Health care reform
Health insurance coverage and fees under the Affordable Care Act
Insurance plans must meet several requirements related to affordability and quality under the ACA. These changes include:
- Adhering to out-of-pocket limits
- Covering dependent children
- Meeting essential health benefits
Several ACA changes related to employee coverage eligibility took effect in 2016. Additionally, insurers are subject to a number of taxes and fees that support the ACA’s provisions and penalize employers who fail to adhere to them.
Taxes and fees
The ACA and other laws introduced a number of taxes and fees for employers, such as:
- Insurance Provider Assessment (IPA) tax: The Michigan tax that replaced the Health Insurance Claims Assessment as a major funding source for Michigan’s Medicaid program. It applies to fully-insured plans
- Patient-Centered Outcomes Research Institute fee: A federal fee that funds the PCORI, which will produce and promote research on clinical effectiveness to help patients and their health care providers make more informed health care decisions. The fee is determined by IRS annually. HAP includes this fee in our rates for all large group plans, and individual and small group qualified health plans.
- Risk adjustment fee: An annual assessment for the administration of a risk adjustment program to reduce the impact of adverse selection. It will transfer funds from plans with membership that is healthier than average to those with membership that is less healthy than average. We include this fee in our rates for individual and small group qualified health plans.
Tax penalties for insufficient coverage
Employers with more than 50 full-time employees will face a tax penalty if they fail to offer their employees’ health insurance. Find out your clients’ responsibilities under the ACA.
Learn whether your client must offer coverage.