In-Patient Hospitalization And "Minimum Value" Under The ACA

Thomas M. "Tom" Greene is a Partner in our Boston office.

HIGHLIGHTS:

• The IRS, DOL and HHS issue guidance on calculating minimum value under the Affordable Care Act for plans not offering substantial coverage for in-patient hospitalization or physician services.
• Employers need to review plans for hospitalization and related physician care services and reassess whether their plans provide "minimum value."

The Patient Protection and Affordable Care Act – more commonly known as the Affordable Care Act (ACA) – imposes many requirements on group health plans, including, among others, that plans must provide "minimum value" (MV) in accordance with the Internal Revenue Code¹ (Code). The MV rules require that group health plans cover at least 60 percent of the benefit costs provided under the plan. If a covered plan does not provide MV, a participant is eligible for coverage in a healthcare exchange and may be entitled to a premium tax credit. If the plan of