There are many exemptions
and waivers to the ACA. Listed below you will find the
exemptions and waivers that the ACA provides to individuals
and businesses.
Medical Loss Ratio (MLR)
The MLR regulation,
published on December 1, 2010, exempts mini-med plans for
2011 by requiring them to meet only half the MLR as other
plans. The regulation requires that these plans submit
certain figures to HHS which HHS will use to determine
whether or not to extend the waiver into 2012 or 2013.
MLR requires insurance companies
to spend at least 80% or 85% of premium dollars on medical
care, with the review provisions imposing tighter limits on
health insurance rate increases. If they fail to meet these
standards, the insurance companies will be required to
provide a rebate to their customers starting in 2012. (Center
for Medicare & Medicaid Services).
Annual Limit Waiver
The waiver program was
initially announced on Sept. 3, 2010, when the U.S.
Department of Health and Human Services (HHS) released
guidance on the process by which certain plans and
insurers could obtain such waivers.
The
Affordable Care Act prohibits health plans from putting
a lifetime dollar limit on most benefits you receive.
The law also restricts and phases out the annual dollar
limits a health plan can place on most of your benefits
— and does away with these limits entirely in 2014. (HHS
Health Care website).
Medical Loss Ratio (MLR)
Waiver for States
The MLR
regulation allows for states to apply for a waiver, or
adjustment, from the MLR. So far, 17 states and
Guam submitted applications. They include, Maine,
NH, NV, KY, FL, GA, ND, IA, LA, Guam, KS, DE, IN, MI,
TX, OK, NC, and WI. (see
details from the Centers for Medical Services (CMS)
website).
State Innovation Waiver
States can be granted a waiver for innovation” from
section 1332 of Obamacare if they meet the following
requiremets:-- provide coverage at least as
comprehensive” as Obamacare;
- “provide coverage and cost
sharing protections against excessive out-of-pocket
spending that are at least as affordable” as Obamacare;
and
- “provide coverage to at least
a comparable number of its residents as” Obamacare.
The employer mandate set to
begin in 2014 is delayed until 2015 (Dept
of Treasury)
The Employer Mandate was scheduled to go into effect
in 2014. This mandate required businesses with
over 50 full-time employees provide health insurnace to
their employees or face a tax penalty. The
employer mandate is also referred to as "shared
responsibility fee". (Obama
Care Facts)
Individual Mandate Waivers
The Individual Mandate requires all individuals to
purchase insurance. It will not apply to the
following individuals:
- Religious objectors - Members of a Health Care
Sharing ministry - Illegal aliens - Jailed inmates - The poor - Members of an Indian Tribe - Hardship sufferers
Since the Employer Mandate has been extended for one
year there is increasing calls for the individual
mandate to be extended as well.
