• 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.       
    (**Note: See Technical Release 2013-03 for comprehensive guidance addressing health reimbursement arrangements that was issued after the date of these FAQs.)
  • Part XII – This set of FAQs addresses limitations on cost-sharing and coverage of preventive services 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.
  • 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.
  • Part XVI – This set of FAQs addresses the employer notice of coverage options and the 90-day waiting period limitation.
  • Part XVII – This set of FAQs addresses the implementation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), as amended by the Affordable Care Act.
  • Part XVIII – This set of FAQs addresses coverage of preventive services, limitations on cost-sharing, expatriate health plans, wellness programs, fixed indemnity insurance, and the Mental Health Parity and Addiction Equity Act of 2008.
  • Part XIX – This set of FAQs addresses updated DOL model notices, limitations on cost-sharing, coverage of preventive services, health FSA carryover and excepted benefits, and the Summary of Benefits and Coverage requirements of PHS Act §2715.
  • Part XX – This set of FAQs addresses coverage of preventive services.
  • Part XXI – This set of FAQs addresses limitations on cost-sharing under the ACA.
  • Part XXII – This set of FAQs addresses compliance of premium reimbursement arrangements.
  • Part XXIII – This set of FAQs addresses excepted benefits.
  • Part XXIV – This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.
  • Part XXV – This set of FAQs addresses the wellness program requirements.
  • Part XXVI – This set of FAQs addresses coverage of preventive services.
  • Part XXVII* – This set of FAQs addresses limitations on cost sharing and provider non-discrimination.
  • Part XXVIII – This set of FAQs addresses transparency reporting for non-QHP issuers and non-grandfathered group health plans.
  • Part XXIX – This set of FAQs addresses coverage of preventive services, wellness programs, and the Mental Health Parity and Addiction Equity Act of 2008.
  • Part 30 – This set of FAQs addresses the summary of benefits and coverage.
  • Part 31 – This set of FAQs addresses coverage of preventive services, rescissions, out-of-network emergency services, coverage for individuals participating in approved clinical trials, limitations on cost-sharing under the Affordable Care Act, the Mental Health Parity and Addiction Equity Act and the Women's Health and Cancer Rights Act.
  • Part 32 – This set of FAQs addresses notice of coverage options – COBRA and the Health Insurance Marketplace.
  • Part 33 – This set of FAQs addresses premium reduction arrangements for student health plan coverage.
  • Part 34 – This set of FAQs addresses the coverage of preventive services and the Mental Health Parity and Addiction Equity Act.
  • Part 35 – This set of FAQs addresses special enrollment for group health plans, coverage of preventive services under the Affordable Care Act and qualified small employer health reimbursement arrangements.
  • Part 36 – This set of FAQs addresses the coverage of preventive services.
  • Part 37 – This set of FAQs addresses health reimbursement arrangements.
  • Part 38 – This set of FAQs addresses the Mental Health Parity and Addiction Equity Act and the 21st Century Cures Act.
  • Proposed Part 39 – This proposed set of FAQs addresses the Mental Health Parity and Addiction Equity Act and the 21st Century Cures Act. Comments are requested by June 22, 2018.
  • Final Part 39 – This final set of FAQs addresses the Mental Health Parity and Addiction Equity Act and the 21st Century Cures Act.
  • Part 40 – This set of FAQs addresses limitations on cost-sharing under the ACA.
  • Part 41 – This set of FAQs addresses the Summary of Benefits and Coverage.
  • Part 42* – This set of FAQs addresses the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act. This document was updated on April 15, 2020, to correct an error in footnote 10 regarding the end date of the current public health emergency related to COVID-19.
  • Part 43* – This set of FAQs addresses the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act.
  • Part 44* – This set of FAQs addresses the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act.
  • Part 45 – This set of FAQs addresses Mental Health Parity Implementation and the Consolidated Appropriations Act, 2021.
  • Part 46 - This set of FAQs addresses limitations on cost sharing under the Affordable Care Act.
