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Important Affordable Care Act Details for Small Employers

Essential Health Benefits

The Affordable Care Act identified ten service categories that became covered under all health plans beginning with the first renewal on or after January 1, 2014. The ten “Essential Health Benefits” included were: Ambulatory Patient Services, Emergency Services, Hospitalization, Maternity and Newborn Care, Mental Health Services, Prescription Drugs, Rehabilitative Services, Laboratory Services, Preventive and Wellness Care, and Pediatric Dental Services, including Oral and Vision Care.

Pediatric Dental

Medical coverage must include essential pediatric dental benefits unless a qualified standalone dental plan is offered.

Wellness Requirement

Health plans are required to offer an annual reimbursement for active participation at a qualified fitness facility.

Summary of Benefits and Coverage (SBC) Notice Requirements

Employers must continue to provide their employees with a standard “Summary of Benefits and Coverage” explaining what their health plan covers and how much those services cost. The SBC must be made available to all eligible employees upon enrollment, renewal, when a plan has been modified and within 7 business days following a participant’s request for the document.

Maximum New Hire Waiting Period

Employees can no longer be made to wait more than 90 days to become eligible for health insurance coverage.

NYS Exchange Small Business Health Care Tax Credits

Businesses that have fewer than 25 full-time equivalent employees, pay average annual wages below $50,000, and contribute 50% or more toward employees’ single health insurance premiums may qualify for a small business health care tax credit of up to 50% to help offset the costs of insurance when purchasing a NY State of Health exchange health plan for their employees.

For additional information on Small Business Tax Credits, please visit our Helpful Resources page or contact our office.

Pay or Play Mandate and Penalties - 50+ Groups Only

Under the Affordable Care Act, an employer with 50 or more employees may be subject to penalties if it does not offer its full-time/full-time equivalent employees (and their dependents) affordable health coverage that provides minimum value. This requirement is also referred to as “employer shared responsibility” or “pay or play” rules.

To learn more, please visit our Health Care Reform page.