Five Years Later…Final Regulations Issued for Key ACA Provisions

    It’s been awhile since we received any guidance from the Internal Revenue Service and Departments of Labor and Health and Human Services (the “Departments”) on the key provisions of the Affordable Care Act (“ACA”) known as the “Insurance Reforms.” In fact, you may not have even been aware that we were still awaiting final rules on these provisions and that, until earlier this month, we were still operating under Interim Final Rules on these provisions that date back to 2010 and subsequent interpretive guidance.

    Over five years after the Interim Final Rules on various Insurance Reforms were issued, the Departments issued Final rules on November 13, 2015. These rules specifically address the following ACA provisions: grandfathered plans, preexisting condition exclusions, lifetime and annual limits, rescissions, age 26 dependent coverage, internal claims and appeals and external review process, and patient protections. These Final Rules are effective January 19, 2016 and are applicable to group health plans and health insurance issuers on the first day of the first plan year (or, on the first day or the first policy year for the individual market) beginning on or after January 1, 2017.

    These Final Rules do not significantly alter the Interim Final Rules. Instead, they memorialize some of the interpretive guidance the Departments issued on these topics after the Interim Final Rules went in effect and provide examples for certain provisions that needed additional clarification.

    Let’s just hope we aren’t waiting until 2020 to receive final guidance on some of the other ACA provisions that so desperately need the Departments’ interpretation and clarification!

    By csmith

    Source: DOL; EBIA

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