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What is the Affordable Care Act (ACA)?

The ACA is a healthcare reform law that was passed in 2010 with the goal of providing affordable healthcare for families. Here are some key elements of the reform. 

  • There are no underwriting rules.
  • Everyone is guaranteed issue, regardless of their medical history.
  • There are no pre-existing condition guidelines.
  • There is no lifetime max for a policy.
  • There are specified enrollment periods.
  • Each plan must cover the Ten Essential Health Benefits (EHBs).
What are the Ten Essential Health Benefits (EHBs) and how do they affect me?

EHB requirements were built into the ACA to ensure that people and small businesses have access to comprehensive health coverage, specifically important health benefits like:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Pregnancy, maternity, and newborn care
  • Mental health and substance abuse services
  • Prescription drugs
  • Rehab services
  • Laboratory services
  • Preventive and wellness services
  • Pediatric services

 

What is special enrollment?

Special enrollment begins after open enrollment closes and is only available if you have experienced a qualifying life event such as:

  • Marriage/divorce
  • Birth/adoption
  • Loss of employer coverage
What does On-Exchange vs Off-Exchange mean?

If you’re shopping for health insurance On-Exchange, you’ll only be able to purchase from the companies available on the public exchange and may qualify for financial assistance.

If you’re shopping for health insurance Off-Exchange, you can purchase from companies on or off the public exchange, so
you have more options. Financial assistance is not available if you are shopping Off-Exchange.

When would I need Short Term Medical coverage?

Short Term Medical was created to provide you with temprorary coverage during a situation where you might encounter a coverage gap. You might need Short Term Medical coverage if you:     

  • Are a recent college grad     
  • In-between jobs        
  • Recently lost individual or employer-based coverage
  • Are retiring
  • Need gap coverage until the next open enrollment period
Why would I need Group Medical coverage?

You might need Group Medical coverage if you own/run a:    

  • Farm    
  • Doctor/Dentist office      
  • Auto-body shop    
  • Veterinarian clinic    
  • School   
  • Law firm
What group benefits are offered through the ACA?
  • Major medical 
  • Life
  • Dental
  • Vision
  • Short term disability
  • Long term disability
How do I know if I need small group or large group coverage in Illinois?

Illinois falls under the Average Total Number of Employees (ATNE) for calculation.

Here's some information to help you calculate whethere your group is considered small or large.    

  • An employee is any person that the company issues a W-2 for whether full-time, part-time or seasonal. 
  • Add all the monthly employee totals together, and then divide by the number of months that the company was in business last year (usually 12 months).
What’s different about group coverage?

Group coverage does not have an open enrollment period and can be established throughout the calendar year.