  • Part 47 - This set of FAQs addresses the preventive services coverage requirements.
  • Part 48 - This set of FAQs addresses the coverage of preventive services.
  • Part 49* - This set of FAQs addresses implementation of the No Surprises Act.
  • Part 50* - This set of FAQs addresses rapid coverage of preventive services for coronavirus and HIPAA nondiscrimination and wellness programs.
  • Part 51* - This set of FAQs addresses coverage of COVID-19 diagnostic testing and coverage of preventive services, including contraceptive coverage.
  • Part 52* - This set of FAQs addresses coverage of COVID-19 diagnostic testing.
  • Part 53* - This set of FAQs addresses Transparency in Coverage machine-readable files.
  • Part 54 - This set of FAQs addresses the preventive services requirements for contraceptive coverage.
  • Part 55* - This set of FAQs addresses implementation of the No Surprises Act and the Transparency in Coverage rules.
  • Part 56 - This set of FAQs addresses reporting of prescription drug and health care spending.
  • Part 57 - This set of FAQs addresses the gag clause prohibition provisions, including the attestation requirement.
  • Part 58 - This set of FAQs addresses the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act, and the end of the COVID-19 Public Health Emergency and National Emergency.
  • Part 59 - This set of FAQs addresses coverage of preventive services.
  • Part 60 - This set of FAQs addresses the No Surprises Act, limitations on cost sharing under the Affordable Care Act and transparency in coverage with regard to facility fees under the No Surprises Act.
  • Part 61 - This set of FAQs addresses the Transparency in Coverage rules.
  • Part 62* - This set of FAQs addresses implementation of the No Surprises Act.
  • Part 63 - This set of FAQs addresses Culturally and Linguistically Appropriate Services (CLAS) County Data, and the No Surprises Act.
  • Part 64 - This set of FAQs addresses the preventive services requirements for contraceptive coverage.
  • Part 65 - This set of FAQs addresses the Transparency in Coverage rules.
  • Part 66 - This FAQ addresses the prohibition on lifetime and annual limits and the annual limitation on cost sharing under the ACA.
  • Part 67 - This FAQ addresses implementation of the No Surprises Act.

*Note:

  • Section 18A of the Fair Labor Standards Act (FLSA) (the automatic enrollment requirement) has been repealed. Accordingly, some of the guidance in FAQs Part V is included on this page for reference only.
  • Some of the guidance in FAQs Parts VIII, IX, and X has been superseded by guidance contained in FAQs Part XIV.
  • Some of the guidance in FAQs Parts VIII, IX, X, and XIV has been superseded by guidance contained in FAQs Part XIX.
  • Some of the guidance in FAQs Part XV has been superseded by guidance contained in FAQs Part XXVII.
  • Some of the guidance in FAQs Part 43 has been superseded by guidance contained in FAQs Part 51.
  • Some of the guidance in FAQs Part 51 has been superseded by guidance contained in FAQs Part 52.
  • The Provider Relief Fund, described in Q14 in FAQs set 44, no longer accepts claims for testing, treatment, or COVID-19 vaccination.
  • Some of the guidance in FAQs Parts 42, 43, 44, 50, 51, and 52 has been superseded by guidance contained in FAQs Part 58.
  • Some of the guidance in FAQs Part 49 and 53 have been superseded by guidance contained in FAQs Part 61.
  • Some of the guidance in FAQs Part 55 is affected by the decision in Texas Medical Association, et al. v. U.S. Department of Health and Human Services, et al., Case No. 6:22-cv-450-JDK (TMA III). See FAQs Part 62 for guidance on the relevant provisions in light of this court decision.
  • Some of the guidance in FAQs Part 55 is affected by the decision in Texas Medical Association, et al. v. U.S. Department of Health and Human Services, et al., Case No. 6:22-cv-450-JDK (TMA III). See FAQs Part 62 for guidance on the relevant provisions in light of this court decision.
  • Some of the guidance in FAQs Part 62 has been superseded by guidance contained in FAQ Part 67.