The torrent of regulations to implement the major provisions of the Affordable Care Act began in earnest Nov. 20 when the Department of Health and Human Services issued two proposed rules and another proposed rule for employer wellness programs was released by HHS, the Internal Revenue Service, and the Department of Labor.

HHS's proposal outlining exchange and issuer standards for coverage of essential health benefits that must be covered by all non-grandfathered individual and small group plans that took effect after ACA enactment on March 23, 2010, now allows for more than one drug per category, which was welcome news for patient groups and the pharmaceutical industry. Actuarial value requirements were loosened for exchange participants so that the lowest "bronze" level of 60 percent could be offered.

Another HHS proposal implements requirements that insurers offer coverage to everyone without charging more due to medical conditions. Plans still cannot charge older policyholders more than three times what they charge younger policyholders, but HHS proposed a plan for phasing the age ratings in on a year-by-year basis, and the agency said states can propose alternative age rating methods. Insurers also must submit all rate filings to HHS, not just rate increases above 10 percent.

Comments are due Dec. 26 on the two HHS proposals and Jan. 25 on the joint wellness program proposal. They were all published in the Nov. 26 Federal Register.