Understanding Excepted Benefits Under the Affordable Care Act
Setnor Byer Insurance & Risk
Health Plan, Health Coverage, Group Health Insurance
Many employers offer benefits packages that provide employees with more than just health insurance coverage. Though some of these benefits, like pre-paid legal service plans, are clearly not health-related, others may provide employees with some health-related benefits. Does this mean they are subject to the Affordable Care Act’s health insurance market reforms? Not necessarily.
Certain types of benefits, due to their nature, are not subject to a number of health-related laws, including the Affordable Care Act, the Health Insurance Portability and Accountability Act, the Mental Health Parity Act and the Genetic Information Nondiscrimination Act. These are known as excepted benefits.
There are four categories of excepted benefits.
1. Benefits Excepted In All Circumstances
The following benefits, or any combination thereof, are considered excepted benefits in all circumstances:
Coverage only for accident (including accidental death and dismemberment)
Disability income coverage
Liability insurance, including general liability and automobile insurance
Coverage issued as a supplement to liability insurance
Workers' compensation or similar coverage
Automobile medical payment insurance
Credit-only insurance (for example, mortgage insurance)
Coverage for on-site medical clinics
2. Limited Excepted Benefits
A number of benefits may be considered excepted benefits if they are provided under a separate policy, certificate or contract of insurance. They can also qualify as a limited excepted benefit if they are not an integral part of a group health plan, which means that participants may decline coverage or that claims for benefits are administered under a separate contract than claims for any other benefits under the plan.
One or more of the following benefits may qualify as a limited excepted benefit:
limited-scope dental benefits
limited-scope vision benefits...
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Affordable Care Act
, Group Health Insurance
, Health Coverage
, Health Plan