STATUS OF OUTSTANDING AFFORDABLE CARE ACT (ACA) REGULATIONS AND NCCMP COMMENTS
April 8, 2016
I. Group Health Plan Coverage Mandates
ACA Provision
1
Informal Guidance: Notices,
Bulletins, FAQs
Notice of Proposed Rulemaking
(NPRM)
Interim Final
Regulation
(IFR)
Final Regulation
Prohibition on Rescission
FAQs;1 Fact Sheet
75 FR 123,
37187 (TriAgencies,
6/28/2010)
Final Rules 80 FR
72192 November 18,
2015
Prohibition on
Pre-Ex Condition Exclusions
FAQs; Fact Sheet
75 FR 123,
37187 (TriAgencies,
6/28/2010)
Final Rules 80 FR
72192 November 18,
2015
Restricted Annual
Limits/Prohibition on Lifetime
Limits
FAQs; Annual Limit Waiver
Guidance, Applications and
Instructions (HHS); Model
Notices; Guidance on
Concluding Annual Waiver
Application; Email with
instructions re: how to file
Annual Limit Update by Dec.
2012 and Dec. 2013; FAQ XI on
standalone HRAs
Treasury Notice 2013-54;
Technical Release 2013-03 (913-13) clarified HRA rules
Notice 2015-87 provided
guidance on coverage of
spouses/dependents
75 FR 123,
37187 (TriAgencies,
6/28/2010)
Final Rules 80 FR
72192 November 18,
2015
Grandfathered Status
FAQs; Model Notice re:
Disclosure of Grandfather
Status; Fact Sheet
 75 FR 221, Final Rules 80 FR
70114 (Tri- 72192 November 18,
2015
Agencies,
11/17/2010)
(amendment
to IFR)
 75 FR 116,
34537 (TriAgencies,
6/17/2010)
NCCMP Comments
Comments to DOL, 8/27/2010 (re:
annual and lifetime limit rules, antirescission rule and payment for care
in emergency room)
Comments to DOL, 8/27/2010 (re:
annual and lifetime limit rules, antirescission rule and payment for care
in emergency room)
Comments to DOL, 8/16/2010
FAQs are available at http://www.dol.gov/ebsa/healthreform/
Prepared by The Segal Company April 8, 2016
1
ACA Provision
Informal Guidance: Notices,
Bulletins, FAQs
Age 26 Mandate
FAQs; IRS Notice 2010-38;
Model Notice; Fact Sheet
Preventive Care
(Non-grandfathered plans)
USPSTF and HRSA preventive
services lists; Technical
Guidance re: religious
organizations and contraception
coverage (dated 8/15/2012 and
2/10/2012); 75 FR 248, 81544
(Tri-Agencies 12/28/2010)
(Request for Information re:
Value Based Ins Design);
multiple FAQs
Prepared by The Segal Company April 8, 2016
Notice of Proposed Rulemaking
(NPRM)
Interim Final
Regulation
(IFR)
75 FR 92,
27121 (TriAgencies,
5/13/2010)
Final Regulation
Final Rules 80 FR
72192 November 18,
2015
NCCMP Comments
Comments to DOL, 8/11/2010
 78 FR 25, 8456 (Tri-Agencies,  76 FR 149,  77 FR 31, 8725 (Tri2/6/13)(religious org. and
46621 (TriAgencies, 2/15/2012)
contraceptive coverage)
Agencies,
(religious org. and
8/3/2011)
contraceptive
 77 Fed. Reg. 55, 16501
(Amendmen
coverage)
(Advanced NPRM) (Trit
to
IFR)
 Final Rule 78 FR
Agencies, 3/21/2012) (religious
org. and contraceptive
39870 (7/2/13)
coverage)
 Final Rules 80 FR
 75 FR 137,
72192 November 18,
41726 (Tri2015
Agencies,
7/19/2010)
2
ACA Provision
Informal Guidance: Notices,
Bulletins, FAQs
Notice of Proposed Rulemaking
(NPRM)
Interim Final
Regulation
(IFR)
Final Regulation
Claims and Appeals,
and External Review (Nongrandfathered plans)
