ACA excepted benefit ruleAs the government continues to add depth and clarity to the sweeping Affordable Care Act (ACA) law, employers should be taking note of the definition and enforcement of “excepted benefits.”

If you are unaware, excepted benefits refer to employee benefits that are excluded, for one reason or another, from the ACA’s portability and nondiscrimination requirements. Excepted benefits fall into at least one of four categories:

1) Generally not health coverage

2) Limited excepted benefits (limited scope vision, dental, long term care, nursing home, home care, community benefits). Only if they are:

A) Contained in a separate policy
B) Not part of a group health plan
C) No coordination
D) Benefits paid regardless of health plan coverage or benefit

3) Non-coordinated excepted benefit (e.g., cancer-only, specific disease coverage)

4) Supplemental excepted benefit (e.g., employee assistance program coverage)

More in-depth information about each of these categories can be found here.

So, as an employer trying to meet the ACA mandates, what should you be doing to ensure you are considering the right benefits “excepted?” Here are a few steps we recommend:

1) Confirm that the ancillary benefits (i.e.: dental, vision, etc) you offer:

A) Have a separate policy, certificate, or contract of insurance
B) Do not coordinate with health care coverage
C) Does not differentiate among individual in eligibility, benefit or premiums based on any health factor

2) If you offer an EAP, confirm that it meets excepted benefit criteria by:

A) Confirming coverage does not act as a gatekeeper to health care coverage
B) Ensuring all employees are eligible for coverage and it not based on group medical coverage
C) Funding the EAP separately from the group health plan
D) Offering the EAP benefit to all employees free of any cost sharing

3) Ensure wraparound coverage meets excepted benefit criteria

4) Take the necessary steps to uncouple benefits from the health plan including changing carriers if needed

5) Contact Spring and let our benefit experts evaluate your offerings and make recommendations specific to your business.

Here is more health care reform coverage from our Spring team.



Image credit: Andreas Cappell via flickr

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Teri Weber

Teri Weber

Partner at Spring Consulting Group, LLC
Teri Weber, ACI is a Senior Vice President with Spring Consulting Group. She has over 10 years of experience in health and welfare plan strategy, design, pricing, and implementation. She also works with absence management programs, including disability, family medical leave and leave of absence tracking. Her areas of expertise have allowed her to work with diverse employers and vendors to streamline processes and programs to meet the needs of insurers, administrators, employers and employees. Teri is on the Board for the New England Employee Benefits Council (NEEBC) and recently served as lead editor for the Disability Management Employer Coalition’s (DMEC) Return to Work Program Manual. Prior to joining Spring, Teri worked with Watson Wyatt, Buck Consultants and AON Consulting. In addition she was an Account Manager with Health Direct, Inc. Teri earned a BS at the University of Connecticut and a MBA at the University of Massachusetts. She holds an ACI designation and is a licensed broker in the states of MA and CT.