The Essential Health Benefits-PACE Act

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HR Workplace Services PACE Act Signed into Law on October 7, 2015

Employers who thought they may get relief from “small group” provisions of the Affordable Care Act (ACA) will not get such relief. On October 7, 2015 President Obama signed into law the Protecting Affordable Coverage for Employees (PACE) Act. Prior legislation would have expanded the definition of a small group from 2 – 50 employees to 2 – 100 employees. The PACE Act keeps the current definition of a small group as it is at 2 – 50 employees.

How a small group is defined is very important to employers, certain provisions of the ACA do not apply to insurance that is offered by employers in the large group market. Therefore, had the PACE act not been signed, many more small employers would have been subject to “essential health benefits” that must be offered as part of the health insurance plan that is offered to employees.

The “Essential health benefit” required by a plan in the small group market items and services in the following ten benefit categories:

• 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

With PACE, states will now have the ability to further either use the 2 – 50 definition of a small group or change the definition for their state.

Give AIS, Inc. a call today for any questions or concerns you may have about healthcare, benefits, or anything else! To receive information about how to obtain an innovative, customized solution contact us today (800) 523-8351.

*information provided by HR Workplace Services