DC Health Insurance Regulations 2 — Questions and Answers
Question 1: Under the ACA as implemented in DC, what is the maximum out-of-pocket limit for in-network services on a qualified health plan for an individual in 2024?
- $5,000
- $7,000
- $9,450 (Correct answer)
- $12,000
Correct answer: $9,450
For 2024, the ACA out-of-pocket maximum for an individual on a qualified health plan is $9,450.
The ACA requires that qualified health plans cap out-of-pocket costs at a federally set maximum, which for 2024 is $9,450 for individual coverage. DC Health Benefit Exchange plans must comply with this limit.
Question 2: DC's DC Health Link operates under which exchange structure?
- Federally-facilitated exchange (FFE)
- State-based exchange (SBE) (Correct answer)
- Partnership exchange
- Multi-state plan only
Correct answer: State-based exchange (SBE)
DC Health Link is a state-based exchange (SBE) established and operated by the District of Columbia.
DC was among the first jurisdictions to establish its own state-based health insurance marketplace, DC Health Link. As an SBE, it is operated by the DC Health Benefit Exchange Authority rather than the federal government.
Question 3: Which federal law prohibits insurers from imposing lifetime or annual dollar limits on essential health benefits?
- HIPAA
- COBRA
- ACA (Affordable Care Act) (Correct answer)
- ERISA
Correct answer: ACA (Affordable Care Act)
The ACA eliminated lifetime and annual dollar limits on essential health benefits for all non-grandfathered plans.
The Affordable Care Act banned lifetime limits on essential health benefits and phased out annual limits, reaching a full prohibition. This protects patients with serious or chronic illnesses from exhausting their benefits.
Question 4: A DC employer with 50 or more full-time equivalent employees who does NOT offer health coverage may be subject to which penalty?
- State individual mandate penalty
- ACA employer shared responsibility payment (Correct answer)
- COBRA surcharge
- HIPAA fine
Correct answer: ACA employer shared responsibility payment
Applicable large employers (50+ FTEs) that fail to offer minimum essential coverage may owe the ACA employer shared responsibility payment (employer mandate penalty).
Under ACA Section 4980H, employers with 50+ full-time equivalent employees that do not offer minimum essential, affordable coverage to full-time employees may face an employer shared responsibility payment if any employee receives a premium tax credit on the exchange.
Question 5: Which provision allows adult children to remain on a parent's health insurance plan until age 26 in DC?
- COBRA continuation provision
- ACA dependent coverage mandate (Correct answer)
- DC Family Coverage Act
- CHIP expansion rule
Correct answer: ACA dependent coverage mandate
The ACA's dependent coverage mandate requires plans offering dependent coverage to extend it to adult children up to age 26.
Under the ACA, health plans that offer dependent coverage must allow adult children to remain on a parent's plan until age 26, regardless of whether the child is married, a student, or financially dependent. DC follows this federal mandate.
Question 6: COBRA continuation coverage in DC must be offered for how long after a qualifying event such as job loss?
- 12 months
- 18 months (Correct answer)
- 24 months
- 36 months
Correct answer: 18 months
COBRA continuation coverage for job loss (reduction in hours or termination) must be offered for up to 18 months.
COBRA requires group health plans with 20+ employees to offer 18 months of continuation coverage upon qualifying events like termination or reduction in hours. Certain qualifying events (disability, death, divorce) extend coverage to 36 months for beneficiaries.
DC Health Insurance Regulations 2
Under the ACA as implemented in DC, what is the maximum out-of-pocket limit for in-network services on a qualified health plan for an individual in 2024?