Do self-insured plans have to comply with the requirements of the Affordable Care Act (ACA)?

Yes. Many of the ACA's requirements apply to self-insured plans, some of which include:

  • Extending dependent coverage for adult children to age 26;
  • Coverage of preventive services with no cost sharing (exception for grandfathered plans);
  • No rescission of coverage except for fraud and misrepresentation;
  • No lifetime or annual dollar limits for essential health benefits;
  • Coverage of emergency services;
  • Choice of provider requirements for pediatricians and OB-GYNs;
  • Automatic enrollment for large employers (effective date to be determined when final regulations are issued);
  • Summary of Benefits and Coverage requirements; and
  • Form W-2 reporting requirements.