What are the minimum benefits that must be offer for ACA plans?
Asked by: Prof. Maximo Stiedemann V | Last update: August 11, 2025Score: 4.9/5 (6 votes)
What are the minimum essential benefits under ACA?
- Ambulatory patient services (outpatient services)
- Emergency services.
- Hospitalization.
- Maternity and newborn care.
- Mental health and substance use disorder services, including behavioral health treatment.
- Prescription drugs.
What is the ACA threshold for benefits?
On September 6, 2024, the IRS issued Revenue Procedure 2024-35. It announced that the Affordable Care Act (ACA) affordability threshold is increased from 8.39% for 2024 to 9.02% for 2025.
What are 5 mandated benefits under the ACA?
The 10 categories of benefits in an EHB package are: 1) ambulatory patient services, 2) emergency services, 3) hospitalization, 4) maternity and newborn care, 5) mental health and substance use disorder services, 6) prescription drugs, 7) rehabilitative and habilitative services and devices, 8) lab services, 9) ...
What are the offer of coverage requirements for ACA?
Employers must offer health insurance that is affordable and provides minimum value to 95% of their full-time employees and their children up to the end of the month in which they turn age 26, or be subject to penalties.
ACA 101: A Comprehensive Guide to the Affordable Care Act
What is a qualifying offer for ACA?
A "Qualifying Offer" is an offer that satisfies all of the following criteria: It is an offer of coverage that provides minimum value; The employee cost for employee-only coverage for each month does not exceed 9.5% (as adjusted) of the mainland single federal poverty line divided by 12; and.
What is the 50/30 rule in the Affordable Care Act?
The Affordable Care Act's “shared responsibility” provisions (also referred to as the "employer mandate" or "play or pay") generally require that “applicable large employers” or ALEs (those with 50 or more full-time employees working at least 30 hours per week or their equivalents when adding together part-time hours) ...
Which of the following is a legally required benefit?
Medicare and social security, unemployment insurance, workers' compensation, health insurance, and family and medical leave are all benefits that the federal government requires businesses to provide. State governments may have other requirements.
What is the 9.5% rule for ACA?
The federal poverty line safe harbor generally treats coverage as affordable for a month if the employee required contribution for the month does not exceed 9.5 percent, adjusted annually, of the federal poverty line for a single individual for the applicable calendar year, divided by 12.
What is the ACA mandate?
The individual mandate is a provision within the Affordable Care Act (ACA) that required individuals to purchase minimum essential coverage – or face a tax penalty – unless they were eligible for an exemption.
What is the minimum value coverage?
An employer-sponsored plan provides minimum value if it covers at least 60 percent of the total allowed cost of benefits that are expected to be incurred under the plan.
What is the ACA 30 hour rule?
If an employee is credited with an average of 30 hours per week or more during the Standard Measurement Period, the employee would be eligible for benefits for the upcoming plan year.
What is the ACA maximum out-of-pocket?
Health insurance plans can set their own out-of-pocket maximums, but they're constrained by federal regulations that impose an upper limit on how high out-of-pocket costs can be. 2024: The upper limits are $9,450 for an individual, and $18,900 for multiple family members on the same plan.
What is the minimum affordability for the ACA 2024?
However, in accordance with the newly announced affordability percentage for 2024 (8.39%), an employee would need to make at least $28,605.48 per year ($2,400/8.39%) for the $200 monthly employee contribution for self-only coverage to be considered affordable.
What is the minimum essential coverage offer indicator?
Column (a) – Minimum Essential Coverage Offer Indicator
This column is used to indicate the months in which the ALE Member offered minimum essential coverage to at least 95% of its full-time employees and their dependents.
What is the 80 20 rule for ACA?
The 80/20 Rule generally requires insurance companies to spend at least 80% of the money they take in from premiums on health care costs and quality improvement activities. The other 20% can go to administrative, overhead, and marketing costs.
What is the 26 week rule for ACA?
This rule states that an employer is eligible to treat a returning employee as a rehire even if their absence was less than the 13 weeks normally required for them to be classified as terminated (26 weeks in the case of educational institutions).
What is one requirement of the Affordable Care Act?
The ACA requires all qualified health benefits plans to cover essential health benefits, including those offered through the Marketplaces and those offered in the individual and small group markets off-exchange.
What is a mandated benefit?
Mandatory benefits are benefits employers are legally required to provide their employees. These benefits are usually related to social security and insurance. Often, employers are required to withhold sums reserved for mandatory benefits from their employees' salaries.
Which of the following benefits is not required by law?
1. The benefit that is not required by Federal law out of the options listed is: Pension plans. Employers are not necessarily required to provide a pension scheme, although if they do, they must conform to the rules and regulations set out in the Employee Retirement Income Security Act. 2.
What are optional benefits?
Optional Benefits are supplemental benefits that employers can offer their employees. These benefits are not a requirement, but rather an option that employees can opt into. Employees can choose to pay for these extra benefits depending on their preferences and needs.
What is the minimum value for ACA?
A health plan meets the minimum value standard if both of these apply: It's designed to pay at least 60% of the total cost of medical services for a standard population.
What is the ACA 29 hour rule?
Any variable hour employee working an average of at least 30 hours per week at the end of a 12-month measurement period is considered to be 'full-time' under the ACA and as a result they will be offered medical coverage for up to a period of 12 months following the completion of their measurement period (called the ...
What is the 60 20 20 rule?
If you have a large amount of debt that you need to pay off, you can modify your percentage-based budget and follow the 60/20/20 rule. Put 60% of your income towards your needs (including debts), 20% towards your wants, and 20% towards your savings.