DOL Technical Releases 201001, 2010-02, 2011-01 (with
Appendix re: states with
consumer assistance programs),
2011-02, 2013-01; Model
Documents; FAQs; Culturally
and Linguistically Appropriate
Services County Data; list of
state’s with approved external
review processes (there is
additional guidance related to
individual plans and public
sector plans that is not included
in this chart)
 76 FR 143, Final Rules 80 FR
44491 (Tri- 72192 November 18,
2015
Agencies,
7/26/2011)
(Correction
to
Amendment
)
 76 FR 122,
37208 (TriAgencies
6/24/2011)
(Amendmen
t to IFR)
 75 FR 141,
43329 (TriAgencies,
7/23/2010)
Patient Protections, includes
right to designate primary care
doctor, pediatrician, and right
to direct access for OB/GYN
services (Non-grandfathered
plans)
Patient Protection Model
Disclosure notice; Fact Sheet
75 FR 123,
37187 (TriAgencies,
6/28/2010)
Final Rules 80 FR
72192 November 18,
2015
Emergency Room Coverage
(Non-grandfathered plans)
FAQs; Fact Sheet
75 FR 123,
37187 (TriAgencies,
6/28/2010)
Final Rules 80 FR
72192 November 18,
2015
Non-grandfathered plan
mandates effective for plan
years beginning on or after
January 1, 2014 (Cost Sharing
Limitation (aka OOP Maximum),
Clinical Trial Coverage, Provider
Nondiscrimination )
FAQ XII re: limitation on out-ofpocket limits; modification of rule
for separate providers in 2014
FAQ XV states that clinical trial
rule and provider
nondiscrimination rule are selfimplementing
FAQ XVIII re: cost-sharing limits
after transition year
FAQ XIX and XXI re: reference
based pricing
FAQ XXVII Guidance on
embedded deductibles
Prepared by The Segal Company April 8, 2016
NCCMP Comments
Comments to DOL, 8/27/2010 (re:
annual and lifetime limit rules, antirescission rule and ER rule)
3
ACA Provision
Wellness Incentives Increased
to 30% (50% for tobacco use)
for plan years beginning on or
after January 1, 2014
Informal Guidance: Notices,
Bulletins, FAQs
FAQs; Fact Sheet; A Review of
US Workplace Wellness Market
(sponsored by DOL and HHS);
Excepted Benefits
Notice of Proposed Rulemaking
(NPRM)
Final Regulation
77 FR 227, 70620
(Tri-Agencies 11/26/2012)
EEOC Proposed Rules 80 FR
21659 April 20, 2015
78 FR 33158 (6/3/13)
78 FR 77632 (Tri-Agencies,
12/24/13) (dental, wrap)
80 FR 13995 March 18,
2015
Final rule permits
limited wraparound
coverage for part-time
workers and retirees for
a 3-year trial period
under certain
conditions. Rule also
provides for coverage
for full-time employees,
but employer penalty
would be applicable.
79 Fed. Reg. 76931 (TriAgencies, 12/23/14) (proposal on
wrap for part-time employees,
retirees, and multi-state plan
enrollees) Comments due
January 22, 2015
Excepted Benefits – Dental
Interim Final
Regulation
(IFR)
NCCMP Comments
Comments filed 2/24/14 on proposed
definition of excepted benefits that
would create a wrap-around benefit
that could be offered to individuals
who are also receiving federally
subsidized coverage in a QHP from
an exchange. Comments noted that
in its current form, proposed rule
would not be useable by most
multiemployer plans, and needed
substantial revision.
