New Requirements for Self-Funded Group Health Plans

December 28, 2011

Employers Sponsoring a Self-Funded Group Health Plan Face New Requirements

Non federal governmental employers who sponsor a self-funded group health plan may no longer opt out of certain requirements under Title XXVII of the Public Health Service (PHS) Act. Prior to enactment of the Affordable Care Act (ACA), sponsors were able to exempt their plans from a total of seven (7) requirement categories.  The following three (3) categories no longer qualify for sponsor exemption:

self funded insurance requirements
    1. Limitations on pre-existing condition exclusion periods
    2. Requirements for special enrollment periods

    3. Prohibitions against discriminating against individual participants and beneficiaries based on health status (but not including provisions added by the Genetic Information Nondiscrimination Act of 2008)

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