Final Regulations Issued for ACA Market Reforms
In a 379-page document, the , the Labor Department and the Department and Human Services jointly issued finalized regulations on half a dozen topics related to the Act.
The regulations make permanent previous proposed and interim rules regarding grandfathered , preexisting condition exclusions, lifetime and annual dollar limits on benefits, rescissions, children to age 26, internal claims and appeal and external review processes, and patient protections under the .
The final rules apply to plan years beginning or after January 1 2017. Because they embody interim measures already familiar to and insurers, they generally provide clarity rather than imposing new requirements.
Grandfathered
The finalized regulations state that the “grandfathered” status a plan applies separately to each benefit in the plan. Such must include a statement in any summary that the plan is believed to be grandfathered. The regulations also include measures aimed at preventing abuses related to the plan’s grandfathered status.
Limits/integrated arrangements
Under the , annual and lifetime limits benefits are generally prohibited. The final regulations show can determine which benefits are not subject to annual or lifetime limits.
The regulations also specify how “account-based ” can be integrated with . Account-based , offered by , reimburse medical expenses up to a specified amount in a given .
Rescissions
The prohibits issuers and from rescinding except if an commits fraud or intentionally misrepresents a material fact. The finalized regulations restate that the ban is not to rescissions based on an ’s medical history.
Dependents
The requires to include children up to age 26. The regulations affirm that dependents under 26 can remain on a parent’s plan even if the dependents are offered through their own .
Appeals and reviews
The final regulations clarify the required notifications and other procedures for the internal and external claims and appeals for under the .
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