Health Insurance Regulations Flashcards

Under the ACA as implemented in DC, what is the maximum out-of-pocket limit for in-network services on a qualified health plan for an individual in 2024?

Answer: $9,450

For 2024, the ACA out-of-pocket maximum for an individual on a qualified health plan is $9,450.

DC's DC Health Link operates under which exchange structure?

Answer: State-based exchange (SBE)

DC Health Link is a state-based exchange (SBE) established and operated by the District of Columbia.

Which federal law prohibits insurers from imposing lifetime or annual dollar limits on essential health benefits?

Answer: ACA (Affordable Care Act)

The ACA eliminated lifetime and annual dollar limits on essential health benefits for all non-grandfathered plans.

A DC employer with 50 or more full-time equivalent employees who does NOT offer health coverage may be subject to which penalty?

Answer: ACA employer shared responsibility payment

Applicable large employers (50+ FTEs) that fail to offer minimum essential coverage may owe the ACA employer shared responsibility payment (employer mandate penalty).

Which provision allows adult children to remain on a parent's health insurance plan until age 26 in DC?

Answer: ACA dependent coverage mandate

The ACA's dependent coverage mandate requires plans offering dependent coverage to extend it to adult children up to age 26.

COBRA continuation coverage in DC must be offered for how long after a qualifying event such as job loss?

Answer: 18 months

COBRA continuation coverage for job loss (reduction in hours or termination) must be offered for up to 18 months.