3 Things You Need to Know About Health Insurance Benefits

Vintage emergency bag / first aid kit for a time before employers provided health benefits!

Image via Flickr by Ephemeral Scraps

With new regulations for the Patient Protection and Affordable Care Act going into effect, there are at least three things you should know about health insurance benefits:

1. All Insurance Plans Must Cover Preventative Health Benefits

Insurance law is changing to include things called Essential Benefits, which will now be covered at 100 percent. These health insurance benefits include:

  • annual exams,
  • preventative screenings, and
  • certain prescriptions.

See also: Introducing The Ultimate Employee Benefits Guide

For example, colonoscopies will be available to people over 50 while mammograms will be available to women over a certain age. For prescriptions, birth control is now covered at 100 percent as are breast feeding supplies. For children, all health plans must also cover vision and dental (although there isn’t a lot of guidance on what this means yet).

2. It’s Easier to Compare Health Benefits, Insurance Plans, and Care

One thing the Affordable Care Act has done is create a better way to compare health plans. Before this, every insurance company had their own terms and definitions, making it very difficult to compare plans. Now every insurance company needs to fill out a Summary of Benefits and Coverage (SBC) while using the new Uniform Glossary of terms so that all the definitions are also identical. This organizes their information in identical ways with identical definitions of things like “copayment” and “deductible.”

What does this mean for an employer and their employee? It makes it much easier to find the plan and the insurance company that offers the best protection for a professional employer and their employees. Think about it as food labels—they tell you how many calories and how many grams of sugar or protein the product contains so that you can easily find the healthiest option. An SBC and new glossary will provide a similar “label” for much easier comparisons.

3. New Requirements for Health Care Mean Changes in Compliance

As health care laws require insurance companies to fill out a Summary of Benefits and Coverage, an employer has a responsibility to discover who will provide these forms and notify their employee of the changes. An employer is responsible for providing their employees with the following:

  1. An employer must send the new SBC’s and accompanying glossaries to every employee.
  2. An employer must also notify employees about the new state or federal insurance exchanges with information on how they can participate.
  3. If an employer is keeping their current insurance plan, they need to explain how their plan is comparable to what an employee may find in the insurance exchange.

These notifications can in some instances be delivered electronically, but they may need to be printed and handed or mailed out. And yes, we can help with that! As a Professional Employer Organization, we will make sure you are in compliance.

Still have questions about health benefits, insurance, or compliance? Your PEO has access to the tools and information you need. Join our email list for regular expert tips and advice!

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