Compliance

The Affordable Care Act (ACA) presents many new compliance challenges that range from ensuring plan designs incorporate the required benefits to notifying employee’s about the public Exchange.

Prohibition on Pre-Existing Condition Exclusions

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The Affordable Care Act enacted a prohibition on pre-existing condition exclusions in a two-step process:

For Plan Years Beginning on or After September 23, 2010 – All group health plans, including grandfathered plans, could not impose any pre-existing condition limitation on children under age 19.

For Plan Years Beginning on or After January 1, 2014 – Group health plans cannot impose any pre-existing condition limitations, irrespective of age.

Note:  Effective December 31, 2014, Health Insurance Portability and Accountability (HIPAA) Certificates of Creditable Coverage are no longer required to be issued.  A HIPAA Certificate of Creditable Coverage is a written statement issued by a group health plan or issuer that certifies an individual’s prior health coverage (i.e., creditable coverage) and is issued when the individual loses coverage, is eligible for COBRA or loses COBRA.  Since the prohibition on pre-existing condition exclusions eliminates the need for certificates, they are longer required to be issued.