79 FR 59130 October 1, Under the final rule, dental and vision
2014 (Tri-Agency)
benefits are considered “limitedscope” benefits and are exempt from
many provisions of federal law if they
are either:
Separately insured; or
If self-insured, either: (1) participants
may decline coverage, including
through an opt-out process; or (2)
claims for the benefits are
administered under a contract
separate from claims administration
for any other benefits under the plan.
Prepared by The Segal Company April 8, 2016
4
ACA Provision
Early Retiree Reinsurance
Program
Informal Guidance: Notices,
Bulletins, FAQs
Application/reimbursement
materials and file uploads; Model
Notice; FAQs; Fact Sheet; HHS
Announcement re: Claims
Ineligible for Reimbursement
under ERRP (9/28/2010); CMS
Announcement re: Explanation
of Appeals Process for ERRP
(updated 3/27/2012); CMS
Announcement re: Explanation
of the Processes for Reporting
Early Retiree and Claims Data
Inaccuracies, and for Reopening
(updated 11/30/2012); CMS
Announcement re: Guidance on
Complying with the Maintenance
of Contribution Requirement
Associated with the Prohibition
on Using ERRP
Reimbursements as General
Revenue (Revised 2/27/2013)
Prepared by The Segal Company April 8, 2016
Notice of Proposed Rulemaking
(NPRM)
Interim Final
Regulation
(IFR)
75 FR 86,
24450 (HHS,
5/5/2010)
Final Regulation
NCCMP Comments
Comments to CMS/HHS, 6/4/2010
 77 FR 55, 16551
(3/21/2012) (Notice
re: Timeframe by
which plan sponsors
must use ERRP
Funds - by no later
than 12/31/2014
 76 FR 739, 77537
(12/13/2011) (Notice
re: CMS will deny
ERRP
reimbursement
requests with claims
incurred after
12/31/2011)
 76 FR 65, 18766
(4/5/2011) (Notice re:
CMS will stop
accepting
applications as of
5/5/2011)
5
II. Employer Shared Responsibility Penalty/90 Day Waiting Period Rule/Automatic Enrollment/Employer Notice
ACA Provision
Informal Guidance:
Notices, Bulletins,
FAQs
NPRM
IFR
Final
Employer Shared Responsibility  IRS Notice 2013-45
Penalty; Definition of Full Time
announced delay of
Employees; Measurement/
one year
Stability Period
 Q&A Dec 28, 2012
 IRS Notice 2012-58
 FAQs from
Employers re:
Automatic
Enrollment,
Employer Shared
Responsibility and
Waiting Period (IRS
Notice 2012-17;
DOL Technical
Release 2012-01;
HHS FAQs)
 IRS Notice 2011-73
 IRS Notice 2011-36
78 FR 1, 218 (IRS/Treasury, 1/2/13)
(preamble includes transition rule for
multiemployer plans)
Final Rule 79 FR 8544
(2/12/14)
Minimum Essential Coverage
78 FR 22, 7314 (IRS/Treasury, 2/1/13); 78
FR 22, 7348 (HHS, 2/1/2013)
79 FR 4302 (IRS/Treasury, 1/27/14)
78 FR 53646
(IRS/Treasury, 8/30/13);
78 FR 39494 (HHS,
7/1/13)
Minimum Value
(60% test)
IRS Notice 2012-31
77 FR 227, 70644 (HHS, 11/26/2012)
(4/26/2012); Minimum 78 FR 25909 (IRS/Treasury, 5/3/13)
Value Calculator (HHS,
2/20/2013); Minimum
Value Calculator
Methodology (HHS,
2/20/2013)
Notice 2014-69 Group
health plans that do not
provide substantial
coverage for inpatient
hospitalization services,
physician services or
both do not provide
minimum value
Prepared by The Segal Company April 8, 2016
NCCMP Comments
 Comments on proposed rule filed on
March 18, 2013.
