The Affordable Care Act ensures that health plans offered in the individual and small
group markets, both inside and outside of the Exchanges, offer a comprehensive package
of items and services known as essential health benefits. Insurance policies must cover
these benefits in order to be certified and offered in the Exchanges, and all
Medicaid/Medi-Cal state plans must cover these services by 2014.

Essential health benefits must include items and services within at least the following 10
categories:
1. Ambulatory patient services (outpatient services)
2. Emergency services
3. Hospitalization, including medically necessary surgeries and other inpatient
procedures
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health
treatment
6. Prescription drug coverage
7. Rehabilitative and habilitative services and devices*
8. Laboratory tests and services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care

Health plans are allowed to impose cost sharing obligations on plan members for most
essential benefits, but those that qualify under a category of preventive health services
will be made available at no charge to plan members.

The ACA gives states authority to specify details surrounding the essential benefits. The
states must each choose a benchmark plan that will serve as a more detailed definition of
benefits within each of the ten Essential Health Benefit categories.

California has selected the "Kaiser Foundation Health Plan, Inc. - Kaiser Foundation Health Plan Small Group HMO 30 ID 40513CA035"as its state benchmark plan.

Colorado selected the "Kaiser Foundation Health Plan of Colorado - Ded HMO 1200D" as its state benchmark plan. Following are sample Evidences of Coverage and Plan Summaries for the benchmark plans.

The Affordable Care Act changed the definition of Small Groups to be those with 1-100 full-time (FTE) employees.  Groups with 51-100 FTEs were required to transition from Large to Small Group on January 1st, 2016. Some groups chose an "Early Renewal" option in order to bypass this requirement for one more year. However, in 2017 there will be no escape.

Small Group guidelines and regulations differ from Large Group.  It’s important to be aware of the changes.  We've collected our considerable resources into one toolkit to help your transition..

These tools include but are not limited to:

• Interactive Plan Comparison Tools
• Multi-Plan Calculators
• Health Care Reform Calculators
• Transition Documents
• Medical Network Comparisons
• Summary Benefit Comparisons
• And many more exclusive tools

Call Unlimited Benefits today to help transition your group as easily as possible. 

888-587-9370

Download your "At-A-Glance Transition Guide."