Persius/hicric huggingface dataset:
FAQS ABOUT AFFORDABLE
     
CARE ACT IMPLEMENTATION
     
(PART X) 
 
August 7, 2012 
 
 
Set out below is an additional Frequently Asked Question (FAQ) regarding implementation of the 
summary of benefits and coverage (SBC) provisions of the Affordable Care Act. This FAQ has been 
prepared jointly by the Departments of Labor, Health and Human Services (HHS), and the Treasury 
(the Departments). Like previously issued FAQs (available at http://www.dol.gov/ebsa/healthreform/ 
and http://cciio.cms.gov/resources/factsheets/), this FAQ answers a question from stakeholders to help 
people understand the new law and benefit from it, as intended. 
 
Q1:  I am an employer sponsoring a group health plan.  One of the benefit packages is 
a Medicare Advantage plan.  Am I required to provide an SBC for the Medicare 
Advantage package?    
 
No.  Medicare Advantage benefits are Medicare benefits (financed by the Medicare Trust fund and 
equivalent to Medicare A and B benefits, which are set by Congress and regulated by the Centers for 
Medicare & Medicaid Services (CMS)).  They are, therefore, not health insurance coverage and 
Medicare Advantage organizations are not required to provide an SBC with respect to such benefits.  
Pending further guidance, the Departments will not take any enforcement action against a group 
health plan because it does not provide an SBC with respect to a Medicare Advantage benefit 
package.1  This enforcement policy does not affect other disclosure requirements administered by 
CMS that apply to Medicare Advantage organizations.  These separately required disclosures will 
ensure that enrollees in these plans receive the necessary information about their coverage and 
benefits.  Nor does this policy affect the obligation of group health plans that offer Medicare 
Advantage benefit options to ensure that SBCs are provided with respect to other benefit packages 
that they offer. 
                                                 
1 Note: Previously published guidance makes clear that, if the Medicare Advantage coverage is a separate retiree-only plan, it 
is exempt from the requirement to provide an SBC.  For more information on the exemption for retiree-only plans, see Q1 of 
Affordable Care Act Implementation FAQs Part III (October 12, 2010), available at http://www.dol.gov/ebsa/faqs/faq-
aca3.html and http://cciio.cms.gov/resources/factsheets/aca_implementation_faqs3.html.
FAQS ABOUT AFFORDABLE CARE ACT 
IMPLEMENTATION (PART XX) 
 
July 17, 2014 
 
Set out below is an additional Frequently Asked Question (FAQ) regarding implementation of 
the Affordable Care Act. This FAQ has been prepared by the Departments of Labor, Health and 
Human Services (HHS), and the Treasury (collectively, the Departments).  Like previously 
issued FAQs (available at http://www.dol.gov/ebsa/healthreform/), this FAQ answers a question 
from stakeholders to help people understand the law and benefit from it, as intended. 
 
Disclosure with respect to Preventive Services 
 
Q:  My closely held for-profit corporations health plan will cease providing coverage for 
some or all contraceptive services mid-plan year.  Does this reduction in coverage trigger 
any notice requirements to plan participants and beneficiaries? 
 
Yes.  For plans subject to the Employee Retirement Income Security Act (ERISA), ERISA 
requires disclosure of information relevant to coverage of preventive services, including 
contraceptive coverage.  Specifically, the Department of Labor's longstanding regulations at 29 
CFR 2520.102-3(j)(3) provide that, the summary plan description (SPD) shall include a 
description of the extent to which preventive services (which includes contraceptive services) are 
covered under the plan.  Accordingly, if an ERISA plan excludes all or a subset of contraceptive 
services from coverage under its group health plan, the plans SPD must describe the extent of 
the limitation or exclusion of coverage.  For plans that reduce or eliminate coverage of 
contraceptive services after having provided such coverage, expedited disclosure requirements 
for material reductions in covered services or benefits apply.  See ERISA section 104(b)(1) and 
29 CFR 2520.104b-3(d)(1), which generally require disclosure not later than 60 days after the 
date of adoption of a modification or change to the plan that is a material reduction in covered 
services or benefits.  Other disclosure requirements may apply, for example, under State 
insurance law applicable to health insurance issuers.
FAQS ABOUT AFFORDABLE CARE ACT 
IMPLEMENTATION (PART 30)  
 
 
March 11, 2016 
 
Set out below is an additional Frequently Asked Question (FAQ) regarding implementation of 
the Affordable Care Act. This FAQ has been prepared jointly by the Departments of Labor, 
Health and Human Services, and the Treasury (collectively, the Departments). Like previously 
issued FAQs (available at http://www.dol.gov/ebsa/healthreform/ and 
http://www.cms.gov/cciio/resources/fact-sheets-and-faqs/index.html), this FAQ answers 
questions from stakeholders to help people understand the Affordable Care Act and benefit from 
it, as intended.  
 
