Many healthcare reform regulations apply to all group health plans, regardless of whether they are fully insured or self-insured, but self-insured plans are exempt from certain provisions of health care reform. The following are examples of reforms that do and do not apply to self-insured plans.
Reforms that do apply:
- Dependent coverage until age 26
- Preventive health coverage without cost-sharing (grandfathered plans are exempt)
- No rescissions of coverage, except in the case of fraud or intentional misrepresentation of material fact
- Improved internal claims and appeals process and minimum requirements for external review (grandfathered plans are exempt)
Reforms that do not apply:
- Essential health benefits package
- Premium rating restrictions
- Review of premium increases
EHD welcomes the opportunity to help your organization examine its plan designs and make recommendations for improvement.
