Consumer Information On Health Plans
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Health Benefits Education Campaign
EBSA provides health benefits education focusing on life and work events and the benefit decisions they impact as well as information on the federal health benefits laws related to employment based group health plans to help employees and their families make informed decisions.
Life And Work Events And Health Benefits
- Top 10 Ways To Make Your Health Benefits Work For You
- Life Changes Require Health Choices-Know your Benefit Options
- Work Changes Require Health Choices-Protect Your Rights
- Life Events Impact Health Benefit Needs
- General Facts on Women and Job Based Health Benefits
- elaws Health Benefits Advisor
Affordable Care Act Regulations and Guidance
Stop Loss Insurance
ACA Implementation Frequently Asked Questions
- Part I
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 II
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 III
This set of FAQs addresses the exemption for group health plans with less than two current employees. - Part IV
This set of FAQs addresses grandfathered health plans. - Part V
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 VI
This set of FAQs addresses grandfathered health plans. - Part VII
This set of FAQs addresses the Summary of Benefits and Coverage and Uniform Glossary requirements of PHS Act �15 and the Mental Health Parity and Addiction Equity Act of 2008. - Part VIII
This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act �15. - Part IX
This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act �15. - Part X
This FAQ addresses the Summary of Benefits and Coverage requirements of PHS Act �15.
Coverage of Preventive Services
- Updated Guidance Regarding Temporary Enforcement Safe Harbor
- Advance Notice of Proposed Rulemaking:
- Final Regulations Regarding Exemption
- Guidance Regarding Temporary Enforcement Safe Harbor
- Amendment to Interim Final Rules
- Interim Final Regulations
- Fact Sheet
- Recommended Preventive Services
- Public Comments on Interim Final Rule
- Public Comments on Amendment to Interim Final Rule
Automatic Enrollment, Employer Shared Responsibility, and Waiting Periods
Summary of Benefits and Coverage and Uniform Glossary
Regulations and Guidance
- Final Regulations
- Guidance for Compliance
- Proposed Regulations
- Solicitation of comments - Templates, Instructions, and Related Materials
- Culturally and Linguistically Appropriate Services (CLAS) County Data
Templates, Instructions, and Related Materials
- Corrected Summary of Benefits and Coverage (SBC) Template [MS Word Format]
- Corrected Sample Completed SBC [MS Word Format]
- Summary of Benefits and Coverage (SBC) Template [MS Word Format]
- Sample Completed SBC [MS Word format]
- Instructions for Completing the SBC - Group Health Plan Coverage
- Instructions for Completing the SBC - Individual Health Insurance Coverage
- Why This Matters language for "Yes" Answers
- Why This Matters language for "No" Answers
- HHS Information For Simulating Coverage Examples
- HHS Coverage Example Calculator and Related Information
- Uniform Glossary of Coverage and Medical Terms
Essential Health Benefits
- Frequently Asked Questions on Essential Health Benefits Bulletin � February 17, 2012
- Essential Health Benefits Bulletin � December 16, 2011
Multiple Employer Welfare Arrangements (MEWAs)
- Proposed Rule on Ex Parte Cease and Desist and Summary Seizure Orders: Multiple Employer Welfare Arrangements
- Proposed Rule on Filings Required of Multiple Employer Welfare Arrangements and Certain Other Related Entities
- Notice of Proposed Revision of Annual Information Return/Report
- Notice of Proposed Revision of the Form M-1
- Proposed Form M-1 Revisions
- Fact Sheet
- News Release
Medical Loss Ratio
- Technical Release on Fiduciary Requirements for Handling Medical Loss Ratio (MLR) Rebates
- HHS final rule on MLR requirements for issuers [PDF]
Internal Claims and Appeals and External Review
Regulations
- Amendment to the Interim Final Rule
- Correction
- Interim Final Rule
- NAIC Uniform Review Model Act
- Public Comments in Interim Final Rule
- Public Comments on Amendment to Interim Final Rule
Guidance
- Technical Release 2011-02
- Technical Release 2011-01
- Technical Release 2010-02
- Technical Release 2010-01
- Revised Model Notice of Adverse Benefit Determination
- Revised Model Notice of Final Internal Adverse Benefit Determination
- Revised Model Notice of Final External Review Decision | [en español]
