Affordable Care Act
The introduction of the Affordable Care Act has spiked confusion as to who and what is considered “ACA compliant.” With ZaneHealth, you can be confident that your plan is designed with careful consideration to comply with the Affordable Care Act.
While the tax-code remains intact, the application of the Affordable Care Act has provided additional requirements for Section 105 plan designs. Specifically, guidance released through IRS Notice 2013-54 confirms that group health plans must not place annual limits on Essential Health Benefits and requires that certain preventive services be covered without cost-sharing (the "Market Reforms").
ZaneHealth is designed to comply with the Affordable Care Act’s “Market Reforms” addressed in IRS Notice 2013-54. Specifically, ZaneHealth complies with the PHS Act 2711 annual limit prohibition and the PHS Act 2713 preventive service requirement.
PHS Act 2711 provides that annual limits and lifetime limits may be placed on benefits that are not essential health benefits. Health insurance premiums are not essential health benefits – thus, ZaneHealth may place a “premium-specific” annual limit on premium reimbursements.
PHS Act 2713 requires ZaneHealth to cover basic preventive health services without cost-sharing. ZaneHealth meets this requirement.