Summary of Benefits and Coverage  
 
Public Health Service (PHS) Act section 2715, as added by the Affordable Care Act and 
incorporated by reference into the Employee Retirement Income Security Act and the Internal 
Revenue Code, directs the Departments to develop standards for use by a group health plan and a 
health insurance issuer offering group or individual health insurance coverage in compiling and 
providing a summary of benefits and coverage (SBC) that accurately describes the benefits and 
coverage under the applicable plan or coverage. On June 16, 2015, the Departments published 
revised joint final regulations regarding the requirements for the SBC.1  Separately, on February 
26, 2016, the Departments published a coordinated information collection request proposing a 
new SBC template and instructions, an updated uniform glossary, and other associated materials 
consistent with the requirements of the Paperwork Reduction Act.2 
 
What is the intended implementation date for SBCs using the new template and associated 
documents? 
 
After the close of the public comment period on March 28, 2016, regarding the proposed SBC 
template and associated documents that were published on February 26, 2016, the Departments 
intend to review the comments and finalize the new SBC template and associated documents 
expeditiously.  The Departments intend that health plans and issuers that maintain an annual 
open enrollment period will be required to use the new SBC template and associated documents 
beginning on the first day of the first open enrollment period that begins on or after April 1, 2017 
with respect to coverage for plan years (or, in the individual market, policy years) beginning on 
or after that date.  For plans and issuers that do not use an annual open enrollment period, the 
new SBC template and associated documents would be required beginning on the first day of the 
first plan year (or, in the individual market, policy year) that begins on or after April 1, 2017.   
                                                 
1 26 CFR 54.9815-2715, 29 CFR 2590.715-2715, and 45 CFR 147.200 published at 80 FR 34292. 
2 81 FR 9860, 9887, 9945.
FAQS ABOUT AFFORDABLE CARE ACT 
IMPLEMENTATION PART 48 
August 16, 2021 
Set out below is an additional Frequently Asked Question (FAQ) regarding implementation of 
the Affordable Care Act. This FAQ has been prepared jointly by the U.S. Departments of Health 
and Human Services (HHS), Labor, and the Treasury (collectively, the Departments). Like 
previously issued FAQs (available at https://www.dol.gov/agencies/ebsa/about-ebsa/our-
activities/resource-center/faqs and http://www.cms.gov/cciio/resources/fact-sheets-and-
faqs/index.html), this FAQ is intended to help stakeholders stay informed about the law. 
Coverage of Preventive Services 
Section 2713 of the Public Health Service Act (PHS Act), as added by the Affordable Care Act 
and incorporated into the Employee Retirement Income Security Act (ERISA) and the Internal 
Revenue Code (the Code), requires that non-grandfathered group health plans and health 
insurance issuers offering non-grandfathered group or individual health insurance coverage 
provide coverage of certain specified preventive services without cost sharing. These preventive 
services include, with respect to women, preventive care and screenings as provided for in 
comprehensive guidelines supported by the Health Resources and Services Administration 
(HRSA), including contraceptive services.  
On November 15, 2018, the Departments published final regulations concerning religious and 
moral exemptions and accommodations regarding coverage of certain preventive services (2018 
final regulations).1 The 2018 final regulations expand exemptions for entities with religious or 
0F
moral objections to the contraceptive coverage requirement to which their health plans would 
otherwise be subject. 
Q1. Are the Departments considering changes to the 2018 final regulations? 
Yes. The Departments are considering how best to address these provisions in light of recent 
litigation.  The Departments intend to initiate rulemaking within 6 months to amend the 2018 
final regulations and obtaining public input will be included as part of the Departments 
rulemaking process. 
                                                            
1 83 FR 57536, 83 FR 57592 (Nov. 15, 2018).