Government Agencies Issue Final Health Care Regulations

By Alistair M. Nevius, J.D.

The IRS, the Employee Benefits Security Administration, and the U.S. Department of Health and Human Services jointly issued final regulations governing many aspects of the Patient Protection and Affordable Care Act (PPACA), P.L. 111-148 (T.D. 9744). Based on comments received, the final rules make changes to various previous proposed and interim final regulations issued in 2010.

The regulations generally apply to group health plans and health insurance issuers in the group and individual market, and they provide detailed rules governing:

  • Grandfathered health plans;
  • Preexisting condition exclusions;
  • Lifetime and annual dollar limits on benefits;
  • Rescissions;
  • Coverage of dependent children to age 26;
  • Internal claims and appeal and external review processes; and
  • Patient protections under PPACA.

The final regulations are effective Jan. 19, 2016, and apply to group health plans and health insurance issuers beginning on the first day of the first plan year (or, in the individual market, the first day of the first policy year) beginning on or after Jan. 1, 2017.

Alistair Nevius (anevius@aicpa.org) is The Tax Adviser’s editor-in-chief.

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