Guidance Addresses Coverage Rescissions, Cost Sharing

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By Kristen Ricaurte Knebel

April 20 — The Obama administration addressed a smattering of issues in the 31st edition of frequently-asked-questions and answers related to Affordable Care Act implementation, including coverage rescissions, preventive services and cost-sharing limitations.

On coverage rescissions, the guidance said a plan can't retroactively cancel the benefits of a worker who has resigned his or her position if no fraud has taken place.

The FAQs, released April 20, tackled two issues related to preventive services.

The guidance said that if a health plan or issuer “utilizes reasonable medical management techniques within a specified method of contraception,” it may develop and use a standard exception form and instructions as part of steps used to ensure it is providing an “easily accessible, transparent, and sufficiently expedient exceptions process that is not unduly burdensome on the individual or a provider.”

Additionally, the guidance stated that a plan or issuer can't impose cost sharing on medications used to prepare for a colonoscopy.

The guidance also said that plans and issuers must disclose how they calculate payments for out-of-network services.

As for cost-sharing limitations, the administration said that a non-grandfathered large group market or self-insured group health plan must count an individual's out-of-pocket expenses for providers who don't accept reference prices toward a maximum out-of-pocket limit.

To contact the reporter on this story: Kristen Ricaurte Knebel in Washington at

To contact the editor responsible for this story: Jo-el J. Meyer at

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