Health Care Regulations Issued

The IRS and Treasury Department issued proposed regulations (TD 9491, REG-120399-10) Tuesday implementing rules for health care insurance coverage and group health plans under the Patient Protection and Affordable Care Act (PL 111-148) and the Health Care and Education Reconciliation Act (PL 111-152). The text of the proposed regulations is substantially similar to that of interim final regulations issued simultaneously by the departments of Health and Human Services and Labor.


The regulations provide guidance regarding the new law’s provisions prohibiting or restricting insurance exclusions for pre-existing conditions, lifetime and annual dollar limits on benefits, rescissions and patient protections. The interim final rules generally apply to group health plans and group health insurance issuers for plan years beginning on or after Sept. 23, 2010. The regulations came a little more than a week after the three federal departments issued regulations concerning health plans grandfathered under the health care legislation (TD 9489).


The latest interim final regulations require that group health plans and group health insurance issuers notify individuals otherwise eligible for coverage who have previously reached a lifetime limit that the lifetime limit no longer applies and of the right to enroll in the coverage. They also generally prohibit rescissions of coverage but require in any allowed rescission that an insurer notify any individual 30 days before a rescission. They also prescribe how plans or health insurance coverage that require covered individuals to designate a primary care provider must notify such individuals of their rights to choose any primary care provider in the plan’s network who is available to accept the individual, to designate a pediatrician in the network for a child, and to obtain obstetrical and gynecological services without a referral.


The Treasury Department regulations amend existing regulations and add new sections under part 54 (miscellaneous excise tax regulations) under the authority of IRC § 9815, which generally incorporates by reference the health care legislation’s provisions relating to group health plans and insurers.


Comments on the proposed Treasury regulations are due within 60 days after their publication in the Federal Register. They may be submitted electronically via the federal eRulemaking Portal at or by mail to CC:PA:LPD:PR (REG-120399-10), Room 5205, IRS, P.O. Box 7604, Ben Franklin Station, Washington, DC 20044.

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