Chapter Nine: PPACA

The Patient Protection and Affordable Care Act defines a full-time employee as one who works at least how many hours a month?

120 hours Beginning in 2014, the PPACA defines a full-time employee as one who works 120 hours per month or more.

The Patient Protection and Affordable Care Act requires a gold health insurance plan to meet what specific actuarial value?

80% All non-grandfathered health insurance plans must meet specific actuarial values, or AVs: 60% for a bronze plan, 70% for a silver plan, 80% for a gold plan and 90% for a platinum plan. These AVs are called "metal levels".

For small group plans, the Patient Protection and Affordable Care Act mandates insurance companies to spend what percentage of all premiums collected on health care?

80% Health insurance companies are mandated to spend 80 percent for every dollar collected on individual and small-group health plans on health care as opposed to administrative costs.

What is the Medical Loss Ratio (MLR) for large group plans?

85% The Medical Loss Ratio (MLR) is 80% for individual and small business plans, and it is 85% for large group plans.

The Federal Patient Protection and Affordable Care Act is sometimes referred to as:

Obama Care The Federal Patient Protection and Affordable Care Act is a federal law signed by President Obama in 2010 as part of the United States health care reform. The PPACA is more commonly referred to as Obama Care.

What does the Patient Protection and Affordable Care Act require before an employee's health insurance plan's coverage can be rescinded?

Prior written notice must be given to the affected employee The rescission of an employee's health insurance plan's coverage may occur only after prior written notice to the affected employee is given.

The Patient Protection and Affordable Care Act requires an employer who gives an "Adverse determination" notice to a claimant to provide which of the following?

The reasons for the denial of the claim To tell the claimant what information might be missing How to appeal The Patient Protection and Affordable Care Act requires an employer providing notice of an "adverse determination" to describe the reasons for the denial of the claim and to tell the claimant what information might be missing, how to perfect the claim, and how to appeal.

As mandated in the Patient Protection and Affordable Care Act, what will be the lifetime dollar limit for health insurance plans?

There will be no lifetime dollar limits. The PPACA regulations dictate that health plans may not establish lifetime limits on the dollar value of benefits for any participant or beneficiary.