Final ACA Market Reform Rules Issued

The Affordable Care Act (ACA) includes certain market reforms that apply to group health plans and health insurance issuers in the group and individual markets.

On Nov. 18, 2015, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments) published final regulations regarding a number of the ACA’s market reform requirements. These final regulations address:

  • Grandfathered plans;
  • Pre-existing condition exclusions;
  • Lifetime and annual dollar limits on benefits;
  • Rescissions;
  • Dependent coverage up to age 26;
  • Internal and external appeals; and
  • Patient protections.

These final regulations generally finalize provisions from previous interim final regulations without any substantial changes, incorporating clarifications issued by the Departments in frequently asked questions (FAQs) and other subregulatory guidance.

 

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