The Wagner Law Group
Wagner Law Group, A Professional Corporation, is a nationally
recognized ERISA & employee benefits, estate planning,
employment, labor & human resources practice.
in 1996, The Wagner Law Group has 26 attorneys engaged
exclusively in employee benefits, estate planning and
employment law. Six of our attorneys are AV rated by
Martindale-Hubbell as having very high to preeminent legal abilities
and ethical standards. The firm is among the largest ERISA boutiques
in the country. Our practice is national in scope, with clients in
more than 40 states and several foreign countries.
Wagner Law Group
Fax: (561) 293-3591
7108 Fairway Drive
Palm Beach Gardens, FL 33418
East Kennedy Boulevard
Tampa, FL 33602
Francisco, CA 94104
100 South 4th Street, Suite 550
St. Louis, MO 63102
November 3, 2016
Health and Welfare Law
Final Regulations Address
DOL, and HHS have issued final regulations providing guidance on
short-term, limited-duration insurance; travel insurance;
supplemental health insurance coverage; and essential health benefits
("EHBs") for purposes of the ACA's annual and lifetime limits.
following provides a summary of the regulations:
Short-term, limited duration insurance is designed to bridge gaps in
coverage when an individual transitions from one form of coverage to
another. This insurance is considered excepted benefit coverage
under the ACA and does not qualify as minimum essential coverage for
purposes of satisfying the ACA's individual mandate
requirement. Therefore, as a form of excepted benefit coverage,
it is exempt from certain ACA requirements, including the prohibition
on pre-existing condition exclusions and annual and lifetime dollar
limits on EHBs.
final regulations confirm that in order for limited-duration
insurance coverage to qualify as an excepted benefit, it must last no
more than three months , including renewals. In addition, the
underlying insurance policies must include a disclaimer explaining
that the coverage does not qualify as minimum essential coverage and,
therefore, the insured may be subject to the ACA's individual
health insurance coverage.
Supplemental health insurance coverage, which is designed to fill
gaps in primary health coverage through either payments of
coinsurance or deductibles, or by providing benefits for items and
services not covered under the primary coverage, is also excepted
benefit coverage and exempt from the ACA's market reforms.
final regulations confirm that in order for supplemental health
insurance coverage to qualify as an excepted benefit, it must either:
benefits that are not covered by primary coverage and are not
cost-sharing for primary benefits; or
- both provide
supplemental benefits and cover cost-sharing.
The final regulations do not change prior
guidance that limited the cost for supplemental coverage to no more
than 15 percent of the cost for the primary coverage.
Travel Insurance. Travel insurance is designed to provide
insurance coverage for personal risks of planned travel, including
trip cancellation, lost baggage, damages to accommodations or rental
vehicles, and sickness, accident, disability or death during transit,
provided that health benefits are not offered on a stand-alone basis
and are incidental to other coverage. The final regulations
formally recognize travel insurance as excepted benefit coverage for
Essential Health Benefits and the ACA's
prohibition on annual and lifetime dollar limits. The ACA requires small group health plans
to offer EHB coverage without annual or lifetime dollar limits.
However, this requirement does not apply to large group plans.
Nevertheless, the final regulations provide that large group health
plans (which are not required to provide EHBs) must define EHBs as
- any EHBs
covered by an EHB-benchmark plan in any state, including
state-mandated benefits that qualify as EHBs; or
under one of the three largest Federal Employees Health Benefit
Program plans, including any benefits added to meet ACA
Takeaway for Employers. The final regulations apply as of the
first day of the first plan year commencing on or after January 1,