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The Affordable Care Act

What is the Affordable Care Act (ACA)?

The Affordable Care Act (ACA) is the new healthcare law that was signed into effect in 2010. It is also called health reform. The ACA began taking effect in 2010, with the largest changes coming in 2014.

The ACA doesn’t have much impact on the coverage offered through most large employers, including the federal government. Instead, most of the changes affect health insurance coverage that individuals pay for on their own and the insurance that small businesses buy.

The new healthcare law brings coverage to those who previously have not had or could not afford health insurance. Starting on October 1, 2013, U.S. citizens and legal residents can use the online marketplaces called “exchanges” to buy health insurance.

By law, starting in 2014, everyone will have to carry health insurance or pay a fee. The Medicaid program will be expanded in some states to cover more people, and financial assistance will be available for people with incomes at or below 400% of the federal poverty level.

While you may hear a lot about the ACA, particularly this fall, federal employees should know they will not see major changes.

Federal employees covered by the Blue Cross and Blue Shield Service Benefit Plan—or another Federal Employees Health Benefits Program (FEHBP) carrier—will see only a few changes. The Service Benefit Plan has made changes to offer more preventive care benefits and extended coverage for children up to age 26 in order to comply with the law.

Three Critical Parts of the New Healthcare Law

  • Guaranteed coverage: Means you are guaranteed the chance to enroll in a health plan once you apply for it and the premium is paid.
  • Cost assistance: Tax credits and financial assistance will be available to help pay for health insurance for those below a certain income threshold.
  • Individual mandate: Requires most Americans to have health insurance.

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How the Affordable Care Act Affects Federal Employees

Summary of Changes 

Here’s a quick summary of what has changed for the Service Benefit Plan since health reform became law and features that were already in place prior to the new law.

Health Reform Key FeaturesIn place before health reformAdded to comply with health reform
Coverage of young adults up to age 26NoYes
Expanded coverage of preventive health services with no cost shareNoYes
No annual and lifetime dollar limitsYesn/a
Limited insurance cancellationsYesn/a
Right to appeal health plan decisionsYesn/a
Full access to emergency servicesYesn/a
No exclusion for pre-existing conditionsYesn/a
Review premium amount spent primarily on healthcare and administrative costsYesn/a
Coverage for tribal employeesNoYes
Summary of Benefits and CoverageNoYes

Expanded coverage for children

If you have children who are covered by your Service Benefit Plan Self and Family enrollment, you are able to keep them on your plan longer now. This change allows young adults up to age 26—whether they are single or married—to stay on or be added to the self-and-family option of a parent’s plan.

The young adult does not have to reside with that parent, be financially dependent on the parent or be a student. Coverage does not extend to a child’s spouse or children, however.

When coverage ends under a parent’s plan, the young adult may continue that coverage on a self-only enrollment for up to 18 months under the Temporary Continuation of Coverage provision of the law. If the young adult does that, he or she must pay the entire premium, plus two percent to cover administrative costs.

There is an exception for unmarried young adults who were disabled before age 26. They can continue to be covered under the parent’s self-and-family plan after they turn 26.

More preventive care services added

The Blue Cross and Blue Shield Service Benefit Plan covers preventive care and screenings. In fact, the Office of Personnel Management (OPM) requires that enrollees pay nothing out-of-pocket for such care when they use their plan’s in-network providers.

The Service Benefit Plan's broad coverage of preventive services has been expanded to comply with the ACA by adding more preventive benefits for women.

Read the 2014 Blue Cross and Blue Shield Service Benefit Plan brochure to review preventive benefits. 

Lifetime limits & pre-existing conditions

Two important parts of the ACA will have no effect on health plans in the FEHBP:

  • There can be no limit on the dollar amount of health benefits paid during a person’s life. The ACA requires the removal of any lifetime cap on the amount of benefits paid.
  • Health plans cannot consider a person’s health problems when they enroll for insurance coverage. Everyone—even people with pre-existing health conditions—may get health coverage.

These provisions of the law have no effect on the Blue Cross and Blue Shield Service Benefit Plan or other plans in the FEHBP. That is because FEHBP carriers have never excluded benefits for pre-existing conditions and previously eliminated any lifetime dollar limits on healthcare. Beginning in 2013, the law requires these same provisions for all other health insurance plans.

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Tribal Employees Eligible for the Federal Employees Health Benefits Program

Certain tribal organizations are now able to enroll in the Federal Employees Health Benefits Program (FEHBP). 

The Blue Cross and Blue Shield Service Benefit Plan is excited to welcome tribal employees to the FEHBP. The Service Benefit Plan has been part of the FEHBP since it began in 1960. About 5.2 million federal employees, retirees and their families are covered by the Blue Cross and Blue Shield Service Benefit Plan.

For more information

Your local Blue Cross and Blue Shield Plan can help you with any questions about your benefits and provider network. You can find the phone number of your local Plan on the Contact Us  page of this website.

Request a benefit brochure

You can either review a PDF copy of the Blue Cross and Blue Shield Service Benefit Plan brochure on your computer or submit a request to receive a printed brochure.

Compare benefit options

The Service Benefit Plan provides two coverage options, Standard Option and Basic Option. Plus, we offer a wide variety of wellness tools to help you and your family stay healthy. Review the coverage options available to you by using the AskBlue guide.

Find a healthcare provider

As a Service Benefit Plan member, you have access to a nationwide network of doctors, hospitals and other healthcare providers. Search our online National Doctor and Hospital Finder to find Preferred healthcare providers who will save you money.

For quick help on the go, you can use your Apple or Android device to find a doctor, hospital or urgent care center anywhere in the country. The National Doctor and Hospital Finder mobile application is available for free download at the App Store, Google Play, or at http://bcbs.com/mobile/.

Interested in enrolling?

Talk to your employer’s Human Resources representative to be sure you are eligible for FEHBP coverage. Then go to the U.S. Office of Personnel Management (OPM) website to find out how to enroll.

Learn more about the FEHBP

To learn more about the FEHBP, visit the OPM website. Details for tribal organizations and employees are available at http://www.opm.gov/healthcare-insurance/indian-tribes/.

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Resources for More Information

For the Blue Cross and Blue Shield Service Benefit Plan Q&A about health reform, click here .

For more Questions and Answers on the Affordable Care Act (ACA) and the Federal Employees Health Benefits Program, visit:
http://www.chcoc.gov/files/the-affordable-care-act-and-the-federal-employees-health-benefit-program-questions-answers.pdf

Members of Congress and their official staff can find additional information on OPM’s website:>
http://www.opm.gov/healthcare-insurance/changes-in-health-coverage/eligibility-enrollment/#url=Members-of-CongressStaff

For detailed information about the ACA, visit the U.S. Department of Health and Human Services “Health Insurance Marketplace” website: http://www.hhs.gov/healthcare/index.html

For a big-picture look at health reform, visit the White House website: http://www.whitehouse.gov/healthreform

For information about how the ACA affects those who have Medicare, visit “The Affordable Care Act & Medicare:” http://www.medicare.gov/about-us/affordable-care-act/affordable-care-act.html

For ACA information that affects those over 50, the AARP has helpful fact sheets: http://www.aarp.org/health/health-care-reform/health_reform_factsheets/

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Page last updated: December 30, 2013

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