PPACA Plan Holders Can’t Go Back


Individuals and small groups that now have PPACA coverage can’t flee back to transitional coverage.

Officials at the Center for Consumer Information & Insurance Oversight rendered that verdict in a new batch of answers to questions about the Patient Protection and Affordable Care Act.

CCIIO officials included answers to several questions about “transitional policy extension” rules.

By Allison Bell

Many PPACA coverage rules originally were supposed to apply to all major medical coverage in effect on or after Jan. 1, 2014.

In late 2013 and early this year, HHS used guidance and regulations to let some holders of health coverage issued before PPACA took effect keep the coverage for as long as two extra years.

One question involves individuals and small employers that now have PPACA-compliant plans.

Can the policyholder have the 2013 plan reinstated and get the transitional policy relief?

The policyholder couldn’t get transitional policy extension relief in that situation, officials say.

In another answer, officials say transitional policy extension coverage counts as “minimum essential coverage,” or MEC, for individuals trying to get out of paying the PPACA individual mandate penalty payments.

Officials also consider the case of a large employer with 51 to 100 employees that had no health coverage on March 5, 2014, when a transitional policy for employers was announced.

The policy will let those midsize employers avoid PPACA employer coverage mandate penalties in 2015.

If an employer with 51 to 100 employees buys a large-employer policy after March 5, 2014, but before Jan. 1, 2016, the large-group transitional rules will help that employer, officials say.

A midsize employer does not have to stay with the same carrier from 2013 through 2016 to get transitional relief in 2016, officials say.