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Articles

Final Regulations Issued for ACA Market Reforms

November 16, 2015 Robert Sheen Affordable Care Act, Regulations
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 .

We’re committed to helping companies reduce risk, avoid penalties, and achieve 100% ACA compliance. For questions about the ACA contact us here.

Short URL of this page: https://acatimes.com/ezt
Robert Sheen

Robert Sheen

Esq., is editor-in-chief of The ACA Times. He also is founder, president and CEO of Trusaic.

Robert Sheen is Founder and President of Trusaic. Robert is a graduate of the University of Southern California, in Business Administration with an emphasis in International Finance. He earned his Juris Doctor from Loyola Law School, Los Angeles, concentrating in Tax Law.

View more by Robert Sheen

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