Consumer Information on the Affordable Care Act
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The Patient Protection and Affordable Care Act (Affordable Care Act) adds many protections related to employment-based group health plans for you and your family. These include extending dependent coverage up to age 26; prohibiting preexisting condition exclusions for children under age 19 and for all individuals beginning in 2014; and requiring easy-to-understand summaries of a health plan’s benefits and coverage.
Additional protections that may apply to your plan include the requirement to provide coverage for certain preventive services (such as blood pressure, diabetes and cholesterol tests, regular well-baby and well-child visits, routine vaccinations and many cancer screenings) without cost-sharing, and coverage of emergency services in an emergency department of a hospital outside your plan’s network without prior approval from your health plan.
The Affordable Care Act also provides coverage options that allow you to maintain health coverage for you and your family. This page provides information on the Affordable Care Act to help you consider your options and make informed decisions, along with contact information if you have further questions.
Employers must provide notice to employees of coverage options. No later than October 1, 2013, employers will be providing these notices to current employees and to new hires within 14 days. If your employer offers a health plan to some or all employees, you will receive this notice. If your employer does not offer a health plan, you will receive this notice.
Option 1: Your employer plan
The Affordable Care Act adds numerous protections related to employment-based group health plans. These include:
- Extension of Dependent Coverage to Age 26
- Pre-existing Condition Exclusion Prohibition
- Summary of benefits and coverage (SBC)
- Coverage of Preventive Services
- Essential Health Benefits
- Internal Claims and Appeals and External Review
- Medical Loss Ratio
- Wellness Programs
- Grandfathered Health Plans
The Affordable Care Act prohibits employers from retaliating against employees who report violations of the Act's health insurance reforms, found in Title I of the Affordable Care Act. For more information, visit www.whistleblowers.gov. For a full list of Affordable Care Act provisions, visit www.dol.gov/ebsa/healthreform/. There also are protections under other federal benefit laws related to your employment-based health plan:
- The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
- The Consolidated Omnibus Budget Reconciliation Act (COBRA)
- HHS Bulletin Allowing COBRA Qualified Beneficiaries to Enroll in the Health Insurance Marketplace
- HHS Fact Sheet on Losing Job-Based Coverage
- The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)
- Women's Health And Cancer Rights Act (WHCRA)
- Newborns' And Mothers' Health Protection Act
- Genetic Information Nondiscrimination Act (GINA)
- Your Health Plan and You - Know Your Health Coverage Protections
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Option 2 – The Health Insurance Marketplace
Under the Affordable Care Act, in addition to health coverage through an employment-based group health plan, there will be a new way to get health coverage – the new health insurance marketplace (the Marketplace). The Marketplace will offer health insurance (called qualified health plans) that include comprehensive coverage, from doctors and medications to hospital visits. Qualified health plans in the Marketplace will present their price and benefit information in simple terms so that you can make apples-to-apples comparisons. Starting in October 2013, you will be able to get information about all of the plans available in your area and enroll.
For more information about obtaining coverage through the Marketplace, visit www.healthcare.gov, contact EBSA electronically at www.askebsa.dol.gov, or call the HealthCare.gov Help Line at 1-800-318-2596.