ACA Provisions Required to be Implemented by All Plans

The following provisions of the Patient Protection and Affordable Care Act are required to be implemented by all healthcare plans.

Coverage for young adults to age 26 (effective upon a member’s next renewal –
January 1, 2011 or July 1, 2011)
1. Dependent children can remain on their parent’s membership through the month of their 26th birthday.
2. An adult child’s residence, student status, marital status, health status or eligibility for other coverage is not considered in determining eligibility. (Grandchildren are not eligible for coverage except for the initial 31 days after birth)
3. Coverage and an employer’s contribution toward coverage must be identical to that offered to other eligible dependents.
4. IRS tax on imputed income was removed as of March 30, 2010.
LGC current guidelines generally allow coverage for adult children up to age 26. Residency requirements will be eliminated as of the required effective date.
Lifetime benefit maximums removed effective for a Member’s next renewal –
January 1, 2011 or July 1, 2011.
The majority of LGC plans (Matthew Thornton, BlueChoice, Comprehensive Deductible Plans and the Preferred Provider Organizations) currently have unlimited lifetime maximums. There is a $1 million maximum for Major Medical services associated with the Medicomp program and JY/ JW plans, which will be removed. Lumenos plans have unlimited lifetime maximums for care within the network. However, out-of-network care currently has lifetime maximums which will be removed.
Only "reasonable" annual limits can apply.
LGC is awaiting a definition of “reasonable” and guidance regarding the types of services where limits can apply, e.g., for physical therapy, occupational therapy, speech therapy and durable medical equipment.