DOL Offers ACA Clarifications

The Department of Labor (DOL) has issued additional frequently asked questions (FAQs) regarding implementation of the Patient Protection and Affordable Care Act (ACA).

The agency explains that Public Health Service (PHS) Act section 2707(b), as added by the ACA, provides that a non-grandfathered group health plan shall ensure that any annual cost sharing imposed under the plan does not exceed the limitations provided for under section 1302(c)(1) of the ACA. Under section 1302(c)(1), an enrollee’s out-of-pocket costs for essential health benefits are limited.                      

In the final Department of Health and Human Services (HHS) Notice of Benefit and Payment Parameters for 2016, HHS clarified that under section 1302(c)(1) of the ACA, the self-only maximum annual limitation on cost sharing applies to each individual, regardless of whether the individual is enrolled in self-only coverage or in coverage other than self-only.  In response to this clarification, the DOL, HHS and the Treasury received questions regarding its application to self-funded and large-group health plans. The FAQs address these questions.   

Coinciding with the FAQs, the DOL announced an ACA compliance webcast to be held June 10 at 2 p.m. Eastern time. The topics will include coverage of certain preventive services with no co-pay, new rules for wellness programs and filing claims for benefits, the prohibition on pre-existing condition exclusions and lifetime and annual limits, and required easy-to-understand summaries of a health plan’s benefits and coverage.

Registration for the webcast is here.