Proposed Expansion of “Excepted Benefits”

Health Care Reform Legislative BriefThe Health Insurance Portability and Accountability Act of 1996 (HIPAA) established certain categories of “excepted benefits” that generally are not governed by the HIPAA portability regulations. Employee benefits that qualify as excepted benefits under HIPAA are also not subject to the market reforms under the Affordable Care Act (ACA), including the ACA’s prohibition on annual limits and preventive care coverage requirement.

On Dec. 20, 2013, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments) issued proposed regulations that would expand excepted benefits. Specifically, the proposed regulations would:

  • Allow self-insured plans to cover dental and vision benefits as excepted benefits without an extra premium payment;
  • Permit limited group wraparound coverage of individual coverage as excepted benefits; and
  • Recognize certain employee assistance programs (EAPs) as excepted benefits.

These proposed regulations would be effective with respect to limited wraparound coverage for plan years starting in 2015. Until final regulations are issued, through at least 2014, the Departments will consider dental and vision benefits and EAP benefits that meet the proposed requirements to qualify as excepted benefits.

Read the full Proposed Expansion of Excepted Benefits Legislative Brief to learn more.

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