RMI 3501 Lecture Notes - Lecture 7: Health Insurance Mandate
12 Dec 2016
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Topic 7 – Chapter Notes
What is the affordable
care act?
Passed March 23, 2010 the Patient Protection Affordable
Care Act passed (Part 1)
March 30, 2010 the Health Care and Education
Reconciliation Act passed (Part 2)
Four main goals of the
ACA?
• Increase access to preventive care
• Increase access to wellness care
• Create transparency for consumers
• Eliminate waste and fraud in the HC system
Dependent coverage to
26
Any dependents who were dropped from coverage because they
were “too old” must be enrolled with NO medical UW. Tax
dependence, residency, student status, marital status,
employment status or eligibility for other coverage does not
come into play.
Lifetime maximum
limits
Anyone who exceeded maximum lifetime limit can be reenrolled
on their plan. Maximum benefits were eliminated
Retroactive recession
Retroactive recession of medical expense coverage is only
allowed for fraud or intentional misrepresentations and a few
other administrative reasons
Preventive care cost
sharing
Preventive care and wellness cost-sharing provisions have
been eliminated
Pre-existing conditions
No longer exists
Medicaid expansion
Medicaid expansion to those up to 133% of the fed. Poverty
level with no dependent requirement
MLR requirements
require health plans to spend a designated portion of the
premium dollars on medical care services
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Passed march 23, 2010 the patient protection affordable. March 30, 2010 the health care and education. Increase access to wellness care: create transparency for consumers, eliminate waste and fraud in the hc system. Any dependents who were dropped from coverage because they were too old must be enrolled with no medical uw. Tax dependence, residency, student status, marital status, employment status or eligibility for other coverage does not come into play. Anyone who exceeded maximum lifetime limit can be reenrolled on their plan. Retroactive recession of medical expense coverage is only allowed for fraud or intentional misrepresentations and a few other administrative reasons. Preventive care and wellness cost-sharing provisions have been eliminated. Medicaid expansion to those up to 133% of the fed. Poverty level with no dependent requirement require health plans to spend a designated portion of the premium dollars on medical care services.
