ACA and Group Health Plans

VII. Key Issues: Regulation & Reform >> C. Health Reform >> Affordable Care Act (ACA) >> ACA and Employers >> ACA and Group Health Plans

 

Major Provisions

Permanent Group Health Plan Requirements

The Affordable Care Act  establishes a number of new requirements for group health plans. More information is available on the websites of the Departments of Health and Human Services and Labor and in additional Legal Guidance for Group Health Plan Requirements (IRS). Unless grandfathered, group health plans must comply with all the new rules listed below. These relate to:

  • Eligibility (Nondiscrimination Provisions, Dependent Coverage of Children to Age 26, 90-Day Waiting Period Limitation, Preexisting Condition Exclusions);
  • Coverage (Lifetime and Annual Limits, Coverage of Preventive Services);
  • Patient Protections (Rescissions, Patient Protections, Internal Claims and Appeals and External Review, Federal External Review Process);  and
  • Reporting Requirements (Reporting Value of Employer-Provided Health Coverage, Disclosures of  the Summary of Benefits and Uniform Glossary)

The following details each of these requirements and provides links to more detailed information about them.

Temporary Provisions

  • Small Business Health Care Tax Credit. This new credit helps small businesses and small tax-exempt organizations afford the cost of covering their employees and is specifically targeted for those with low- and moderate-income workers. The credit is designed to encourage small employers to offer health insurance coverage for the first time or maintain coverage they already have. More details at ACA and Small Employers.

Resources

This list is restricted to general resources. For resources focused on large employers, see ACA and Large Employers; for resources for small employers, see ACA and Small Employers.

On-line Resources

Print Guides

Frequently Asked Questions

Calculators

Research and Analysis

News

  • ObamaCare Watch. Business Impact includes latest business-related health reform news.