1. THE AFFORDABLE CARE ACT
NO POLITICS PLEASE!!!!!!!

2. We Will Cover Four Topics
 Some Definitions
 Statistics
 The Year 2015
 Documents and Forms

3. First
Some

4. Affordable Coverage
 Employee’s share of the annual premium for self-
only coverage is no greater than 9.5% of annual
household income.

5. Community Rating
 A rule that prevents health insurers from varying
premiums within a geographic area based on age,
gender, health status or other factors.

6. Employer Shared Responsibility Payment (ESRP)
 The Affordable Care Act requires certain employers
with at least 50 full-time employees (or equivalents)
to offer health insurance coverage to its full-time
employees (and their dependents) that meets certain
minimum standards set by the Affordable Care Act
or to make a tax payment called the ESRP.

7. Employer or Union Retiree Plans
 Plans that provide health and/or drug coverage to
former employees or members, and, in some cases,
their families. These plans are offered to people
through their (or a spouse's) former employer or
employee organization. Many of these plans aren't
legally required to meet many of the provisions of the
Affordable Care Act, including providing coverage
for children up to age 26.

8. Essential Health Benefits
 Insurance policies must cover 10 benefits in order to be
certified and offered in the Health Insurance
Marketplace.
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Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder services, including
behavioral health treatment
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care

9. Full-Time Employee
 An employee who works an average of at least 30
hours per week (so part-time would be less than 30
hours per week).

10. Grandfathered Health Plan
 As used in connection with the Affordable Care Act:
A group health plan that was created—or an
individual health insurance policy that was
purchased—on or before March 23, 2010.

11. Health Coverage
 Legal entitlement to payment or reimbursement for
your health care costs, generally under a contract
with a health insurance company, a group health
plan offered in connection with employment, or a
government program like Medicare, Medicaid, or the
Children’s Health Insurance Program (CHIP).

12. Health Plan Categories
 Plans in the Marketplace are primarily separated
into 4 health plan categories — Bronze, Silver, Gold,
or Platinum — based on the percentage the plan pays
of the average overall cost of providing essential
health benefits to members. The plan category you
choose affects the total amount you'll likely spend for
essential health benefits during the year. The
percentages the plans will spend, on average, are
60% (Bronze), 70% (Silver), 80% (Gold), and 90%
(Platinum). This isn't the same as coinsurance, in
which you pay a specific percentage of the cost of a
specific service.

13. Health Insurance Marketplace
 A resource where individuals, families, and small
businesses can: learn about their health coverage
options; compare health insurance plans based on
costs, benefits, and other important features; choose
a plan; and enroll in coverage.

14. Next
Some Statistics

18. Moving On
Are You Ready?

19. Finally
Finding Forms