Affordable Care Act Implementation

Frequently Asked Questions

The Patient Protection and Affordable Care Act (ACA) adds many protections related to employment-based group health plans for you and your family. These include extending dependent coverage up to age 26; prohibiting preexisting condition exclusions for all individuals; and requiring easy-to-understand summaries of a health plan's benefits and coverage.

We continuously release frequently asked questions to help workers, their families, employers, and advisers learn about ACA implementation. Choose a part to find answers to common questions. 

  • Part 1

    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 2

    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 3

    This set of FAQs addresses the exemption for group health plans with less than two current employees.

  • Part 4

    This set of FAQs addresses grandfathered health plans.

  • Part 5

    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 6

    This set of FAQs addresses grandfathered health plans.

  • Part 7

    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 8

    This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.

  • Part 9

    This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.

  • Part 10

    This FAQ addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.

  • Part 11

    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.

  • Part 12

    This set of FAQs addresses limitations on cost-sharing and coverage of preventive services under the ACA.

  • Part 13

    This set of FAQs addresses expatriate health plans.

  • Part 14

    This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.

  • Part 15

    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 16

    This set of FAQs addresses the employer notice of coverage options and the 90-day waiting period limitation.

  • Part 17

    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 18

    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 19

     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 20

     This set of FAQs addresses coverage of preventive services.

  • Part 21

    This set of FAQs addresses limitations on cost-sharing under the ACA.

  • Part 22

    This set of FAQs addresses compliance of premium reimbursement arrangements.

  • Part 23

    This set of FAQs addresses excepted benefits.

  • Part 24

    This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.

  • Part 25

    This set of FAQs addresses the wellness program requirements.

  • Part 26

    This set of FAQs addresses coverage of preventive services.

  • Part 27

    This set of FAQs addresses limitations on cost sharing and provider non-discrimination.

  • Part 28

    This set of FAQs addresses transparency reporting for non-QHP issuers and non-grandfathered group health plans.

  • Part 29

    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.

  • Part 39 (Proposed)

    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.

  • Part 39 (Final)

    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.

  • Part 68

    This set of FAQs addresses coverage of preventive services.

  • Part 69

    This FAQ addresses implementation of the No Surprises Act the gag clause prohibition provisions, including the attestation requirement.

  • Part 70

    This FAQ addresses the machine-readable file disclosure requirements under the Transparency in Coverage Final Rules.

  • Part 71

    This set of FAQs addresses the No Surprises Act and limitations on cost sharing under the Affordable Care Act.