All new individual major medical policies sold after January 1, 2014 are required to be ACA-compliant. This means they must include coverage for the ten essential benefits with no lifetime or annual benefit maximums, and must adhere to the consumer protections built into the law. The ACA defines ten essential health benefits:
- Hospitalization
- Ambulatory services (visits to doctors and other healthcare professionals and outpatient hospital care)
- Emergency services
- Maternity and newborn care
- Mental health and substance abuse treatment
- Prescription drugs
- Lab tests
- Chronic disease management, “well” services and preventive services recommended by the U.S. Preventive Services Task Force
- Pediatric services for children, including dental and vision care (there is some flexibility on the inclusion of pediatric dental if the plan is purchased within the exchange)
- Rehabilitative and “habilitative” services
To learn more about compliance, contact Kamm Insurance Group and we’ll walk you through the requirements.