With January 1, 2014 approaching, HealthSmart would like to remind you that certain plan amendments may be required in order to comply with the Affordable Care Act. Compliance with the 2014 mandates will depend on the start date of your plan year, as well as whether you sponsor a grandfathered or non-grandfathered group health plan. Below is an outline of upcoming requirements (although your plan may require additional changes not identified below). In addition, your plan may be subject to other plan amendments not listed here in the event your plan loses its grandfathered status in 2014. Please review the list and contact your HealthSmart Account Executive to discuss any necessary plan amendments.

Pre-existing Condition Exclusions Prohibited
• Group health plans are prohibited from imposing any pre-existing condition exclusions.
• Applies to plan years beginning on or after January 1, 2014.
• Applies to grandfathered and non-grandfathered group health plans.

Annual Dollar Limits on Essential Health Benefits Prohibited
• Group health plans cannot impose annual dollar limits on Essential Health Benefits.
• Applies to plan years beginning on or after January 1, 2014.
• Applies to grandfathered and non-grandfathered group health plans.

Coverage for Clinical Trials
• Group health plans must provide coverage for certain items and services furnished in connection with an approved clinical trial.
• Applies to plan years beginning on or after January 1, 2014.
• Applies to non-grandfathered group health plans only.

Excessive Waiting Periods Prohibited
• Group health plans may not impose a waiting period that exceeds 90 days.
• Applies to plan years beginning on or after January 1, 2014.
• Applies to grandfathered and non-grandfathered group health plans.

Cost-Sharing Limitations
• Group health plans may not impose cost-sharing greater than $6,350 for self-only coverage and $12,700 for family coverage. 
• Safe harbor available for plans that use more than one service provider to administer benefits that are subject to the annual out-of-pocket maximum limitation.
• Applies to plan years beginning on or after January 1, 2014.
• Applies to non-grandfathered group health plans only.

This document is for informational purposes only and does not constitute legal advice. Group health plans should consult their own legal counsel to determine what plan amendment(s) (if any) are appropriate.