Public Employee Plans

Although the law is very wide in its scope, the Affordable Care Act (ACA) affects some types of plans and plan sponsors differently than other types. Public employee plans have a few unique issues.



Government Resources

  • HIPAA Opt-Out Elections for Self-Funded, Non-Federal Governmental Plans, CMS, 6/1/2017 Table lists plan sponsors with active HIPAA exemption elections for at least one category: Standards relating to benefits for mothers and newborns, mental health parity, required coverage for reconstructive surgery following mastectomies and coverage of dependent students on medically necessary leave of absence

  • Affordable Care Act (ACA) Information for Government Entities, IRS, 3/24/2017 Guidance for state and local governmental plans on complying with and reporting for the Affordable Care Act

  • Market Reforms (ACA & HIPAA) Grandfathered Plan Provisions, HHS, 7/12/2016 Checklist for self-funded, non-federal governmental group health plans

  • Exchange and Insurance Market Standards for 2015 and Beyond, CMS, HHS, 5/27/2014 Final rule on general terms and conditions necessary for a self-funded, non-federal governmental plan sponsor to make a HIPAA opt-out election. Plans sponsors such as state and local governments, except to the extent that the special rule for collectively bargained plans still applies, cannot opt out of HIPAA�s limitation on pre-existing condition limitations, requirements for special enrollment periods, or the prohibitions on discriminating against individuals based on health status. CMS will replace the mailing address for submitting HIPAA opt-out documents and that opt-out elections must be submitted in an electronic format. Hard copy elections will not be accepted after December 31, 2014.