The health care law does not require employers to provide health insurance for their employees. However, employers with 50 to 99 or more full-time employees that do not offer insurance or offer insurance that is unaffordable will be subject to fees beginning January 1, 2016. Those with 100 or more full time equivalent employees will face fees beginning January 1, 2015 if they do not offer coverage to at least 70 percent of their full time workforce.
A set of health care service categories that must be covered by certain plans, starting in 2014.
The Affordable Care Act defines essential health benefits to “include at least the following general categories and the items and services covered within the categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.”
Insurance policies must cover these benefits in order to be certified and offered in Marketplaces, and all Medicaid State plans must cover these services by 2014. Starting with plan years or policy years that began on or after September 23, 2010, health plans can no longer impose a lifetime dollar limit on spending for these services. All plans, except grandfathered individual health insurance policies, must phase out annual dollar spending limits for these services by 2014. The Department of Health and Human Services is working with a number of partners to develop the essential health benefits package. In the fall of 2011, HHS launched an effort to collect public comments and heard directly from many Americans who were interested in sharing their thoughts on this important issue.
A new transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans. Affordable Insurance Marketplaces will offer you a choice of health plans that meet certain benefits and cost standards. Starting in 2014, Members of Congress will be getting their health care insurance through Marketplaces and you will be able buy your insurance through Marketplaces too.
Items or services that aren’t covered under your contract for insurance and which an insurance company won’t pay for. For example, your policy may not cover pregnancy care or any services related to a pre-existing condition.