Affordable Care Act
- Statement of US Secretary of Labor Hilda L. Solis on implementation of Affordable Care Act’s early retiree reinsurance program
- Statement of Assistant Secretary of Labor Phyllis C. Borzi calling on employers and benefit plans to make young adult coverage available immediately
- Statement of U.S. Secretary of Labor Hilda L. Solis on passage of health care reform by U.S. House of Representatives
- Statement of Assistant Secretary of Labor Phyllis C. Borzi on Health Care Reform
Affordable Care Act Regulations and Guidance
Notice to Employees of Coverage Options
- Technical Release 2013-02 - Guidance on the notice to employees of coverage options under FLSA §18B and updated model election notice under COBRA
- Model Notice for employers who offer a health plan to some or all employees
- Model Notice for employers who do not offer a health plan
- COBRA Model Election Notice | Redline Version (to show May 2013 changes)
Ninety-Day Waiting Period Limitation
Wellness Programs
- Proposed Regulations
- Study
- Fact Sheet
- Press Release
- HHS Final Regulation – Health Insurance Market Rules
- HHS Proposed Regulation – Health Insurance Market Rules
Stop Loss Insurance
Frequently Asked Questions
- Part I - This set of FAQs addresses implementation topics including compliance, grandfathered health plans, claims, internal appeals and external review, dependent coverage of children, out-of-network emergency services, and highly compensated employees.
- Part II - This set of FAQs addresses grandfathered health plans, dental and vision benefits, rescissions, preventive health services, and ACA effective date for individual health insurance policies.
- Part III - This set of FAQs addresses the exemption for group health plans with less than two current employees.
- Part IV - This set of FAQs addresses grandfathered health plans.
- Part V - This set of FAQs addresses a variety of ACA implementation topics, the HIPAA nondiscrimination and wellness program rules, and the Mental Health Parity and Addiction Equity Act of 2008.
- Part VI - This set of FAQs addresses grandfathered health plans.
- Part VII - This set of FAQs addresses the Summary of Benefits and Coverage and Uniform Glossary requirements of PHS Act §2715 and the Mental Health Parity and Addiction Equity Act of 2008.
- Part VIII* - This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.
- Part IX* - This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.
- Part X* - This FAQ addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.
- Part XI - This set of FAQs addresses the employer notice of coverage options, health reimbursement arrangements, disclosure of information related to firearms, employer group waiver plans supplementing Medicare Part D, fixed indemnity insurance and payment of PCORI fees. Related information: CMS Bulletin on Non-Medicare Supplemental Drug Benefits.
- Part XII - This set of FAQs addresses limitations on cost-sharing under the ACA.
- Part XIII - This set of FAQs addresses expatriate health plans.
- Part XIV - This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715 (* Note: Some of the guidance in FAQs Parts VIII, IX, and X has been superseded by guidance contained in FAQs Part XIV.)
- Part XV - This set of FAQs addresses annual limit waiver expiration date based on a change to a plan or policy year, provider non-discrimination, coverage for individuals participating in approved clinical trials and transparency reporting.
Coverage of Preventive Services
- Proposed Rules regarding Coverage of Certain Preventive Services
- Updated Guidance Regarding Temporary Enforcement Safe Harbor
- Advance Notice of Proposed Rulemaking:
- Final Regulations Regarding Exemption
- Guidance Regarding Temporary Enforcement Safe Harbor
- Amendment to Interim Final Rules
- Interim Final Regulations
- Fact Sheet
- Recommended Preventive Services
- Public Comments on Interim Final Rule
- Public Comments on Amendment to Interim Final Rule
Automatic Enrollment, Employer Shared Responsibility, and Waiting Periods
- Technical Release 2012-02 | Public Comments
- IRS Notice 2012-58
- Technical Release 2012-01 | Public Comments
Summary of Benefits and Coverage and Uniform Glossary
Regulations and Guidance
- Final Regulations
- Guidance for Compliance
- Proposed Regulations
- Solicitation of comments - Templates, Instructions, and Related Materials
- Culturally and Linguistically Appropriate Services (CLAS) County Data
Templates, Instructions, and Related Materials
- Summary of Benefits and Coverage (SBC) Template (authorized for second year of applicability) MS Word Format
- Sample Completed SBC (authorized for second year of applicability) MS Word Format
- Summary of Benefits and Coverage (SBC) Template (authorized for first year of applicability) MS Word Format
- Sample Completed SBC (authorized for first year of applicability) MS Word Format
- Instructions for Completing the SBC - Group Health Plan Coverage
- Instructions for Completing the SBC - Individual Health Insurance Coverage
- Why This Matters language for "Yes" Answers
- Why This Matters language for "No" Answers
- HHS Information For Simulating Coverage Examples
- HHS Coverage Example Calculator and Related Information
- Uniform Glossary of Coverage and Medical Terms
