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- Health Benefits Advisor for Employers

The Patient Protection and Affordable Care Act

Under the Patient Protection and Affordable Care Act (the Affordable Care Act), there are new provisions that apply to group health plans and health insurance issuers. This includes new protections and benefits for consumers that are beginning to take effect or that will become effective very soon.

The Departments of Labor, Health and Human Services, and the Treasury (the Departments) are working together with employers, issuers, States, and other stakeholders to help them understand and comply with the new law. The Departments also are working with employees and employers to help employees and their families understand the new law and exercise their rights.

To implement the law, guidance has been issued on an ongoing basis since May 2010. Regulatory guidance has been issued on the following:

  • Dependent Coverage of Children to Age 26;
  • Grandfathered Health Plans;
  • Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections;
  • Coverage of Preventive Services;
  • Internal Claims and Appeals and External Review Processes; and
  • Summary of Benefits and Coverage and Uniform Glossary.

There are additional materials available with many of these regulations to help you understand and comply with the new rules. In addition, the Departments have issued additional guidance including:

  • Technical releases regarding interim procedures for the Federal external review process and State external review processes ;
  • Model notices relating to internal claims and appeals and external;
  • Technical releases regarding interim procedures for internal claims and appeals;
  • Requests for Information regarding Federal External review process and value-based insurance design in connection with preventive care benefits; and
  • Several sets of FAQs addressing commonly asked questions on the law and the published regulatory guidance.

Additional guidance will be issued. For the most recent information on the Affordable Care Act, visit our website: EBSA website. If you have questions, please contact our Benefits Advisors electronically or by calling toll-free 1-866-444-3272.

In the case of expatriate health plans, visit the EBSA website for the most current information. You may also contact the Office of Health Plan Standards and Compliance Assistance at 202-693-8335 for more information. Expatriate health plans are subject to the provisions under Section 715 of ERISA, however, during a transitional period expat plans could continue to comply with the pre-Affordable Care Act requirements under HIPAA. See DOL FAQs About the Affordable Care Act Implementation Part XIII, question 1 and DOL FAQs About the Affordable Care Act Implementation Part XVIII, question 6-7.

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