Affordable Care Act and PremiumSaver FAQ

How is the Premium Saver viewed in conjunction with the Affordable Care Act (ACA)?

The Premium Saver is an excepted benefit under Category 4 (supplemental benefits - similar to Medicare Supplements).   Benefits are supplemental excepted benefits only if they are provided under a separate policy, certificate or contract of insurance.  Also one requirement to be similar supplemental benefits under a group plan is that the coverage “must be specifically designed to fill gaps in primary coverage, such as coinsurance or deductibles.”

If a group puts in a high deductible major medical plan would it still be in compliance if we added the Premium Saver?

The Premium Saver does not disturb the Major Medical’s plan for ACA compliance.  The Major Medical plan must stand on its own for ACA compliance given the Premium Saver is an excepted benefit.

Does the Premium Saver go towards the affordability and minimum value requirements under the ACA mandates?

The Premium Saver provides supplemental benefits to the Major Medial plan.  The major medical plan must stand alone for maintaining affordability and minimum value coverage for ACA mandates.  (Side note – many agents see how the Premium Saver actually helps with the affordability portion).

Is supplemental coverage exempt from the ACA requirements?

The Premium Saver is an excepted benefits and yes this does mean that we are exempt from many of the ACA requirements (certain taxes, certain reporting, reinsurance fees, minimum loss ratios, etc.).

Can an individual enroll in an ACA plan and offer the Premium Saver to this member?

The Premium Saver is a group based product only and stand-alone policies for individuals are not available.

Why does the Premium Saver no longer offer an SBC with its groups?

The Premium Saver is not subject to this requirement because it is an excepted benefit.  If the Premium Saver was providing an SBC it could open us up to other ACA regulations.