ACA Now

Implementation Status

2012

A November 26, 2012, HHS, DOL and Treasury proposed rule outlined ACA-driven changes to regulations regarding nondiscriminatory wellness programs in group health coverage. The Departments proposed using ACA authority to further raise the maximum reward to 50 percent for wellness programs relating to tobacco use.

2013

On January 25, 2013, a group of House Democrats wrote to HHS, DOL and Treasury seeking changes to the wellness program rules that would clarify what constitutes reasonably designed wellness programs, among other things.

In a February 27, 2013, final rule on health insurance market rules, HHS finalized its proposal that a health insurance issuer in the small group market may implement the tobacco rating factor (see PHSA section 2701) only in conjunction with a wellness program meeting this section’s parameters.

On May 29, HHS, DOL, and Treasury released a final rule on wellness programs in group health coverage. Under the rule, the maximum permissible reward under a health-contingent wellness program increases from 20 percent to 30 percent of the cost of coverage. The final rule also raises the maximum permissible reward to 50 percent for wellness programs designed to prevent or reduce tobacco use. Also see HHS’ statutorily required Report to Congress.

On June 3, DOL, HHS and Treasury released a final rule on wellness programs in group health coverage that – among other provisions – increases the maximum reward under a health-contingent wellness program from 20 percent to 30 percent of the cost of coverage; the rule additionally raises the maximum permissible reward to 50 percent for wellness programs designed to prevent or reduce tobacco use.

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).

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.

2014

On Jan. 9, in a wide-ranging set of FAQs, DOL, HHS and Treasury clarify that ACA out-of-pocket maximums apply in 2015 across all essential health benefits (EHBs), despite a 2014 transitional policy that allowed some plans with separate prescription drug or pediatric dental benefit administrators, for example, to apply separate OOP maximums to such benefits. Additional FAQs address expatriate health plans, wellness programs and the ACA’s effect on mental health parity in the individual and small group markets.

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.

On Apr. 16, the Equal Employment Opportunity Commission (EEOC) released a proposed rule on wellness programs and the Americans with Disabilities Act. Comments are due by Jun. 19, 2015. Also see DOL FAQs.

2016

On May 16, 2016 the Equal Employment Opportunity Commission finalized rules specifying the extent to which employer-sponsored wellness plans can offer incentives while still protecting employees against discrimination. Under one rule, the EEOC lowered the maximum financial penalty employers may use to incentivize employee spouses into participating in a workplace wellness program under the Genetic Information Nondiscrimination Act. The other rule implements the Americans with Disabilities Act, and imposes a penalty limited to 30 percent of self-only coverage.

2019

On September 30, 2019, CCIIO announced through an informational bulletin a new opportunity for 10 states to apply for participation in a wellness program demonstration for their respective individual markets.