On September 20, 2010, the Departments posted FAQs and answers regarding the PPACA regulations on topics such as (1) grandfathered health plans, (2) claims, internal appeals, and external review, (3) coverage of dependent children, and (4) out-of-network emergency services. Some of the grandfathered health plan FAQs address the steps issuers and employer plan sponsors should take to communicate changes to the plan sponsor contribution rate for purposes of determining whether an insured group health plan is a grandfathered health plan.
Additionally, the FAQ relating to coverage of dependent children states that a plan or issuer may limit health coverage for children until the child turns 26 to only those children who are described in Code section 152(f)(1). This Code section defines children to include only sons, daughters, stepchildren, adopted children (including children placed for adoption), and foster children. For an individual not described in Code section 152(f)(1), such as a grandchild or niece, a plan may impose additional conditions on eligibility for health coverage, such as a condition that the individual be a dependent for income tax purposes.
The FAQs also note that the Departments have made revisions to the model notice of adverse benefit determination, which includes a header that reads, "Revised as of September 20, 2010." The FAQs are accessible online at www.dol.gov/ebsa.