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.



The information provided herein is intended solely for the use of our clients. You may not display, reproduce, copy, modify, license, sell or disseminate in any manner any information included herein, without the express permission of the Publisher or Publishers of articles within.

The information provided is for informational purposes only and does not constitute legal advice. The information above contains only a summary of the applicable legal provisions and does not purport to cover every aspect of any particular law, regulation or requirement. Depending on the specific facts of any situation, there may be additional or different requirements. This is to be used only as a guide and not as a definitive description of your compliance obligations.