Affordable Care Act Resource Page
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This page contains some basic resources for people and employers about the federal Patient Protection and Affordable Care Act (PPACA). More information is available from the federal government at www.HealthCare.gov.
- HHS.gov/HealthCare from the U.S. Department of Health & Human Services
Toll-free call center: 1-800-318-2596 (24 hours a day, seven days a week)
- Timeline: What's Changing and When provides a year-by-year summary of PPACA provisions.
- FAQs: Prepared Jointly by the Departments of Health and Human Services, Labor, and the Treasury
- Taxes: Internal Revenue Service (IRS) provides a summary of tax-related provisions.
- Regulations: Center for Consumer Information and Insurance Oversight (CCIIO) is a source for federal regulations and guidance.
- Compilation of Patient Protection and Affordable Care Act is the easiest way to read the full text of the law.
- Frequently Asked Questions
- Resources for Health Carriers
- The Affordable Care Act and You publication
Health Insurance Marketplace
- Texas has indicated that it will not create a state-based health insurance marketplace (formerly called the exchange). See the letter from Governor Perry dated November 2012.
- A federally-created marketplace is scheduled to begin open enrollment periods for individual and small employer coverage in October 2013, for coverage beginning in January 2014. People with incomes between 100 and 400 percent of the federal poverty level may be eligible for premium and cost sharing subsidies.
- Find more information on the health insurance marketplace.
Essential Health Benefits
- The Affordable Care Act requires individual and small employer group plans to cover a minimum package of essential health benefits beginning in 2014.
- The essential health benefits package is based on the coverage offered in the most popular plan in Texas' small group market, the BCBS BestChoice PPO. See Plan Summary | Full Plan Document | More Information
- Preventive Care - Individual and small and large employer plans are required to provide certain preventive care services without cost sharing.
- The law imposes restrictions on the range of rates that different policyholders may be charged for the same policy.
- The law sets a minimum medical loss ratio (MLR), which requires health insurers and HMOs to spend 80 to 85 percent of premiums on health-related expenses or pay rebates to consumers. These rebates were first paid to eligible consumers in August 2012. See more information on the MLR or look up information about your insurer.
- Most people will be required to have qualifying health insurance coverage.
- People without coverage may have to pay a tax penalty.
- Employers with 50 or more full-time and full-time-equivalent employees may be required to pay tax assessments if their employees receive subsidized coverage through the marketplace because the employer doesn't offer minimum coverage or because the coverage offered is unaffordable.
- Employers with 25 or fewer employees may be eligible for tax credits if they provide health insurance.
- Find general information for employers or find answers on employer responsibilities.
- Plans issued before March 23, 2010, are not subject to many of the requirements of the federal reforms and will not include many of the required coverages.
- Find more information on grandfathered plans.
For answers to general insurance questions, for information about filing an insurance-related complaint, or to report suspected insurance fraud, call the Consumer Help Line at 1-800-252-3439 between 8 a.m. and 5 p.m., Central time, Monday-Friday, or visit our website.
File an Insurance Complaint
TDI accepts and reviews written complaints against insurance companies, HMOs, insurance agents, adjusters, and fully insured or fully funded health benefit plans (health plans purchased by an employer from an insurance company or HMO).
For information on filing an insurance-related complaint, visit our website at www.tdi.texas.gov/consumer/complfrm.html or call the Consumer Help Line between 8 a.m. and 5 p.m., Central time, Monday-Friday.
Help Us Prevent Insurance Fraud
Report suspected insurance fraud to the TDI Fraud Unit online at www.tdi.texas.gov/fraud/report.html or by calling our toll-free Consumer Help Line at 1-800-252-3439.
For more information contact:
Last updated: 11/08/2016