Patient Protection and Affordable Care Act
The Patient Protection and Affordable Care Act, also called the Affordable Care Act (ACA), was enacted in 2010, and included significant regulatory overhauls and expansion of coverage.
Some of the act’s major provisions included:
- Requiring employers with at least 50 employees to cover insurance for their workers, or pay penalties
- Creating state insurance exchanges, with federal subsidies to limit premium costs
- Expanding Medicaid to cover people with incomes below 133 percent of federal poverty guidelines
- Creating high-risk pools for those with preexisting health conditions
- Requiring insurance plans to cover young adults on parents’ policies
- Prohibiting lifetime monetary caps on insurance coverage and limiting the use of annual caps
- Prohibiting insurance plans from excluding coverage for children with preexisting conditions
- Prohibiting insurance plans from cancelling (rescinding) coverage, except in cases of fraud
- Establishing state-based rate reviews for “unreasonable” insurance premium increases
- Requiring insurance to cover certain preventive care without cost-sharing, such as immunizations and screening for conditions such as high blood pressure, high cholesterol, diabetes, and cancer
The ACA also had various provisions aimed at improving quality and system performance.
Most of the provisions of the ACA did not apply to the LACERA-administered Retiree Healthcare Benefits Program. See Healthcare Reform for more about the ACA and its effects on LACERA coverage.
Mental Health and Substance Abuse Parity and Addiction Equity Act of 2008
In 2010, LACERA implemented the Mental Health and Substance Abuse Parity and Addiction Equity Act of 2008. This act requires that coverage for mental, nervous, and substance abuse treatment be consistent with coverage for all other medical services. This means that treatment limits such as caps on inpatient days and out-patient visits, and financial requirements like cost sharing, deductibles, and out-of-pocket limits must be the same for all services.
Pension Protection Act of 2006 (PPA)
The Pension Protection Act of 2006 (PPA) permits eligible retired Public Safety Officers (PSOs) to exclude up to $3,000 of distributions from their LACERA retirement plan for direct payment of healthcare premiums. These excluded distributions are used by LACERA for direct payment of qualified accident or health and/or long-term care insurance premiums for the public safety officer, his or her spouse, and/or dependents.
Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), eligible PSOs who wish to have LACERA make direct payments to their LACERA-sponsored long-term care plans must contact the carriers directly to authorize the necessary payment agreement. LACERA does not administer the long-term care program and cannot initiate direct payments on premiums for these plans until the policyholder contacts the carrier and establishes a direct payment arrangement.
Read more about the Public Safety Officer Healthcare Tax Benefit.