Essential Health Benefits
- HHS Final Regulation on Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation
- HHS Proposed Regulation on Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation
- Frequently Asked Questions on Essential Health Benefits Bulletin – February 17, 2012
- Essential Health Benefits Bulletin – December 16, 2011
Multiple Employer Welfare Arrangements (MEWAs)
- Multiple Employer Welfare Arrangement/Form M-1
- Filings Required of Multiple Employer Welfare Arrangements and Certain Other Related Entities - Final Rule
- Ex Parte Cease and Desist and Summary Seizure Orders – Multiple Employer Welfare Arrangements - Final Rule
- Notice of 2012 Form M-1 Revisions and Availability
- Notice of adoption of revisions to Annual Return/Report Forms
- Fact Sheet
- Form M-1 Online Filing System
- An Analysis of 2007-2009 Filings of Form M-1
- News Release
- Proposed Rule on Ex Parte Cease and Desist and Summary Seizure Orders: Multiple Employer Welfare Arrangements
- Proposed Rule on Filings Required of Multiple Employer Welfare Arrangements and Certain Other Related Entities
- Notice of Proposed Revision of Annual Information Return/Report
- Notice of Proposed Revision of the Form M-1
- Proposed Form M-1 Revisions
- Fact Sheet
- News Release
Medical Loss Ratio
- Technical Release on Fiduciary Requirements for Handling Medical Loss Ratio (MLR) Rebates
- HHS final rule on MLR requirements for issuers PDF
- Medical Loss Ratio (MLR) Insurance Rebates
Internal Claims and Appeals and External Review
Regulations
- Amendment to the Interim Final Rule
- Correction
- Interim Final Rule
- NAIC Uniform Review Model Act
- Public Comments in Interim Final Rule
- Public Comments on Amendment to Interim Final Rule
Guidance
- Technical Release 2013-01 - Extension of the transition period for the temporary NAIC-similar State external review process under ACA
- Technical Release 2011-02 - Guidance on external review for group health plans and health insurance issuers offering group and individual health coverage, and guidance for states on external review processes
- Technical Release 2011-01 - Extension of non-enforcement period relating to certain interim procedures for internal claims and appeals under ACA
- Technical Release 2010-02 - Interim procedures for internal claims and appeals under ACA
- Technical Release 2010-01 - Interim procedures for federal external review relating to internal claims and appeals and external review under ACA
- Revised Model Notice of Adverse Benefit Determination
- Revised Model Notice of Final Internal Adverse Benefit Determination
- Revised Model Notice of Final External Review Decision | en español
- Consumer Assistance Programs
- Status of State External Review Processes
- Culturally and Linguistically Appropriate Services (CLAS) County Data
Other Information
Public Forum on Automatic Enrollment in Large Employer Health Plans
Value-Based Insurance Design in Connection with Preventive Care Benefits
Grandfathered Health Plans
- Amendment to Interim Final Rules
- Fact Sheet on Amendment
- Public Comments on Amendment
- Regulation
- Fact Sheet on Regulation
- Frequently Asked Questions
- Provisions Summary Chart
- Model Notice | en español
- Public Comments on Regulation
Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections
- Regulation
- Fact Sheet
- Patient Protection Model Notice | en español
- Lifetime Limits Model Notice | en español
- Public Comments
Extension of Coverage For Adult Children
- Regulation
- Fact Sheet
- Frequently Asked Questions
- IRS Guidance
- Model Notice | en español
- Public Comments
Small Business Health Care Tax Credit for Small Employers
Affordable Care Act Nondiscrimination Provisions Applicable to Insured Group Health Plans
Early Retiree Reinsurance Program
Pre-Existing Condition Insurance Plan Program
Frequently Asked Questions on Health Care Reform and COBRA
Affordable Care Act Mandated Research Studies and Surveys
- A Review of the U.S. Workplace Wellness Market - 2012
- An Analysis of 2007-2009 Filings of Form M-1
- 2013 Annual Report on Self-Insured Group Health Plans: 2013 Report | Appendix A | Appendix B
- 2012 Annual Report on Self-Insured Group Health Plans: 2012 Report | Appendix A | Appendix B
- 2011 Annual Report on Self-Insured Group Health Plans: 2011 Report | Appendix A | Appendix B
- Study of the Large Group Market
- Recent Data on Health Benefits from the National Compensation Survey | Letter from Secretary Hilda L. Solis
Law
EBSA Health Related Information
- Consumer Information on Health Plans
- Compliance Assistance for Health Plans
- Group Health Plan Reports and Form 5500 Data
- Health Benefits Education Campaign
Compliance Workshops, Seminars and Webcasts
- None scheduled at this time
Participant Workshops and Webcasts
- La Ley del Cuidado de Salud de Bajo Precio: medidas de protección nuevas e importantes para usted y su familia - Archivo
- The Affordable Care Act: Important New Protections for You and Your Family Webcast Archive
Health Insurance Marketplace
- HHS FAQ – State Participation in Certain Plan Management Activities
- About the Health Insurance Marketplace | en español
- The Value of Health Insurance | en español
- About the Small Business Health Options Program (SHOP) | en español