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.