This trend marks the latest attempt by some employers to avoid meeting certain standards for employee health plans under the Affordable Care Act.
Last year, regulators banned large employers from offering “skinny plans” — coverage with no inpatient hospital benefits — according to the report. Now, insurance administrators and many employers have come up with a new version of the skinny plan to meet the ACA’s standards while still cutting costs. The new plans exclude outpatient surgery. Because these plans are offered by employers, eligible employees do not qualify for federal subsidies to obtain more comprehensive coverage in the online marketplaces.
However, some experts believe these new health plans will have a similar fate to the skinny plans.
“I really wonder whether they can do that,” said Timothy Jost, a law professor at Washington and Lee University in Virginia and an authority on the ACA, according to PBS. “Refusing to cover any outpatient physician surgical services is arguably a violation.”
Large employers are not compelled to offer a list of “essential health benefits” to employees, as insurance sold to individuals and small businesses on the online marketplaces requires. Instead, large employer-sponsored plans must offer minimum value, similar to that of a high-deductible “bronze” marketplace plan, according to the report. The minimum value is determined by an online calculator and regulatory guidance, and companies that do not provide this are subject to a penalty.
Large employers that have excluded outpatient surgery in their employees’ 2016 health plans are mostly staffing companies, home health agencies, hoteliers and other lower-wage employers that had not provided major medical coverage to employees prior to the ACA.
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