Health Care Reform Act Update – Federal Agencies Issue Guidance


On June 28, 2010, the Department of Health & Human Services ("HHS"), in conjunction with the Department of Labor ("DOL") and the Treasury Department, issued interim final regulations that address pre-existing condition exclusions, lifetime and annual limits, rescissions, and patient protections. These regulations provide guidance under the Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010 (collectively, the "Health Care Reform Act"). The DOL has also issued certain model notices for use by plan sponsors.

Pre-existing Condition Exclusions.

Under the Health Care Reform Act, effective January 1, 2014, a participant cannot be denied benefits based upon a pre-existing condition. The regulations, however, (i) clarify that a plan can exclude benefits for a specific condition if the exclusion applies regardless of when the condition arose and (ii) appear to expand the rules regarding pre-existing condition exclusions to include exclusions on eligibility for coverage.

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