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ACA Update: Final Rule Issued on Excepted Health Benefits

Nov 13, 2014


On October 1, 2014, the Departments of the Labor, Health and Human Services and Treasury published a final rule regarding excepted health benefits. Excepted benefits are generally exempt from ACA’s market reform, including limits on pre-existing conditions and guaranteed renewability.

The final rule is effective December 1, 2014 and applies to group health plans effective January 1, 2015 and later.

Stand-alone dental and vision plans are already considered excepted benefits. The final rule expands the definition of excepted benefits to include employee assistance plans (EAPs) if the EAP plan meets certain conditions, including:

  • The EAP is free to employees, and
  • EAP benefits are not coordinated with benefits in a group health plan, and
  • The EAP does not provide significant benefits in the nature of medical care or treatment

The final rule also clarified that self-insured plans that offered dental and vision benefits without charging an employee contribution also qualify as excepted benefits. Fully insured vision and dental benefits, and self-insured vision and dental coverage that requires employee contributions, previously qualified as excepted benefits.

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