Final rule issued on “excepted” benefits under the ACA

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By Milliman Employee Benefits Research Group | 10 November 2014
Employee assistance programs (EAPs) and dental, vision, and long-term care benefits that satisfy newly relaxed requirements under a recent final rule are exempt from the Affordable Care Act’s (ACA) health insurance market reforms, starting with plan years that begin on or after January 1, 2015. With the exemption, these programs and “limited scope” benefits will not have to satisfy the ACA’a requirements on preexisting condition exclusions, prohibition on discrimination based on health status, and guaranteed renewability, among other standards. In addition, the final rule from the Departments of Treasury, Labor, and Health and Human Services will not preclude an individual from receiving federal subsidies to purchase coverage in a health insurance exchange if he or she is eligible for these excepted benefits, thereby removing the penalties a group health plan sponsor could face under the ACA’s employer mandate.