Health Care Reform: Regulationson Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions and Patient Protections


On June 22, 2010, the Departments of Treasury, Labor and Health and Human Services (the Departments) released interim final regulations (the Regulations) on the provisions of the Patient Protection and Affordable Care Act (the Act)relating to preexisting condition exclusions, lifetime and annual limits, rescissions and patient protections. This alert summarizes the Regulations and their impact on group health plans.

Preexisting Condition Exclusions

Prior to the Act, group health plans were permitted to impose limited preexisting condition exclusions if certain requirements were met under HIPAA. Now, the Act prohibits a group health plan from imposing any preexisting condition exclusions. This prohibition is effective with respect to plan years beginning on or after January 1, 2014, but for participants who are under 19 years of age, this prohibition becomes effective for plan years beginning on or after September 23, 2010. This prohibition applies regardless of grandfathered-plan status.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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