This morning the Department of Labor, Health and Human Services and the Treasury Department released additional Frequently Asked Questions relating to implementation of the Affordable Care Act. Among the topics discussed include administrative issues relating to out of pocket maximum limitations and wellness programs and a new category of excepted benefits for fixed indemnity insurance.
Specifically, the regulators clarified that a health plan or insurer can divide annual limits on out of pocket maximums across multiple categories of benefits and are not required to count an individual’s expenses for out of network items and services toward the annual out of pocket maximum. Additionally, the regulators confirm that a group health plan participant who declines to participate in an employer’s wellness program at the beginning of the plan year can be required to wait until the next plan year to enter the program and does not have to be provided the benefit mid-year. The FAQs also announce HHS’ intention to propose regulations which would allow certain fixed indemnity coverage sold in the individual health insurance market to be considered an “excepted benefit” and exempt from some of the ACA requirements.