As a business owner, you may want to know what the Affordable Care Act (ACA) means for your company.
A good place to start is this page on Aetna.com that provides an overview of health insurance exchanges. This page includes an easy-to-understand video to help you navigate the complex and changing health care insurance landscape.
As you’ll learn from the video, ACA has its own special language.
One way to keep up with the health care law is to familiarize yourself with these terms.
Public exchanges: Think of these as online insurance shopping centers. Everyone can use them. And shoppers with a limited income can get financial help from the government. Many states are setting up their own public exchanges, while others are relying on the federal government. Public exchanges become effective October 1, 2013. Plans go into effect January 1, 2014.
SHOP: This stands for Small Business Health Options Program. This is an online insurance shopping center for small business owners like you. SHOP plans offer four standard levels of coverage, from bronze to silver to gold to platinum.
SHOP employee choice model: This means your workers have a choice of health plans to choose from. This part of the law is delayed until 2015 because of start-up issues. Until then, you will be able to choose a single plan from SHOP, similar to the way you do now.
Guaranteed issue: This means everyone can get health care insurance. Health care insurance companies will have to offer coverage to anyone who applies – regardless of past or present medical conditions. This part of the law starts January 1, 2014.
Individual mandate: This means everyone has to get health insurance coverage – or pay tax penalties. This part of the law also starts January 1, 2014.
Medical loss ratio (MLR): This is the minimum percentage of premium dollars a health insurance company must spend on the reimbursement of certain medical costs. The health reform law requires insurers in the small group and individual markets to have an MLR of 80 percent.
Preventive care: Most insurance plans now must pay 100 percent of the cost of preventive services. This long list includes HIV testing, well-woman visits and diabetes screening.
Grandfathered plan: This means a health plan that was in place before March 23, 2010. A grandfathered plan does not have to meet some requirements of ACA.
Non-grandfathered plans: If your health plan became effective after the health care law was signed on March 23, 2010, or if your plan existed before ACA but later lost its grandfathered status, then your plan must meet all of the health care law requirements.
Accountable Care Organization: This is a new model for delivering health care. It offers doctors and hospitals financial rewards for providing quality care while keeping costs down. The hospital is rewarded not necessarily for each transaction completed, but for improving the health care status of its patients.
Learn more about the Affordable Care Act with Health Reform Connection.
Learn more about Aetna insurance solutions.
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