An Exchange is required to be a governmental agency or nonprofit entity that is established by a State and each Exchange must make available only qualified health plans to qualified individuals and qualified employers.
On June 28, 2010, Interim Final Regulations (the Regulations) were issued implementing certain provisions of the Patient Protection and Affordable Care Act (the Act).
The interim final regulations extending dependent coverage to age 26 provide transitional relief for a child whose coverage ended, or who was denied coverage (or was not eligible for coverage) under a group health plan or health insurance coverage because, under the terms of the plan or coverage, the availability of dependent coverage of children ended before the attainment of age 26.
When applicable, it is important that individuals enrolled in a plan or health insurance coverage know of their rights to (1) choose a primary care provider or a pediatrician when a plan or issuer requires designation of a primary care physician; or (2) obtain obstetrical or gynecological care without prior authorization.
Plans and issuers are required to give written notice that the lifetime limit on the dollar value of all benefits no longer applies and that an individual, if covered, is once again eligible for benefits under the plan.
This section prohibits group health plans and a health insurance issuers from offering group or individual health insurance coverage with lifetime limits on the dollar value of benefits for any participant or beneficiary.
This section states that nothing in the new law requires that an individual terminate coverage under a group health plan or health insurance coverage in which the individual was enrolled on March 23, 2010 and that certain provisions of the new law will not apply to the plan or coverage, regardless of whether the individual renews coverage after March 23, 2010.
Guidance about "grandfathered" group health plans was issued jointly by Federal agencies on June 17, 2010 (the "Regulations").
This section applies to "eligible small employers," defined as an employer which has no more than 25 full-time equivalent employees for the taxable year, the average annual wages of which do not exceed an amount equal to twice the "dollar amount" in effect under for the taxable year, and which has a "contribution arrangement" in effect.
The 2010 open enrollment period provides employers with an opportunity to explain changes made to benefits, many of which are required as a result of the Patient Protection and Affordable Care Act of 2010 (as amended by the Health Care and Education Reconciliation Act) (collectively, "the Act"), and to allay any fears that employees have regarding their employers' group health plans.