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Consumer Information On Health Plans

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Health Benefits Education Campaign

EBSA provides health benefits education focusing on life and work events and the benefit decisions they impact as well as information on the federal health benefits laws related to employment based group health plans to help employees and their families make informed decisions.

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Life And Work Events And Health Benefits

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Affordable Care Act Regulations and Guidance

In ACA Regulations and Guidance

Wellness Programs

Stop Loss Insurance

ACA Implementation Frequently Asked Questions

  • Part I
    This set of FAQs addresses implementation topics including compliance, grandfathered health plans, claims, internal appeals and external review, dependent coverage of children, out-of-network emergency services, and highly compensated employees.
  • Part II
    This set of FAQs addresses grandfathered health plans, dental and vision benefits, rescissions, preventive health services, and ACA effective date for individual health insurance policies.
  • Part III
    This set of FAQs addresses the exemption for group health plans with less than two current employees.
  • Part IV
    This set of FAQs addresses grandfathered health plans.
  • Part V
    This set of FAQs addresses a variety of ACA implementation topics, the HIPAA nondiscrimination and wellness program rules, and the Mental Health Parity and Addiction Equity Act of 2008.
  • Part VI
    This set of FAQs addresses grandfathered health plans.
  • Part VII
    This set of FAQs addresses the Summary of Benefits and Coverage and Uniform Glossary requirements of PHS Act �15 and the Mental Health Parity and Addiction Equity Act of 2008.
  • Part VIII
    This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act �15.
  • Part IX
    This set of FAQs addresses the Summary of Benefits and Coverage requirements of PHS Act �15.
  • Part X
    This FAQ addresses the Summary of Benefits and Coverage requirements of PHS Act �15.
  • Part XI
    This set of FAQs addresses the employer notice of coverage options, health reimbursement arrangements, disclosure of information related to firearms, employer group waiver plans supplementing Medicare Part D, fixed indemnity insurance and payment of PCORI fees.
  • Part XII
    This set of FAQs addresses limitations on cost sharing and coverage of preventive services.

Coverage of Preventive Services

Automatic Enrollment, Employer Shared Responsibility, and Waiting Periods

Summary of Benefits and Coverage and Uniform Glossary

Regulations and Guidance

Templates, Instructions, and Related Materials

Essential Health Benefits

Multiple Employer Welfare Arrangements (MEWAs)

Medical Loss Ratio

Internal Claims and Appeals and External Review

Regulations

Guidance

Other Information

Enrollment in Large Employer Health Plans

Value-Based Insurance Design in Connection with Preventive Care Benefits

Grandfathered Health Plans

Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient

Extension of Coverage For Adult Children

Small Business Health Care Tax Credit for Small Employers

Affordable Care Act Nondiscrimination Provisions Applicable to Insured Group Health Plans

Early Retiree Reinsurance Program

Pre-Existing Condition Insurance Plan Program

Frequently Asked Questions on Health Care Reform and COBRA

COBRA Continuation Health Coverage

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HIPAA Health Coverage Portability And Nondiscrimination

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Children's Health Insurance Program

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Genetic Information Nondiscrimination Act

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Health Benefit Claims And Appeals

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Workers' Rights To Health Plan Information

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Newborns' And Mothers' Health Protection Act

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Women's Health And Cancer Rights Act

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Mental Health Parity and Addiction Equity Act of 2008

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Retiree Health

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Health Benefits Coverage Information For Dislocated Workers

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Health Benefits Coverage Information For Reservists

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What To Do If Your Health Coverage Can No Longer Pay Benefits

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Related Health Care Web Sites

AARP - Formerly known as the American Association of Retired Persons, provides useful generic consumer information on managed care. Included in this site are a glossary of terms, checkpoints for comparing plans, descriptions of differences between traditional fee-for-service and managed care, and AARP principles on essential managed care plan features and services.

Centers For Medicare & Medicaid Services - An agency within the Department of Health and Human Services responsible for Medicare and the new prescription drug program among other issues.

Commonwealth Fund - Offers articles researched and written by experts in fields such as managed care quality, employer value-based purchasing, insurance and coverage, and women, children and minority health.

Department of Health and Human Services - Website has materials concerning federal health care laws. These materials include information on the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Mental Health Parity Act of 1996 (MHPA).

Federal Employees Health Benefit Plan - Gives current and valuable information to help you choose a health plan. This site offers extensive information on the health benefit plans offered to employees, beneficiaries and retirees of the Federal government. Participants are able to obtain information on the various plans offered as well as instructions for changing plans, filing claims, reporting fraud, and patients rights.

Georgetown University Health Policy Institute - Consumer guides on getting and keeping health insurance for each state and the District of Columbia.  These consumer guides summarize your protections and may not answer all of your questions.

Healthfinder - Sponsored by the Department of Health and Human Services� Office of Disease Prevention and Health Promotion (ODPHP) is a gateway consumer health information website that can lead consumers to selected online publications, databases and websites.

Healthcare.gov - A Website managed by the US Department of Health and Human Services that provides information on public and private health insurance options.

Healthreform.gov - The Department of Health and Human Services' Website on the 2010 health reform law.

Indian Health Service - An agency of the U.S. Public Health Service, provides information about healthcare services available to the general public and offers answers to questions and concerns regarding illness and protection.

Joint Commission on Accreditation of Healthcare Organizations - Evaluates and accredits more than 18,000 health care organizations in the United States, including hospitals, health care networks, managed care organizations, and health care organizations that provide home care, long term care, behavioral health care, laboratory, and ambulatory care services. Their website has information about quality, making health care choices, and performance measurement. Performance reports on health care facilities can be accessed and downloaded.

Leap Frog Group - Comprised of more than 100 public and private organizations that provide health care benefits, The Leapfrog Group works with medical experts throughout the U.S. to identify problems and propose solutions that it believes will improve hospital systems that could break down and harm patients. Representing approximately 32 million health care consumers in all 50 states, Leapfrog provides information and solutions for consumers and health care providers.

Medicare.gov - Provides information about Medicare and the expanded health plan options with the creation Medicare+Choice. Information is available in English and Spanish.

National Committee for Quality Assurance - The National Committee for Quality Assurance is a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality everywhere.  NCQA is active in quality oversight and improvement initiatives at all levels of the health care system.

National Women's Health Information Center - This site includes a database and links to more than 1,000 federal agencies, publications and hundreds of government-screened private sector organizations related to women's health.

Pacific Business Group on Health - Provides practical information about how to use report cards and other indicators to select health plans and providers. It also has information on health services in general and health and wellness benefits.

State Children's Health Insurance Program (SCHIP) - From the Centers for Medicare & Medicaid Services.  SCHIP is designed to provide health insurance coverage to "targeted low-income children" of families that earn too much money to be eligible for Medicaid, but not enough money to purchase private insurance.

State Insurance Departments - Continue to regulate heath insurance issuers (e.g., insurance companies or HMOs) who sell group insurance to ERISA-covered group health plans, even under the Health Insurance Portability and Accountability Act (HIPAA), the Mental Health Parity Act, and the Newborns� and Mothers� Health Protection Act. In addition, States continue to have responsibilities in individual insurance market (e.g., selling individual insurance policies). The National Association of Insurance Commissioners has created access to state websites with information on particular state health insurance laws. You may also contact your state insurance commissioner for further information on particular state health insurance laws.

Veterans Administration - Sponsors a telemedicine healthcare site dedicated towards improving access, coordination, continuity and outcomes for healthcare for veterans. Through the use of this electronic information and support, consumers are able to overcome distance and time.