For Workers and Families

• Affordable Care Act Implementation
  • 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 §2715 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 §2715.
  • Part IX* – This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.
  • Part X* – This FAQ addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.
  • Part XI – This set of FAQs addresses the employer notice of coverage options, health reimbursement arrangements, disclosure of information related to firearms, employer group waiver plans supplementing Medicare Part D, fixed indemnity insurance and payment of PCORI fees. Related information: CMS Bulletin on Non-Medicare Supplemental Drug Benefits.
    (**Note: See Technical Release 2013-03 for comprehensive guidance addressing health reimbursement arrangements that was issued after the date of these FAQs.)
  • Part XII – This set of FAQs addresses limitations on cost-sharing and coverage of preventive services under the ACA.
  • Part XIII – This set of FAQs addresses expatriate health plans.
  • Part XIV* – This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.
  • Part XV* – This set of FAQs addresses annual limit waiver expiration date based on a change to a plan or policy year, provider non-discrimination, coverage for individuals participating in approved clinical trials and transparency reporting.
  • Part XVI – This set of FAQs addresses the employer notice of coverage options and the 90-day waiting period limitation.
  • Part XVII – This set of FAQs addresses the implementation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), as amended by the Affordable Care Act.
  • Part XVIII – This set of FAQs addresses coverage of preventive services, limitations on cost-sharing, expatriate health plans, wellness programs, fixed indemnity insurance, and the Mental Health Parity and Addiction Equity Act of 2008.
  • Part XIX – This set of FAQs addresses updated DOL model notices, limitations on cost-sharing, coverage of preventive services, health FSA carryover and excepted benefits, and the Summary of Benefits and Coverage requirements of PHS Act §2715.
  • Part XX – This set of FAQs addresses coverage of preventive services.
  • Part XXI – This set of FAQs addresses limitations on cost-sharing under the ACA.
  • Part XXII – This set of FAQs addresses compliance of premium reimbursement arrangements.
  • Part XXIII – This set of FAQs addresses excepted benefits.
  • Part XXIV – This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.
  • Part XXV – This set of FAQs addresses the wellness program requirements.
  • Part XXVI – This set of FAQs addresses coverage of preventive services.
  • Part XXVII* – This set of FAQs addresses limitations on cost sharing and provider non-discrimination.
  • Part XXVIII – This set of FAQs addresses transparency reporting for non-QHP issuers and non-grandfathered group health plans.
  • Part XXIX – This set of FAQs addresses coverage of preventive services, wellness programs, and the Mental Health Parity and Addiction Equity Act of 2008.
  • Part 30 – This set of FAQs addresses the summary of benefits and coverage.
  • Part 31 – This set of FAQs addresses coverage of preventive services, rescissions, out-of-network emergency services, coverage for individuals participating in approved clinical trials, limitations on cost-sharing under the Affordable Care Act, the Mental Health Parity and Addiction Equity Act and the Women's Health and Cancer Rights Act.
  • Part 32 – This set of FAQs addresses notice of coverage options – COBRA and the Health Insurance Marketplace.
  • Part 33 – This set of FAQs addresses premium reduction arrangements for student health plan coverage.
  • Part 34 – This set of FAQs addresses the coverage of preventive services and the Mental Health Parity and Addiction Equity Act.
  • Part 35 – This set of FAQs addresses special enrollment for group health plans, coverage of preventive services under the Affordable Care Act and qualified small employer health reimbursement arrangements.
  • Part 36 - This set of FAQs addresses the coverage of preventive services.
  • Part 37 - This set of FAQs addresses health reimbursement arrangements.

  *Note:

  • Section 18A of the Fair Labor Standards Act (FLSA) (the automatic enrollment requirement) has been repealed. Accordingly, some of the guidance in FAQs Part V is included on this page for reference only.
  • Some of the guidance in FAQs Parts VIII, IX, and X has been superseded by guidance contained in FAQs Part XIV.
  • Some of the guidance in FAQs Parts VIII, IX, X, and XIV has been superseded by guidance contained in FAQs Part XIX.
  • Some of the guidance in FAQs Part XV has been superseded by guidance contained in FAQs Part XXVII.
• COBRA Continuation Health Coverage
• Genetic Information Nondiscrimination Act
• Health Insurance Portability and Accountability Act (HIPAA)
• Louisiana Storms Relief
• Medical Loss Ratio (MLR) Insurance Rebates
• Mental Health Parity and Addiction Equity Act
• Newborn's and Mothers' Health Protection (Newborns' Act)
• Reservists Being Called to Active Duty
• Understanding Implementation of the Mental Health Parity and Addiction Equity Act
• Women's Health and Cancer Rights (WHCRA)

