Improving health is our policy
Amended by section 10103 of the Manager’s Amendment. Prohibits a group health plans and issuers offering group or individual coverage from imposing any preexisting condition exclusions. Effective for plan years beginning on or after January 1, 2014. Additionally, applies prohibition on pre-existing conditions exclusion for those under age 19 – including to grandfathered group plans – for plan years beginning on or after 6 months after enactment.
2010
A June 28, 2010 interim final rule published by DOL, Treasury and HHS implements the preexisting condition exclusion provisions generally applicable – per the statute – for plan years beginning on or after January 1, 2014 but with early applicability for those under age 19 (September 23, 2010).
An October 13, 2010 Q&A on the CCIIO website addresses the preexisting condition exclusion applicable to children under age 19. A page on www.healthcare.gov provides general information and links to more details about these provisions as they relate to covering children with pre-existing conditions.
2013
On Nov. 14, coinciding with the President’s remarks on the Administration’s pursuit of an administrative fix for those receiving policy cancellations and following his apology for those facing such cancellations, CCIIO released a letter to state Insurance Commissioners (White House fact sheet) laying out a transitional policy under which insurers “may choose to continue coverage that would otherwise be terminated or cancelled, and affected individuals and small businesses may choose to re-enroll in such coverage” – without complying with 2014 market reforms detailed on p. 2 of the letter – under a set of specified parameters (see p. 2 of the letter). Prior to the announcement, on Nov. 9, CMS also had released a fact sheet on policy cancellation letters and Marketplace options.
On Nov. 21, the Center for Consumer Information and Insurance Oversight released guidance and standard notices for health plans to use in the individual and small group markets under the Administration’s transitional policy for – with state insurance commissioner approval – extending into 2014 non-ACA compliant plans that otherwise would or already have been canceled. Also see a White House blog post and CCIIO Q&A on notices. On Nov. 20, President Obama met with Insurance Commissioners regarding the policy.
On Dec. 2, Rep. Darrell Issa (R-CA), chairman of the House Oversight and Government Reform Committee, wrote to 15 insurers asking about, among other issues, ACA-related plan cancellations and providers no longer in networks. On Dec. 4, the House Ways and Means Health Subcommittee held a hearing that addressed, in part, plan cancellations; among those testifying was the Washington state insurance commissioner. On Dec. 6, the House Oversight and Government Reform Committee held an Arizona-based field hearing, “ObamaCare Implementation, The Broken Promise: If You Like Your Current Plan You Can Keep It” (details).
2014
On Jan. 3, CCIIO released Q&As clarifying eligibility for hardship exemption from the individual mandate for policyholders whose plans have been canceled, noting that “in order to receive [the exemption] and be able to purchase catastrophic coverage, you must submit the hardship exemption form and should submit supporting documentation showing your health insurance policy was cancelled to an issuer offering catastrophic coverage in your area.” CCIIO indicates that the agency may contact those not including such documentation; the exemption can be revoked if this substantiation is not provided.
On March 5, CCIIO issued guidance extending, for two additional years (to October 1, 2016), the transitional policy enabling non-ACA-compliant small group and individual plans to continue if state Insurance Commissioners elect. It extended the hardship exemption from the individual mandate for canceled policyholders, through which they also can gain access to catastrophic plans, to the same date.
On Mar. 16, HHS, DOL and Treasury issued a final rule amending the definition of excepted benefits and establishing two pilot programs through which employers may provide certain limited wraparound coverage to individual plans, including those purchased in Marketplaces. One pilot enables limited wraparound coverage only for ACA Multi-State Plans, while the other permits it for “part-time workers who enroll in an individual health insurance policy or in Basic Health Plan coverage for low-income individuals established under the Affordable Care Act.
2017
On Jan. 5, 2017, HHS issued a report finding that between 2010 and 2014, the share of Americans with pre-existing conditions who went without health insurance all year fell by 22 percent, meaning 3.6 million fewer people with pre-existing conditions went uninsured.
On Feb. 15, 2017, CMS released a market stability proposed rule on which comments were due by March 7. Key proposals address special enrollment period verification, guaranteed availability, a shorter annual open enrollment period, network adequacy, revised de minimus variations for QHPs, and revisions to the QHP certification calendar.
‘‘SEC. 2704 [42 U.S.C. 300gg–3]. PROHIBITION OF PREEXISTING CONDITION EXCLUSIONS OR OTHER DISCRIMINATION BASED ON HEALTH STATUS. ‘‘(a) IN GENERAL.—A group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage.’’; and (B) by transferring such section (as amended by subparagraph (A)) so as to appear after the section 2703 added by paragraph (4); (3)(A) in section 2702 (42 U.S.C. 300gg–1)— (i) by striking the section heading and all that follows through subsection (a); (ii) in subsection (b)— (I) by striking ‘‘health insurance issuer offering health insurance coverage in connection with a group health plan’’ each place that such appears and inserting ‘‘health insurance issuer offering group or individual health insurance coverage’’; and (II) in paragraph (2)(A)— (aa) by inserting ‘‘or individual’’ after ‘‘employer’’; and (bb) by inserting ‘‘or individual health coverage, as the case may be’’ before the semicolon; and (iii) in subsection (e)— (I) by striking ‘‘(a)(1)(F)’’ and inserting ‘‘(a)(6)’’; (II) by striking ‘‘2701’’ and inserting ‘‘2704’’; and (III) by striking ‘‘2721(a)’’ and inserting ‘‘2735(a)’’; and (B) by transferring such section (as amended by subparagraph (A)) to appear after section 2705(a) as added by paragraph (4); and (4) by inserting after the subpart heading (as added by paragraph (1)) the following:
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