under aca section 1557, a health plan

under aca section 1557, a health plan

1 hour ago 2
Nature

Under Section 7 of the Affordable Care Act (ACA), a health plan generally refers to a group health plan or health insurance coverage that meets the ACA's requirements for coverage and consumer protections. Specifically:

  • Section 7 of the ACA does not stand alone but relates to provisions in the Public Health Service Act regarding health plans, including mandates on coverage of essential health benefits and nondiscrimination in benefits based on health status.
  • The ACA requires group health plans and health insurance issuers to comply with rules such as prohibiting preexisting condition exclusions, ensuring coverage for preventive services without cost-sharing, and maintaining limits on out-of-pocket costs.
  • Health plans under the ACA must provide minimum essential coverage and meet standards such as covering at least 60% of total allowed costs of benefits for covered individuals.
  • The plans are subject to protections against discrimination based on health factors and must comply with mental health parity rules if offering mental health or substance use disorder benefits.
  • The ACA also requires transparency, like providing summaries of benefits and coverage to enrollees.

This means a health plan under ACA Section 7 is regulated to ensure fair access, essential coverage, and consumer protections in health insurance policies offered in the group or individual markets, particularly non- grandfathered plans.

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