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Medical ExpenseVerified · outline & fact-checked · Sep 2026Difficulty 1/5

Under PPACA's guaranteed issue requirement in the small group market, a health insurer must:

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Answer & full 3-part explanation (select an option above, or peek)

Why A is correct

PPACA makes guaranteed issue the law in both the individual and small group markets: insurers must accept every eligible applicant and may not decline a small employer because of the health status of its employees. The statute also bars health-based discrimination in the premiums charged to small groups — rates may vary by age, geography, and tobacco use, but not by claims history or the health of covered individuals. This requirement replaced the pre-ACA practice of medical underwriting and outright denial in the small group market, and it is the core reason small employers can obtain coverage for a workforce of any health profile.

Why the other options are wrong

  • B) Medical screening as a gate to acceptance is precisely what guaranteed issue eliminates in the small group market, so this answer describes the pre-ACA practice the law abolished.
  • C) Industry-based acceptance is not part of the guaranteed issue rule; the obligation applies to all eligible small employers, so this answer invents an irrelevant industry test.
  • D) Guaranteed issue means the insurer may not exclude coverage for any individual based on health, so carving out chronically ill employees directly contradicts the requirement.

Memory hook

Guaranteed issue = the insurer says yes to every small employer, whatever the group's health report card says.

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