- Consumer Assistance Programs
- Status of State External Review Processes
- Culturally and Linguistically Appropriate Services (CLAS) County Data
Other Information
Public Forum on Automatic Enrollment in Large Employer Health Plans
Value-Based Insurance Design in Connection with Preventive Care Benefits
Grandfathered Health Plans
- Amendment to Interim Final Rules
- Fact Sheet on Amendment
- Public Comments on Amendment
- Regulation
- Fact Sheet on Regulation
- Frequently Asked Questions
- Provisions Summary Chart
- Model Notice | [en español]
- Public Comments on Regulation
Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient
- Regulation
- Fact Sheet
- Patient Protection Model Notice | [en español]
- Lifetime Limits Model Notice | [en español]
- Public Comments
Extension of Coverage For Adult Children
- Regulation
- Fact Sheet
- Frequently Asked Questions
- IRS Guidance
- Model Notice | [en español]
- Public Comments
Small Business Health Care Tax Credit for Small Employers
Affordable Care Act Nondiscrimination Provisions Applicable to Insured Group Health Plans
Early Retiree Reinsurance Program
Pre-Existing Condition Insurance Plan Program
Frequently Asked Questions on Health Care Reform and COBRA
COBRA Continuation Health Coverage
- COBRA Continuation Coverage
- An Employee's Guide to Health Benefits Under COBRA | [en español]
- FAQs About COBRA Continuation Health Coverage
- COBRA Fact Sheet
- Model General Notice | [en español]
- Model Election Notice | [en español]� Note: The Trade Adjustment Assistance Extension Act of 2011 made significant changes to the HCTC through January 1, 2014. For more information, call the HCTC Customer Contact Center at 1-866-628-HCTC or visit the HCTC website at www.irs.gov.
- elaws Health Benefits Advisor
HIPAA Health Coverage Portability And Nondiscrimination
- Changes To HIPAA Special Enrollment Provisions Under The Children's Health Insurance Program Reauthorization Act
- Your Health Plan And HIPAA...Making The Law Work For You
- FAQs About Portability Of Health Coverage And HIPAA
- FAQs About The HIPAA Nondiscrimination Requirements
- HIPAA Fact Sheet
- Model Certificate of Coverage | [en español]
- elaws Health Benefits Advisor
Children's Health Insurance Program
- Fact Sheet
- Children's Health Insurance Program Working Goup
- Model Notice for Employers Regarding Premium Assistance Opportunities | Printer Version | en español
- Federal Register Notice
Genetic Information Nondiscrimination Act
- Fact Sheet: The Genetic Information Nondiscrimination Act of 2008 (GINA)
- FAQs on the Genetic Information Nondiscrimination Act
- Your Genetic Information and Your Health Plan - Know the Protections Against Discrimination
Health Benefit Claims And Appeals
Workers' Rights To Health Plan Information
Newborns' And Mothers' Health Protection Act
- Protections For Newborns, Adopted Children, and New Parents
- FAQs About Newborns' And Mothers' Health Protection
- Newborns' and Mothers' Fact Sheet
- elaws Health Benefits Advisor
Women's Health And Cancer Rights Act
- Your Rights After a Mastectomy...Women's Health & Cancer Rights Act of 1998
- FAQs About Womens' Health And Cancer Rights
- WHCRA Fact Sheet
- elaws Health Benefits Advisor
Mental Health Parity and Addiction Equity Act of 2008
- MHPAEA Fact Sheet
- FAQ on Mental Health Parity and Addiction Equity Act
- FAQs on Mental Health Parity Implementation
- FAQs on Mental Health Parity Implementation
- elaws Health Benefits Advisor
Retiree Health
Health Benefits Coverage Information For Dislocated Workers
- Job Loss Resources
- Retirement And Health Care Coverage...Q&As For Dislocated Workers
- Job Loss Fact Sheet
- elaws Health Benefits Advisor
Health Benefits Coverage Information For Reservists
- Retirement and Health Care Benefits...Q&As for Reservists
- FAQs For Reservists Being Called To Active Duty
- Fact Sheet: Reservists Called To Active Duty
What To Do If Your Health Coverage Can No Longer Pay Benefits
- Fact Sheet
- Palombo Reopen Order | [Monetary Award Order] | [News Release]
- MIWU Consent Order | [News Release]
- IUPIW Consent Order | [News Release]
Related Health Care Web Sites
AARP - Formerly known as the American Association of Retired Persons, provides useful generic consumer information on managed care. Included in this site are a glossary of terms, checkpoints for comparing plans, descriptions of differences between traditional fee-for-service and managed care, and AARP principles on essential managed care plan features and services.
