ACA FAQs Touch on HRAs and Women’s Health



Group health plans have until December 2017 to implement new women’s preventive service guidelines recommended by the Health Resources and Services Administration, the 35th edition of Frequently Asked Questions about Affordable Care Act Implementation said. 

Health plans must cover the updated list of services without cost-sharing, according to the FAQs released by the Department of Labor, Internal Revenue Service and Health and Human Services Department Dec. 20, 2016.

The updated guidelines make small changes to existing women’s preventive service requirements. Changes include new breast cancer screening guidelines for average-risk women and expanding the explanation of contraception to include a list of the full range of contraception methods. 

The HRSA’s new guidelines are based on recommendations developed by the Women’s Preventive Services Initiative, a coalition of national health professional organizations and consumer groups, led by the American College of Obstetricians and Gynecologists. 

The FAQs also address recent changes to health reimbursement arrangement compliance under the ACA.  

Signed by President Obama Dec. 13, the 21st Century Cures Act (Pub. L. 114-255) partially overturned previous guidance, allowing qualified small employers to offer their employees HRAs. (See related story, Cures Act Puts HRAs Back on the Table for Small Employers.)

The FAQs clarify that the Cures Act only applies to qualified small employers and that prior guidance continues to apply to employee payment plans and HRAs that do not qualify as qualified small employer health reimbursement arrangements (QSEHRA).

Qualified small employers are those with fewer than 50 employees that don't offer any type of group health plan.  Further, QSEHRAs are not considered a group health plan. 

The FAQs include the Cures Act criteria that a QSEHRA must meet: 

  • compliant HRAs must be exclusively funded by employer contributions and can't receive any funding from employees via salary reductions;
  • HRAs are provided after the employee provides proof of coverage for payment or reimbursement of eligible medical expenses;
  • maximum annual reimbursements can't exceed $4,950 for individuals or $10,000 for family coverage (to be annually indexed); and
  • the employer offers the same HRA to all eligible employees.

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