PPACA

Affordable Care Act
States and National Exchanges.

So let’s take a closer look at the Health Insurance Exchange rules set forth in the Affordable Care Act (ACA). The ACA creates state-based Health Insurance Exchanges administered by a governmental agency or non-profit organization, through which individuals and small businesses with up to 100 employees can purchase qualified coverage. In 2014 and beyond most Americans who work for small businesses or obtain their coverage in the individual health insurance market will do so through health insurance exchanges.

Exceptions

Those covered by grandfathered plans and Those covered by self-funded plans (this will apply to very few businesses) States also have discretion to allow businesses with more than 100 employees to purchase coverage in the Exchanges beginning in 2017. In addition, states may opt to allow the federal government to establish an Exchange in their state rather than implement their own. Another possibility allowed by the ACA is for states to form regional Exchanges or allow more than one Exchange to operate in a state as long as each Exchange serves a distinct geographic area. The ACA specifically requires all new policies (except stand-alone dental, vision, and long-term care insurance plans), including those offered through the Exchanges and those offered outside of the Exchanges, to comply with one of the four benefit categories. Existing individual and employer-sponsored plans that achieve Grandfather Status do not have to meet the new benefit standards.