Affordable Care Act (ACA) and Premium Saver 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 — like Medicare Supplements). Supplemental benefits are excepted 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.”
Would a high deductible major medical plan still comply with the ACA if we added the Premium Saver?
The major medical must stand on its own for ACA compliance, so the Premium Saver does not affect that.
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 helps with the affordability portion).
Is the Premium Saver exempt from the ACA requirements?
As a supplemental benefit, the Premium Saver is exempt from many of the ACA requirements (certain taxes, certain reporting, reinsurance fees, minimum loss ratios, etc.).
Can the Premium Saver be offered to an individual enrolled in an ACA plan?
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 a Summary of Benefits and Coverage (SBC) with its groups?
The Premium Saver is not subject to this requirement because it is an excepted benefit. Given the Premium Saver is an excepted benefit, it cannot provide an SBC without opening itself up to ACA regulations.