 Outline of topics to be discussed at
public hearing scheduled for 4-23Final rule provides that
2013 were submitted 4-3-2013
contributing employers
satisfy their obligation
 Comments on IRS Notice 2012-58
for an employee by
on 9/30/2012
contributing to a

Comments to DOL, 4/9/2012
multiemployer plan
(comments in response to FAQs
(pursuant to a CBA or
from Employers re: Automatic
participation agreement)
Enrollment, Employer Shared
that provides minimum
Responsibility and Waiting Period)
value/affordable

Comments to IRS on Notice 2011coverage to participants
36, 6/17/2011
and dependents up to
age 26. Rule is
effective until further
guidance is issued.
78 FR 37, 12834 (HHS,
2/25/2013)
6
ACA Provision
Informal Guidance:
Notices, Bulletins,
FAQs
NPRM
IFR
Final
Affordability Test (9.5% of
household income for self-only
premium)
Notice 2015-87 on
 78 FR 1, 218 (IRS/Treasury 1/2/2013)
affordability testing for
(affordability safe harbors)
HRAs, wellness
 76 FR 159, 50931 (IRS/Treasury
incentives and opt outs
8/17/2011) (this is the NPRM for the
Health Insurance Premium Tax Credit)
 78 FR 22, 7264
(IRS/Treasury
2/1/2013)
(affordability for
related individuals)
 77 FR 100, 30380
(IRS/Treasury
5/23/2012)
 Final rule 79 FR
8544 (2/12/14)
(affordability safe
harbors)
90-Day Waiting Period
 FAQ XVI announced
multiemployer rule
 DOL Technical
Release 2012-02;
IRS Notice 2012-59:
HHS Guidance on
90-Day Waiting
Period Limitation
Under PHSA 2708
 FAQs from
Employers re:
Automatic
Enrollment,
Employer Shared
Responsibility and
Waiting Period (IRS
Notice 2012-17;
DOL Technical
Release 2012-01;
HHS FAQs
 IRS Notice 2011-36
79 FR 10296 (TriAgencies, 2/24/14)
Prepared by The Segal Company April 8, 2016
Proposed Rule 78 FR 55, 17313 (TriAgencies, 3/21/2013)
Proposed Rule 79 FR 10320 (2/24/14) (30day orientation periods)
NCCMP Comments
 Comments re: DOL Technical
Release 2012-02; IRS Notice 201259: HHS Guidance on 90-Day
Waiting Period Limitation Under
PHSA 2708 on 9/30/2012
 Comments to DOL, 4/9/2012
(comments in response to FAQs
from Employers re: Automatic
Enrollment, Employer Shared
Responsibility and Waiting Period)
 Comments to IRS on Notice 201136, 6/17/2011
 Comments on proposed rule filed
May 20, 2013
7
ACA Provision
Automatic Enrollment
Informal Guidance:
Notices, Bulletins,
FAQs
FAQs from Employers
re: Automatic
Enrollment, Employer
Shared Responsibility
and Waiting Period
(IRS Notice 2012-17;
DOL Technical Release
2012-01; HHS FAQs)
Employer Notice to employees FAQ Part XI, #1
about Exchange; required under (delayed March 2013
Fair Labor Standards Act § 18B date)
Technical Release
2013-02 - Guidance on
the notice, models, and
updated model election
notice under COBRA
FAQ XVI on notice and
multiemployer plans
FAQ on lack of financial
penalty:
http://www.dol.gov/ebsa
/faqs/faqnoticeofcoverageoption
s.html
Prepared by The Segal Company April 8, 2016
NPRM
IFR
Final
NCCMP Comments
Repealed by the
 Comments to DOL, 4/9/2012
Bipartisan Budget Act
(comments in response to FAQs
of 2015 (Public Law
from Employers re: Automatic
114-74)
Enrollment, Employer Shared
Responsibility and Waiting Period
and Notice 2012-17))
 Request to DOL, 3/18/2011 (request
to participate in Health Plan
Automatic Enrollment Forum)
FAQ XVI clarified concerns about
whether multiemployer plans could
