancy and delivery at a hospital is about $7,600.

Mental health and substance use disorder-This is care to evaluate, diagnose and treat mental health and substance abuse issues.

Prescription drugs-Drugs prescribed by a doctor to treat an illness like an infection, or an ongoing condition like high blog pressure.

Rehabilitative and habilitative services and devices- These are services and devices to help people with injuries, disabilities or chronic conditions gain or recover mental and physical skills.

Laboratory services- These services are utilized when you’re testing blood, tissues, etc. from a patient to help a doctor diagnose a medical condition and monitor the effectiveness of treatment.

Preventative and wellness services and chronic disease treatment- Preventative care such as physicals, immunizations, and cancer screening is designed to prevent or detect medical conditions. Chronic disease management is an integrated approach to managing an ongoing condition, like asthma or diabetes.

Pediatric Services- Medical care that’s provided to infants and children including vaccines and immunizations and well-child visits. Any child under 19 must have dental and vision care offered to them. Including two dental exams, eye exams, and corrective lenses each year.

Essential Health Benefits

Under the Affordable Care Act, these ten essential health benefits are the minimum requirement for many health insurance plans. Fully insured plans  (when the employer pays a per-employee premium to an insurance company, and the insurance company assumes the risk of providing health coverage for insured events) are not required to include essential health benefits. Many other plans have additional health benefits on top of these. When your employees are looking to choose a health care plan they will look at the summary of benefits, which highlights coverage, before making a decision.

ACA Employee Benefits

Is your business offering these coverages to your employees? No matter the size of your business, it’s still important to make sure your employees are covered. If you feel that you can’t offer these benefits, look into having a staffing agency provide you with great people and great benefits. Then, you won’t be bothered by any of the ACA mandates.

Contact us today to work with an experienced staffing agency. We have an amazing Job Search page that makes it easy to both share and find open positions. You can learn more about our staffing services here. We look forward to hearing from you soon!