Federal departments have answered common questions about special enrollment for group health plans and coverage of women’s preventive health services. A summary of their responses is below.
Special enrollment for group health plans
Q1: If an individual who enrolled in individual market health insurance coverage, including coverage purchased through a Marketplace, loses eligibility for that coverage, is the individual entitled to a special enrollment period in an employer-sponsored group health plan for which the individual is otherwise eligible and had previously declined to enroll?
Coverage of Preventive Services under the ACA
Q2: The Health Resources and Services Administration (HRSA) updated its Women’s Preventive Services Guidelines on Dec. 20, 2016. When must non-grandfathered group health plans and health insurance issuers begin offering coverage for preventive services without cost sharing based on the updated guidelines?
A: Women’s preventive services are required to be covered without cost sharing in accordance with the updated guidelines for plan years (or, in the individual market, policy years) beginning on or after Dec. 20, 2017. Until the new guidelines become applicable, non-grandfathered group health plans and health insurance issuers are required to provide coverage without cost sharing consistent with the previous HRSA guidelines and the Public Health Service Act section 2713 for any items or services that continue to be recommended.
Based on recommendations developed by the Women’s Preventive Services Initiative, the updated guidelines complement and build upon recommendations from organizations such as the U.S. Preventive Services Task Force. To view the new guidelines, follow this link.
The questions and complete answers are contained in “FAQs about Affordable Care Act Implementation Part 35,” which was released on Dec. 20, 2016, by the U.S. Departments of Labor, Health and Human Services and the Treasury. Follow this link for the complete document.