Affordable Care Act

The Patient Protection and Affordable Care Act (ACA) is the health reform legislation signed into law in March 2010. Key provisions of the legislation include extending coverage to millions of uninsured Americans, implementing measures that will lower health care costs and eliminating industry practices that include denial of coverage due to preexisting conditions. The ACA does not require businesses to provide health benefits to their workers, but applicable large employers may face penalties if they don’t make affordable coverage available. The Employer Shared Responsibility Provision of the ACA penalizes employers who either do not offer coverage or do not offer coverage that meets minimum value and affordability standards. As a participating employer in PEBA-administered insurance benefits, you must offer coverage to all employees who are eligible to participate in the insurance benefits. The Plan of Benefits allows coverage for permanent full-time employees, as well as non-permanent full-time employees and variable-hour, part-time and seasonal employees.

Notification of grandfathered status under the ACA

PEBA offers “grandfathered health plans” under the ACA. As permitted by the ACA, a grandfathered health plan can preserve certain basic health coverage that was already in effect when the law was enacted. This means, as a grandfathered plan, PEBA can minimize the increase in State Health Plan premiums while it assesses the future financial impact of the act. Being a grandfathered health plan means that the Plan may not include certain consumer protections of the ACA that apply to other plans, such as the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the ACA, such as the elimination of lifetime limits on benefits. You can direct questions about which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status to our Customer Contact Center. You may also contact the U.S. Department of Health and Human Services at www.healthcare.gov.