The ACA added numerous protections related to employment-based group health plans. These include:
- 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/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers.
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.
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.
AARP - Formerly known as the American Association of Retired Persons, provides useful generic consumer information on managed care. Included in this site are a glossary of terms, checkpoints for comparing plans, descriptions of differences between traditional fee-for-service and managed care, and AARP principles on essential managed care plan features and services.
Centers For Medicare & Medicaid Services - An agency within the Department of Health and Human Services responsible for Medicare and the new prescription drug program among other issues.
Commonwealth Fund - Offers articles researched and written by experts in fields such as managed care quality, employer value-based purchasing, insurance and coverage, and women, children and minority health.
U.S. Department of Health and Human Services - Website has materials concerning federal health care laws. These materials include information on the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Mental Health Parity Act of 1996 (MHPA).
Federal Employees Health Benefit Plan - Gives current and valuable information to help you choose a health plan. This site offers extensive information on the health benefit plans offered to employees, beneficiaries and retirees of the Federal government. Participants are able to obtain information on the various plans offered as well as instructions for changing plans, filing claims, reporting fraud, and patients rights.
Georgetown University Health Policy Institute - Consumer guides on getting and keeping health insurance for each state and the District of Columbia. These consumer guides summarize your protections and may not answer all of your questions.
Healthfinder - Sponsored by the Department of Health and Human Services' Office of Disease Prevention and Health Promotion (ODPHP) is a gateway consumer health information website that can lead consumers to selected online publications, databases and websites.
Healthcare.gov - A website managed by the U.S. Department of Health and Human Services that provides information on public and private health insurance options.
Indian Health Service - An agency of the U.S. Public Health Service, provides information about healthcare services available to the general public and offers answers to questions and concerns regarding illness and protection.
Joint Commission on Accreditation of Healthcare Organizations - Evaluates and accredits more than 18,000 health care organizations in the United States, including hospitals, health care networks, managed care organizations, and health care organizations that provide home care, long term care, behavioral health care, laboratory, and ambulatory care services. Their website has information about quality, making health care choices, and performance measurement. Performance reports on health care facilities can be accessed and downloaded.
Leap Frog Group - Comprised of more than 100 public and private organizations that provide health care benefits, The Leapfrog Group works with medical experts throughout the U.S. to identify problems and propose solutions that it believes will improve hospital systems that could break down and harm patients. Representing approximately 32 million health care consumers in all 50 states, Leapfrog provides information and solutions for consumers and health care providers.
Medicare.gov - Provides information about Medicare and the expanded health plan options with the creation Medicare+Choice. Information is available in English and Spanish.
National Committee for Quality Assurance - The National Committee for Quality Assurance is a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality everywhere. NCQA is active in quality oversight and improvement initiatives at all levels of the health care system.
National Women's Health Information Center - This site includes a database and links to more than 1,000 federal agencies, publications and hundreds of government-screened private sector organizations related to women's health.
Pacific Business Group on Health - Provides practical information about how to use report cards and other indicators to select health plans and providers. It also has information on health services in general and health and wellness benefits.
SSA Extra Help with Medicare Prescription Drugs Program - The Social Security Administration website providing information and an application for the Extra Help with Medicare Prescription Drug Plan Costs Program.
Children's Health Insurance Program (CHIP) - From the Centers for Medicare & Medicaid Services. CHIP is designed to provide health insurance coverage to "targeted low-income children" of families that earn too much money to be eligible for Medicaid, but not enough money to purchase private insurance.
State Insurance Departments - Continue to regulate health insurance issuers (e.g., insurance companies or HMOs) who sell group insurance to ERISA-covered group health plans, even under the Health Insurance Portability and Accountability Act (HIPAA), the Mental Health Parity Act, and the Newborns' and Mothers' Health Protection Act. In addition, States continue to have responsibilities in individual insurance market (e.g., selling individual insurance policies). The National Association of Insurance Commissioners has created access to state websites with information on particular state health insurance laws. You may also contact your state insurance commissioner for further information on particular state health insurance laws.
Veterans Administration - Sponsors a telemedicine healthcare site dedicated towards improving access, coordination, continuity and outcomes for healthcare for veterans. Through the use of this electronic information and support, consumers are able to overcome distance and time.
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