On January 20, President Trump released an executive order regarding repealing the Patient Protection and Affordable Care Act. This act will require employers to look into how their workplace-offered insurance plans will affect their employees.
While the executive order is simply a statement of intention, the ACA could be repealed in the near future. If this occurs, here are some of the potential results your company may encounter:
1. Prohibition on Lifetime and Annual Limits: Currently, the ACA limits lifetime and annual spending and covers essential health benefits that employers typically cover.
2. Out-of-pocket Maximum Limit: The ACA has set maximum out-of-pocket limits for families and individuals on the plan. Once an enrollee reaches the limit his or her insurance will cover all further expenses for the year.
3. Waiting Period Limit: Health insurance waiting periods refer to the time a group health plan or group health insurer can impose on a new enrollee when his or her plan goes live. The ACA prohibits waiting periods longer than 90 days, preventing eligible employees and dependents from having to go without insurance for longer than 90 days.
4. Prohibition on Pre-existing Condition Exclusions: No matter an enrollee's age, the ACA disallows group health plans and health insurance companies from limiting or excluding benefits based on a pre-existing condition.
5. Dependent Coverage to Age 26: Until a child reaches age 26, he or she can be enrolled as a dependent under the ACA. The age limit may change.
6. Preventative Care Coverage Requirement: Today, plans are required to cover preventative care like women's health specific issues, regular doctors appointments, cancer screenings and immunizations.
7. Prohibition on Recessions: Other than instances of fraud or intentional misrepresentation of a material fact, the ACA prevents health insurance providers from canceling coverage and shirking responsibility from medical claims they have already processed.
These are just some of the factors protected and provided by the ACA that may be altered in the event it is repealed. It is not yet known if President Trump plans to replace the ACA with a different healthcare plan or system, but individuals who enroll in the ACA in 2017 will still receive coverage for the entirety of the year, regardless of a repeal. Business owners should pay attention to the appointing of the heads of federal agencies under President Trump as these are the people who will have the power to affect the repeal in the year to come.
Triton Benefits & HR Solutions provides group health insurance with Human Resource support for U.S. based companies. Keep informed by visiting Triton's ACA news and updates.