HEALTH INSURANCE

It’s advised if you are going to offer Health Insurance to employees, that you offer a Qualified Health plan for compliance and tax purposes.

What is a Qualified Health Plan?

A Qualified Health Plan (QHP) is a health insurance plan that meets Minimum Essential Coverage (MEC) under the Affordable Care Act (ACA).

Requirement to be certified as a QHP established under the Affordable Care Act (ACA), aka “Obamacare”  include being licensed in the state where coverage is provided, covering pre-existing conditions, following cost-sharing limits, prohibiting annual and lifetime benefit limits, and covering the ACA’s ten essential health benefits.

Benefits to Employers

Generally, employers can deduct 100 percent of the cost of monthly premiums they pay on qualifying group health plans from their federal business taxes. Offering health insurance coverage to workers as part of their compensation package could also potentially mean that a business may benefit from reduced payroll taxes

Minimal Essential Coverage under a QHP Includes:

• Ambulatory Services
  Outpatient care received without being admitted to a hospital, such as at a doctor’s office, clinic, or same-day (“outpatient”) surgery center. Also included are home health services and hospice care.

• Emergency Services
  Care receives for conditions that could lead to serious disability or death if not immediately treated, such as accidents or sudden illness. Typically, this is a trip to the emergency room and includes transport by ambulance. Patients cannot be penalized for going out-of-network or for not having prior authorization.

• Hospitalization
  Care received as a hospital patient, including care from doctors, nurses, and other hospital staff, laboratory and other tests, medications received during a hospital stay, including room and board. Hospitalization coverage also includes surgeries, transplants, and care received in a skilled nursing facility.

• Maternity and Newborn Care
  Care that women receive during pregnancy (prenatal care), throughout labor, delivery, and post-delivery, and care for newborn babies.

• Mental Health Services and Addiction Treatment
  Inpatient and outpatient care provided to evaluate, diagnose, and treat a mental health condition or substance abuse disorder. This includes behavioral health treatment, counseling, and psychotherapy.

• Prescription Drugs
  Medications that are prescribed by a doctor to treat an illness or condition.

• Rehabilitative Services and Devices
  Rehabilitative services to help recover skills, like speech therapy after a stroke. Devices to help patients gain or recover mental and physical skills lost to injury, disability or a chronic condition and this also includes devices needed for “habilitative reasons”).

• Laboratory Services
  Testing provided to help a doctor diagnose an injury, illness, or condition, or to monitor the effectiveness of a particular treatment. Some preventive screenings, such as breast cancer screenings and prostrate exams, are provided free of charge.

• Preventive Services, Wellness Services and Chronic Disease Treatment
  This includes counseling, preventive care, such as physicals, immunizations, and screenings, like cancer screenings and care for chronic conditions, such as asthma and diabetes.

• Pediatric Services
  Health care services provided to infants and children, including well-child visits and recommended vaccines and immunizations. Dental and vision care must be offered to children younger than 19.

Non-Qualified Health Plan

While Non-Qualified Health Plans haven’t gone through the ACA Exchange/Marketplace certification process, it doesn’t mean they don’t provide good health insurance coverage.  Examples include Medicare, Medicaid, TriCare, VA Benefits, Flexible Spending Accounts (FSA), Health Reimbursement Arrangements (HRA), Medical Expense Reimbursement Plans (MERP).