The latest set of frequently asked questions (FAQs) regarding the Affordable Care Act’s (ACA) implementation responds to questions on health plan annual dollar limitations, provider nondiscrimination provisions, and transparency reporting, among other topics.
The ACA bans annual dollar limits on covered expenses under a health plan starting in 2014, and imposes restrictions on annual limits until then. Certain group health plans and health insurance issuers have been granted waivers from this annual limit prohibition. One of the FAQs clarifies that the wavier expiration date does not change if a plan or issuer that has been granted such a waiver changes its plan or policy year prior to the waiver’s expiration. By way of example, the FAQ explains:
[I]f a waiver approval letter states that a waiver is granted for an April 1, 2013 plan or policy year, the waiver will expire on March 31, 2014, regardless of whether the plan or issuer later amends its plan or policy year. That said, waiver recipients may terminate the waiver at any time prior to its approved expiration date, for example, on December 31, 2013 rather than on March 31, 2014.
Another ACA provision adds section 2706(a) to the Public Health Service (PHS) Act, which states that a “group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable state law.” This section applies to “non-grandfathered group health plans and health insurance issuers offering group or individual health insurance coverage for plan years (in the individual market, policy years) beginning on or after January 1, 2014.” In response to questions about this requirement, the FAQs explain that section 2706(a) is a self-implementing provision, and that the federal agencies charged with enforcing ACA will not be issuing regulations on this section prior to its effective date. Similarly, the requirement imposed on non-grandfathered group health plans and issuers offering group or individual coverage regarding participation in approved clinical trials is deemed to be self-implementing. This provision becomes effective for the 2014 plan year, and the federal agencies do not intend to issue regulations prior to its effective date.
Finally, the ACA includes transparency in coverage reporting requirements. Health insurance issuers seeking certification of a health plan as a qualified health plan (QHP) “must make accurate and timely disclosures of certain information to the appropriate Health Insurance Marketplace (also known as Exchange), the Secretary of HHS, and the state insurance commissioner, and make it available to the public.” The FAQs clarify that because QHP issuers will not initially have all of the data that will need to be reported, such issuers need only begin submitting information after they have been certified as QHPs for one benefit year. In addition, the FAQs note that the agencies intend to “coordinate regulatory guidance on the transparency in coverage standards for coverage offered inside and outside of the Marketplaces.”
Previous sets of FAQs can be found here.