Healthcare and insurance are essential for Americans, allowing them to receive necessary treatments and prescriptions. The passage of the Affordable Care Act (ACA) transformed many healthcare requirements, from more accessibility to lower premium costs.
However, the ACA also brought in new compliance regulations. Understanding the new compliance standards and how they affect insurance plans is critical, but ACA compliance requirements can vary by insurance type, making it a challenge to keep up with every regulation.
Learn more about ACA compliance requirements and how you can stay compliant.
ACA compliance refers to healthcare plans that comply with the Affordable Care Act (ACA). Also known as Obamacare, the ACA was passed in 2010 to increase healthcare coverage. The law had these three goals:
Overall, the ACA was a massive reform for health insurance plans in America. The act aimed to improve access, coverage and affordability of most health insurance types across the country. These are examples of some of its updates:
An ACA-compliant health insurance plan abides by all the new changes set in the ACA. All new insurance plans purchased after January 1, 2014, must be ACA-compliant. This law applies to both individual and group insurance plans. In other words, all plans after this date must reflect the changes passed by the Affordable Care Act.
All companies offering insurance plans after January 1, 2014, must be ACA compliant. The coverage specifics depend on the type of insurance and health plan enrollees’ purchase. For instance, all companies with 50 or more employees must offer health insurance for their workers, but those with fewer than 50 aren’t required to.
Another differentiation with ACA compliance is with grandmothered or grandfathered plans. These healthcare plans took effect before 2014 and are subject to different compliance requirements.
Here is a closer look at these types of plans and their ACA requirements:
While most health insurance plans must be ACA-compliant, the specifics of compliance vary. Here is an overview of the different types of health insurance types and ACA compliance requirements:
Individual or family coverage plans are policies people purchase independently and not through their employer. For instance, an enrollee might buy a health insurance plan directly from a health insurance company rather than enroll through their worksite.
To comply with the ACA, individual plans must follow the outlined changes in the law. For example, all plans must feature:
The term “small group” refers to an employer or company that purchases health insurance for their employees. Businesses with 50 or fewer full-time employees are considered small groups. They are also required to comply with ACA requirements.
Small group requirements are very similar to the regulations for individual and family plans, including:
Employers with 51 or more full-time employees are considered large groups. The requirements for ACA compliance differ slightly for large group coverage. Many large group companies also choose self-insured plans, which can also follow large group rules.
ACA requirements for large groups include:
Healthcare companies must stay compliant with ACA regulations. If you have questions and concerns, use the form below to connect with one of our healthcare leaders today.