According to the Affordable Care Act, as of January 1, 2014, all newly purchased individual and small group policies, whether sold on or off the exchange, must adhere to the ACA's regulations, including coverage for the ten essential health benefits with no annual or lifetime coverage maximums.
Very few plans covered all ten of the essential health benefits prior to implementation of the Affordable Care Act. What are these benefits?
- Ambulatory services (outpatient services)
- Emergency services
- Maternity and newborn care
- Chronic disease management, "well" and preventive services
- Habilitative and rehabilitative services (services which help patients acquire, maintain, or improve skills necessary for daily functioning) and devices
- Laboratory services
- Mental health and substance abuse disorder services, and behavioral health treatment
- Prescription drugs
- Pediatric services (including vision and dental)
There are different requirements for small and large employers, with different ACA-compliance. Your Mountcastle agent will help you determine what your requirements are when you create your company's plan.
ACA Compliance FAQs
During open enrollment, these benefits are guaranteed issue (regardless of age, income, health status, and medical history) so that pre-existing conditions are not a factor in eligibility.