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Amended by section 2301 of HCERA. Prohibits individual and group plans, including grandfathered plans, from rescinding coverage except in cases of fraud or enrollees’ intentional misrepresentation of material fact, and requires prior notice of cancellation to the enrollee.
An HHS website provides general information and links to implementation details.
2010
On April 27, 2010, HHS issued a statement regarding WellPoint’s announcement that it will end coverage rescissions before the statutory deadline; this followed an April 20, 2010, HHS letter to the company regarding rescission practices. On April 28, 2010, HHS issued a release noting that United Healthcare also would “join with other insurers and stop using rescissions.”
An HHS, Labor and Treasury interim final rule published on June 28, 2010, implements ACA rescission rules. Also see a CCIIO FAQ response regarding rescissions.
2013
On April 4, 2013, CMS published a Paperwork Reduction Act Notice relative to the requirement for health plans to provide advance notices of the potential for coverage rescission, as well as patient protection notifications that inform enrollees of their right to select a primary care provider or pediatrician or use OG/GYN services without obtaining prior approval. The Notice also indicates the discontinuation of the requirement for plans and issuers to provide an enrollment opportunity notice to individuals whose coverage ended because they reached a lifetime limit, saying this was a “one-time” requirement.
On June 28, CMS published a Federal Register Notice pursuant to Paperwork Reduction Act procedures including a reinstatement with change of a previously approved information collection, “Enrollment Opportunity Notice Relating to Lifetime Limits; Required Notice of Rescission of Coverage; and Disclosure Requirements for Patient Protection under the Affordable Care Act.”
On Nov. 29, the DOL’s Employee Benefits Security Administration published a Notice regarding proposed extensions of information collections: the “ACA Advance Notice of Rescission” and the “Patient Protection Notice” regarding the right to designate primary care and certain other providers. Comments are due on Jan. 28, 2014.
2014
On Feb. 27, Treasury published an information collection notice regarding extensions and/or revisions to currently approved collections pursuant to these sections. Comments on the underlying burden estimates, among other aspects, are due by March 31, 2014.
2016
On Apr. 20, HHS, DOL, and the Treasury issued joint FAQs regarding implementation of ACA market reform provisions, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), and the Women’s Health and Cancer Rights Act of 1998 (WHCRA). Specific market reforms made by the ACA, including emergency services protections, coverage of preventive services, prohibition on rescissions, coverage of individuals participating in approved clinical trials, and limitations on cost sharing, are all addressed.
‘‘SEC. 2712 [42 U.S.C. 300gg–12]. PROHIBITION ON RESCISSIONS. ‘‘A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not rescind such plan or coverage with respect to an enrollee once the enrollee is covered under such plan or coverage involved, except that this section shall not apply to a covered individual who has performed an act or practice that constitutes fraud or makes an intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage. Such plan or coverage may not be cancelled except with prior notice to the enrollee, and only as permitted under section 2702(c) or 2742(b).
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