assist employers with the notice, or
send it on behalf of the employer
Additional FAQ stated that there is no
financial penalty
8
III. Tax/Fee Assessments, and Medical Loss Ratio Rebates
ACA Provision
Informal Guidance: Notices,
Bulletins, FAQs
Comparative Effectiveness Fees
(also known as Patient Centered
Outcomes Research Institute
(PCORI) Fees)
Under FAQ issued 1/24/13 by DOL,
multiemployer plans may pay the
fees from plan assets.1
IRS PCORI Page at
http://www.irs.gov/uac/Newsroom/P
atient-Centered-OutcomesResearch-Institute-Fee
Standards Related
to Reinsurance,
Risk Corridors and
Risk Adjustment
(known as, Reinsurance Rules,
and includes Transitional
Reinsurance Fee Program)
 HHS Risk Adjustment Model
 76 FR 136, 41930 (HHS,
Algorithm Instructions (HHS,
7/15/2011)
1/15/2013); Technical Details on  77 FR 236, 73118 (HHS,
the Proposed HHS Risk
12/7/2012)
Adjustment Model (1/15/2013);

78 FR 72322 (HHS,
Bulletin on the Transitional
12/2/13)
Reinsurance Program Proposed
Payment Operations by HHS
(5/31/2012); Bulletin on the Risk
Adjustment Program: Proposed
Operations by HHS (5/1/2012);
Regulatory Impact Analysis
(CCIIO/HHS, March 2012);
Preliminary Regulatory Impact
Analysis (CCIIO/HHS, July 2011);
 Tax Treatment of Fee -- FAQs
http://www.irs.gov/uac/Newsroo
m/ACA-Section-1341Transitional-ReinsuranceProgram-FAQs
Deadline extended to December
5, 2014
Excise Tax on High Cost Health
Plans
Notice 2015-16 (2-23-15)
Notice 2015-52 (7-30-15)
1
NPRM
IFR
Final
NCCMP Comments
77 FR 235, 72721
 Comments filed requesting
(IRS/Treasury, 12/6/
guidance concerning whether a
2012)
multiemployer plan can use plan
assets to pay the fees; and how
Form 720 released, and
fees are paid when there are
first filings were made
multiple entities involved.
as of July 31, 2013
77 FR 74, 22691
(IRS/Treasury, 4/17/2012)
78 FR 47,
15541 (HHS,
3/11/2013)
 77 FR 57, 17220
(HHS, 3/23/2012)
 78 FR 47, 15410
(HHS 3/11/2013)
 79 FR 13744 (HHS,
3/11/14)
 80 FR 10750 (HHS
February 27, 2015)
Final rule exempts
self-insured selfadministered plans
for 2015 and 2016
only
 Comments to CMS/HHS,
10/31/2011 (re: new reinsurance
rules)
 Comments to both proposed and
final regulations sought
clarification that reinsurance fees
for individual market do not apply
to self-insured and selfadministered multiemployer plans
 Comments on Notice of Payment
Parameters filed December 30,
2012
 Comments filed July 19, 2013 on
reinsurance rule
 Comments filed December 26,
2013 concerning self-insured, selfadministered plans
Consolidated
Appropriations Act of
2015 (PL 114-113)
delayed tax until 2020
and made tax
deductible
Comments to Senate Finance
Committee May 2009
Comments filed on both Notice 201516 and Notice 2015-52
NCCMP has been participating in
meetings with the Administration on
the excise tax
A voluntary employees’ beneficiary association (VEBA) that provides retiree-only health benefits may also pay the fee from plan assets, where the plan sponsor is a trustee
or board of trustees that has no source of funding other than plan assets. However, if the plan sponsor is an employer sponsoring a single employer plan or an association of
employers that act as a plan sponsor, the plan sponsor may not use plan assets to pay the fee — even if the plan uses a VEBA trust to provide benefits.
