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Affordable Care Act – Mandatory and Excepted Health Benefits

The Affordable Care Act (ACA) has had many people scratching their head and wondering what will be included on their new ACA-Compliant policy. What are the Mandatory Benefits and Excepted Benefits?

What are Mandatory Benefits?

As you probably know by now, the Affordable Care Act (ACA) has issued benefits that MUST be included on a health insurance policy. These benefits include:

  1. Outpatient Care
  2. Prescription Drug Coverage
  3. Emergency Care
  4. Mental Health Services
  5. Hospitalization Coverage
  6. Rehabilitation Services
  7. Wellness Services (otherwise known as Preventive Services)
  8. Laboratory Services
  9. Pediatric Care
  10. Maternity/Newborn Care

What are Excepted Benefits?

Certain benefits are used to supplement comprehensive medical coverage and are outside the ACA regulation, these are called Excepted Benefits.  A few examples of Excepted Benefits are stand-alone dental and vision plans. However, if the dental and vision plans are NOT stand-alone, they are still subject to the ACA reforms.

What are other Excepted Benefits?

As of October 1, 2014 a few other Excepted Benefits were added to the list.

Employee Assistance Plans (EAPs) are now considered Excepted Benefits if:

  • The EAP is free to employees
  • EAP benefits are not coordinated with benefits in a group health plan
  • The EAP does not provide significant benefits in the nature of medical care or treatment

The October 1 ruling also clarified that self-insured plans which include dental and vision benefits but do not charge an employee for contribution also qualify as excepted benefits.

Partner Agency Insurance Services, Inc. can provide you with professional expertise in understanding your health care options, guidance in application and eligibility process plus offer you affordable health care coverage through Covered California or directly with medical insurance carriers for Individuals and Families or Employer Group coverage for groups of any size.  Please feel free to contact us for a complimentary quote from various companies for almost any kind of insurance at (714) 482-9500.


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