For Employers and Advisers

• 2009 Form 5500 Schedule C
• Affordable Care Act Implementation
  • 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 §2715 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 §2715.
  • Part IX* – This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.
  • Part X* – This FAQ addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.
  • Part XI – This set of FAQs addresses the employer notice of coverage options, health reimbursement arrangements, disclosure of information related to firearms, employer group waiver plans supplementing Medicare Part D, fixed indemnity insurance and payment of PCORI fees. Related information: CMS Bulletin on Non-Medicare Supplemental Drug Benefits.
    (**Note: See Technical Release 2013-03 for comprehensive guidance addressing health reimbursement arrangements that was issued after the date of these FAQs.)
  • Part XII – This set of FAQs addresses limitations on cost-sharing and coverage of preventive services under the ACA.
  • Part XIII – This set of FAQs addresses expatriate health plans.
  • Part XIV* – This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.
  • Part XV* – This set of FAQs addresses annual limit waiver expiration date based on a change to a plan or policy year, provider non-discrimination, coverage for individuals participating in approved clinical trials and transparency reporting.
  • Part XVI – This set of FAQs addresses the employer notice of coverage options and the 90-day waiting period limitation.
  • Part XVII – This set of FAQs addresses the implementation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), as amended by the Affordable Care Act.
  • Part XVIII – This set of FAQs addresses coverage of preventive services, limitations on cost-sharing, expatriate health plans, wellness programs, fixed indemnity insurance, and the Mental Health Parity and Addiction Equity Act of 2008.
  • Part XIX – This set of FAQs addresses updated DOL model notices, limitations on cost-sharing, coverage of preventive services, health FSA carryover and excepted benefits, and the Summary of Benefits and Coverage requirements of PHS Act §2715.
  • Part XX – This set of FAQs addresses coverage of preventive services.
  • Part XXI – This set of FAQs addresses limitations on cost-sharing under the ACA.
  • Part XXII – This set of FAQs addresses compliance of premium reimbursement arrangements.
  • Part XXIII – This set of FAQs addresses excepted benefits.
  • Part XXIV – This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act §2715.
  • Part XXV – This set of FAQs addresses the wellness program requirements.
  • Part XXVI – This set of FAQs addresses coverage of preventive services.
  • Part XXVII* – This set of FAQs addresses limitations on cost sharing and provider non-discrimination.
  • Part XXVIII – This set of FAQs addresses transparency reporting for non-QHP issuers and non-grandfathered group health plans.
  • Part XXIX – This set of FAQs addresses coverage of preventive services, wellness programs, and the Mental Health Parity and Addiction Equity Act of 2008.
  • Part 30 – This set of FAQs addresses the summary of benefits and coverage.
  • Part 31 – This set of FAQs addresses coverage of preventive services, rescissions, out-of-network emergency services, coverage for individuals participating in approved clinical trials, limitations on cost-sharing under the Affordable Care Act, the Mental Health Parity and Addiction Equity Act and the Women's Health and Cancer Rights Act.
  • Part 32 – This set of FAQs addresses notice of coverage options – COBRA and the Health Insurance Marketplace.
  • Part 33 – This set of FAQs addresses premium reduction arrangements for student health plan coverage.
  • Part 34 – This set of FAQs addresses the coverage of preventive services and the Mental Health Parity and Addiction Equity Act.
  • Part 35 – This set of FAQs addresses special enrollment for group health plans, coverage of preventive services under the Affordable Care Act and qualified small employer health reimbursement arrangements.
  • Part 36 - This set of FAQs addresses the coverage of preventive services.
  • Part 37 - This set of FAQs addresses health reimbursement arrangements.

  *Note:

  • Section 18A of the Fair Labor Standards Act (FLSA) (the automatic enrollment requirement) has been repealed. Accordingly, some of the guidance in FAQs Part V is included on this page for reference only.
  • Some of the guidance in FAQs Parts VIII, IX, and X has been superseded by guidance contained in FAQs Part XIV.
  • Some of the guidance in FAQs Parts VIII, IX, X, and XIV has been superseded by guidance contained in FAQs Part XIX.
  • Some of the guidance in FAQs Part XV has been superseded by guidance contained in FAQs Part XXVII.
• Benefit Claims Procedure Regulation
• COBRA Continuation Health Coverage
• EFAST2 Form 5500 Electronic Filing for Small Businesses
• EFAST2 Form 5500 Processing
• EFAST2 Credentials
• Fiduciary Responsibilities under an Apprenticeship and Training Plan
• Form M-1 Online Filing System
• Genetic Information Nondiscrimination Act
• Health Coverage Portability (HIPAA)
• Mental Health Parity and Addiction Equity Act (MHPAEA)
• Multiemployer Plan Leasing Arrangements
• Notice of Coverage Options
• Reporting Delinquent Participant Contributions on the Form 5500
• Supplemental 2009 Schedule C
• Understanding Implementation of the Mental Health Parity and Addiction Equity Act