by James A. Woehlke, Esq., CPA
General Counsel / COO, MBL Benefits Consulting Corp.
The Patient Protection and Affordable Care Act (the ACA*) was enacted on March 23, 2010. The ACA requires that both new and grandfathered group health plans be designed without exclusions for pre-existing conditions. The Administration issued guidance on this (and several other) requirement(s) in the form of interim final regulations on June 28, 2010.
ACA prohibits health plans from denying coverage due to preexisting conditions effective for plan years beginning after 2013. In addition, they may not deny coverage to children under age 19 due to preexisting conditions for plan years beginning on or after September 23, 2010. Until the effective date, HIPAA rules that permit exclusions due to preexisting conditions remain in effect. Grandfathered group health plans must comply with this requirement.
If you have questions about the new pre-existing exclusion prohibition, please contact your MBL Benefits consultant or the author at firstname.lastname@example.org.
* For simplicity, the Patient Protection and Affordable Care Act and the Health Care and Education Affordability Reconciliation Act are collectively referred to as the Affordable Care Act, or ACA.
Additional resources available at
Official publication of interim final regulations on pre-existing condition coverage: http://www.federalregister.gov/articles/2010/06/28/2010-15278/patient-protection-and-affordable-care-act-preexisting-condition-exclusions-lifetime-and-annual