HEALTH CARE REFORM COMPLIANCE

The following checklist is provided for your assistance in complying with the various annual requirements of the Affordable Care Act:

  1. Waiting Periods - Employer sponsored group health plans cannot exceed 90 days.
  2. Essential Health Benefits Coverage - Plan includes all coverages required by the Act, including child coverage for certain dental and vision care benefits.
  3. Clinical Trial Coverage – Plans must cover routine patient costs.
  4. Maximum Employee Contribution - For plan years beginning in 2019 the amount is 9.86% of an employee’s salary for employee only coverage.
  5. Dependent Coverage – for Children to Age 26
  6. Annual Maximum Out-of-Pocket Amount – stated annually; in 2019 it is self-only: $7,900, Family: $15,800. For high deductible and HSA health plans , in 2019 it is self-only: $6,750, Family: $13,500.
  7. Health Flexible Spending Account Cap – Current annual maximum amount in 2019 is $2,700.
  8. Emergency Services – Coverage is the same in or out of network facilities
  9. Medical Loss Ratio Requirements and Rebates – Employers will need to determine how to allocate the rebates.
  10. W-2 Reporting – Employers include the aggregate cost of employer sponsored health coverage.
  11. 60 Day Advance Notice of Material Changes
  12. Patient Centered Outcomes Research Institute Fee (PCORI) – the last annual fee at $2.45 per person covered by plan years ending Oct. 1, 2018, through Sept. 30, 2019. Due July 31, 2019.
  13. Health Benefit Exchange Notice – Written notice required to plan p