Centers For Medicare & Medicaid Services - An agency within the Department of Health and Human Services responsible for Medicare and the new prescription drug program among other issues.
Commonwealth Fund - Offers articles researched and written by experts in fields such as managed care quality, employer value-based purchasing, insurance and coverage, and women, children and minority health.
Department of Health and Human Services - Website has materials concerning federal health care laws. These materials include information on the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Mental Health Parity Act of 1996 (MHPA).
Federal Employees Health Benefit Plan - Gives current and valuable information to help you choose a health plan. This site offers extensive information on the health benefit plans offered to employees, beneficiaries and retirees of the Federal government. Participants are able to obtain information on the various plans offered as well as instructions for changing plans, filing claims, reporting fraud, and patients rights.
Georgetown University Health Policy Institute - Consumer guides on getting and keeping health insurance for each state and the District of Columbia. These consumer guides summarize your protections and may not answer all of your questions.
Healthfinder - Sponsored by the Department of Health and Human Services� Office of Disease Prevention and Health Promotion (ODPHP) is a gateway consumer health information website that can lead consumers to selected online publications, databases and websites.
Healthcare.gov - A Website managed by the US Department of Health and Human Services that provides information on public and private health insurance options.
Healthreform.gov - The Department of Health and Human Services' Website on the 2010 health reform law.
Indian Health Service - An agency of the U.S. Public Health Service, provides information about healthcare services available to the general public and offers answers to questions and concerns regarding illness and protection.
Joint Commission on Accreditation of Healthcare Organizations - Evaluates and accredits more than 18,000 health care organizations in the United States, including hospitals, health care networks, managed care organizations, and health care organizations that provide home care, long term care, behavioral health care, laboratory, and ambulatory care services. Their website has information about quality, making health care choices, and performance measurement. Performance reports on health care facilities can be accessed and downloaded.
Leap Frog Group - Comprised of more than 100 public and private organizations that provide health care benefits, The Leapfrog Group works with medical experts throughout the U.S. to identify problems and propose solutions that it believes will improve hospital systems that could break down and harm patients. Representing approximately 32 million health care consumers in all 50 states, Leapfrog provides information and solutions for consumers and health care providers.
Medicare.gov - Provides information about Medicare and the expanded health plan options with the creation Medicare+Choice. Information is available in English and Spanish.
National Committee for Quality Assurance - The National Committee for Quality Assurance is a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality everywhere. NCQA is active in quality oversight and improvement initiatives at all levels of the health care system.
National Women's Health Information Center - This site includes a database and links to more than 1,000 federal agencies, publications and hundreds of government-screened private sector organizations related to women's health.
Pacific Business Group on Health - Provides practical information about how to use report cards and other indicators to select health plans and providers. It also has information on health services in general and health and wellness benefits.
State Children's Health Insurance Program (SCHIP) - From the Centers for Medicare & Medicaid Services. SCHIP is designed to provide health insurance coverage to "targeted low-income children" of families that earn too much money to be eligible for Medicaid, but not enough money to purchase private insurance.
State Insurance Departments - Continue to regulate heath insurance issuers (e.g., insurance companies or HMOs) who sell group insurance to ERISA-covered group health plans, even under the Health Insurance Portability and Accountability Act (HIPAA), the Mental Health Parity Act, and the Newborns� and Mothers� Health Protection Act. In addition, States continue to have responsibilities in individual insurance market (e.g., selling individual insurance policies). The National Association of Insurance Commissioners has created access to state websites with information on particular state health insurance laws. You may also contact your state insurance commissioner for further information on particular state health insurance laws.
Veterans Administration - Sponsors a telemedicine healthcare site dedicated towards improving access, coordination, continuity and outcomes for healthcare for veterans. Through the use of this electronic information and support, consumers are able to overcome distance and time.