ACA and HIPAA Excepted Benefits

Summary

This practice note explains the concept of excepted benefits as it relates to compliance with the Patient Protection and Affordable Care Act (Pub. L. No. 111-148), as amended by the Health Care and Education Reconciliation Act (Pub. L. No. 111-152) (ACA) and the Health Insurance Portability and Accountability Act (Pub. L. No. 104-191) (HIPAA). Certain so-called excepted benefit plans are excluded from the ACA and HIPAA definitions of group health plan. Consequently, they are generally exempt from ACA market reform provisions, HIPAA portability requirements, and other rules that otherwise apply to such plans. This practice note also describes the conditions that certain types of excepted benefit arrangements must satisfy to be eligible for exemption. Benefits practitioners need to be familiar with these rules to advise their clients on compliance of their health benefit plans and programs.