Plan compliance

PPACA compliant plans

All small groups must switch to a new benefit plan that incorporates the 2014 PPACA requirements, unless the employer group plan is grandfathered. This switch will occur on the group’s plan year/renewal date. For example, if the plan year/renewal date is April, the group must move to a new benefit plan that complies with the PPACA in April 2014.

The law’s coverage standards include the following:

• Cover at least the Essential Health Benefits (EHB)*
• Plans must be categorized by metal tiers providing a specified percentage of coverage *(the amount the plan would cover for benefits offered) – Bronze (60%), Silver (70%), Gold (80%) and Platinum (90%)
• Cap annual deductibles: $2,000 for single coverage and $4,000 for family coverage*
• Cap annual out-of-pocket cost sharing* ($6,350 for single coverage and $12,700 for family coverage)
• No annual dollar limits on the value of Essential Health Benefits
• Limit waiting periods (no more than 90 days)