The ACA has required implementation of many plan changes and inclusions as part of healthcare reform. Coffee Bean & Tea Leaf has been proactive in ensuring that our full time employee benefit plans meet all of ACA’s requirements for:

• Preventive Services
  
• Minimum Value
  
• Affordability
  

Coverage of Preventive Care Services
For plan years beginning on or after September 23, 2010, non-grandfathered group health plans must cover certain preventive care services and may not charge copayments, coinsurance or deductibles for these services when delivered by a network provider.

The recommended preventive care services covered by these requirements are: Immunizations for routine use in children, adolescents and adults that are currently recommended by the Centers for Disease Control and Prevention (CDC) and included on the CDC’s immunization schedules; For infants, children and adolescents, evidence-informed preventive care and screenings provided for in the Health Resources and Services Administration (HRSA) guidelines; and For women, evidence-informed preventive care and screening provided in guidelines supported by HRSA (for plan years beginning on or after Aug. 1, 2012).

These recommended preventive services include screening for a number of conditions, as well as counseling for various health-related issues. The complete list of recommended preventive services that must be covered can be found at: www.HealthCare.gov/center/regulations/prevention.html.

Office Visits
The interim final rules clarify the cost-sharing requirements when a recommended preventive care service is provided during an office visit. Whether cost-sharing requirements may be imposed will depend on:

(a) whether the preventive care service is billed or tracked separately, and

(b) whether the preventive care service is the primary purpose of the office visit. Cost-sharing is permitted only if: the recommended preventive care service is billed separately (or is tracked as individual encounter data separately) from an office visit; or the recommended preventive care service is not billed separately from the office visit and the primary purpose of the office visit is not to obtain the recommended preventive care service. Cost-sharing requirements are not allowed in cases where the recommended preventive care service is not billed separately, but it is the primary purpose of the office visit.

Example - An individual covered by a group health plan visits an in-network health care provider. While visiting the provider, the individual is given a cholesterol screening (a recommended preventive care service). The provider bills the plan for an office visit and for the laboratory work of the cholesterol screening test. The plan may not impose any cost-sharing requirements with respect to the laboratory work. Because the office visit is billed separately from the cholesterol test, the plan may impose cost-sharing requirements for the office visit.

Covered Health Services
The preventive care guidelines for women cover the following health services:

Well-woman visits	Well-woman preventive care visit annually for adult women to obtain the recommended preventive services that are age and developmentally appropriate, including preconception and prenatal care. This well-woman visit should, where appropriate, include other preventive care services covered under ACA.	Annual, although several visits may be needed to obtain all necessary recommended preventive care services, depending on a woman’s health status, health needs and other risk factors
Screening for gestational diabetes	Screening for gestational diabetes	In pregnant women between 24 and 28 weeks of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetes
Human papillomavirus (HPV) testing	High-risk HPV DNA testing in women with normal cytology results	Screening should begin at 30 years of age and should occur no more frequently than every three years.
Counseling for sexually transmitted infections	Counseling on sexually transmitted infections for all sexually active women	Annual
Counseling and screening for human immunodeficiency virus (HIV)	HIV counseling and screening for all sexually active women	Annual
Contraceptive methods and counseling	All FDA-approved contraceptive methods, sterilization procedures and patient education and counseling for all women with reproductive capacity Special provisions apply to religious employers.	As prescribed
Breastfeeding support, supplies and counseling	Comprehensive lactation support and counseling by a trained provider during pregnancy and/or in the postpartum period and costs for renting breastfeeding equipment	In conjunction with each birth
Screening and counseling for interpersonal and domestic violence	Screening and counseling for interpersonal and domestic violence	Annual

Minimum Value
The ACA states that a plan fails to provide minimum value if the plan’s share of total allowed costs of benefits provided under the plan is less than 60 percent of those costs. Minimum value is calculated by dividing the cost of essential health benefits (EHBs) the plan would pay for a standard population by the total cost of EHBs for the standard population (including amounts the plan pays and amounts the employee pays through cost-sharing) and then converting the result to a percentage.

All of Coffee Bean & Tea Leaf’s full time health insurance offerings meet the requirements for minimum value. You must be a full time Team Member to qualify for the Coffee Bean & Tea Leaf's health insurance plan.

Affordability
Under the ACA, eligible employer-sponsored coverage is affordable only if an employee’s required contribution for self-only coverage does not exceed 9.5 percent of household income. Although the rule measures affordability based on household income, the IRS established three safe harbors for employers to use, which measure affordability based on the employee's W-2 wages, the employee's rate of pay or the federal poverty level for a single individual.

All of Coffee Bean & Tea Leaf’s full time health insurance offerings meet federal requirements for affordability. You must be a full time Team Member to qualify for the Coffee Bean & Tea Leaf's health insurance plan.