Prepared by The Segal Company April 8, 2016
9
ACA Provision
Informal Guidance: Notices,
Bulletins, FAQs
Medical Loss Ratio
Requirements
(Guidance specific to non-federal
governmental plans is not
included)
DOL Technical Release 2011-4
(12/2/2011) (Guidance on Rebates):
FAQs (IRS, DOL and CCIIO); CCIIO
Regulatory Impact Analysis and
Technical Appendix (11/22/2010);
CCIIO Technical Guidance (series
that dates from 12/17/20107/17/2012); Memos to Insurance
Companies (March 30, 2012, May
15, 2012, March 29, 2013)
Small Business
Tax Credit
 Forms and Step-by-Step
Instructions: Form 8941, Credit
for Small Employer Health
Insurance Premiums and
Instructions for Form 8941
 IRS Website: “Small Business
Health Care Tax Credit for Small
Employers:”
http://www.irs.gov/uac/SmallBusiness-Health-Care-TaxCredit-for-Small-Employers
 Notices 2010-44 and 2010-82.
Health Insurance Provider Tax
(Section 9010)
Prepared by The Segal Company April 8, 2016
NPRM
IFR
Final
 77 FR 95,
 77 FR 95, 28790
28788
(HHS, 5/16/2012)
(HHS,
5/16/2012)  76 FR 235, 76573
(Technical
(HHS, 12/7/2011)
Corrections
(revising rules re:
Amendment
distribution of
)
rebates, and
 75 FR 250,
addressing other
82277
items)
(HHS,
12/30/2010)
(Correction,
Req for
Comments)
 75 FR 230,
74864
(HHS,
12/1/2010)
78 FR 52719 (8/26/13)
78 FR 42,14034 (IRS/Treas,
3/4/2013)
NCCMP Comments
Comments to CCIIO/HHS, 1/31/2011
This row may not be complete
because HHS issues ongoing
guidance to insurers on MLR
calculation, but ongoing guidance is
not relevant to how ERISA plans
receive MLR payments
NCCMP has requested that small
employers that contribute to
multiemployer plans in 2014 be
eligible for the small business tax
credit
78 FR 71476
(IRS/Treasury,
11/29/13)
Consolidated
Appropriations Act of
2015 (PL 114-113)
suspended tax for
2017
Comments filed June 3, 2013, and
testimony June 23, 2013
NCCMP recommended that final
regulations except VEBAs and selfinsured multiemployer plans from fee
Final regulations adopted NCCMP
suggestions
10
IV. Reporting and Disclosure Requirements
ACA Provision
Informal Guidance: Notices,
Bulletins, FAQs
NPRM
Summary of Benefits and
Template, Instructions, and Related 76 FR 162, 52442 (TriCoverage and Uniform Glossary Materials; Coverage Examples
Agencies, 8/22/2011)
(SBC)
Information (including Calculator);
Culturally and Linguistically
Appropriate Services County Data;
FAQs; Uniform Glossary;
Updated model and additional FAQs
for 2014
FAQ 30 (March 11, 2016) Plan
sponsors that have an annual open
enrollment period would be required
to use a new SBC template
beginning on the first day of the first
open enrollment period that begins
on or after April 1, 2017 (for
coverage beginning on or after that
date).
W-2 Reporting
Information Reporting
on Health Insurance Coverage
(purpose is to verify whether
individual has “minimum essential
coverage;” §§ 6055 (plan
reporting), 6056 (employer
reporting))
IFR
Final
 77 FR 30, 8668 (Tri- Comments to DOL, 10/21/2011
Agencies, 2/14/2012)
 77 FR 30, 8706 (TriAgencies 2/14/2012)
(Compliance
Guidance)
 80 FR 34292 (June
16, 2015)
]
IRS Notice 2012-9; IRS Notice 201128 (superseded by Notice 2012-9);
IR-2011-31; IRS Notice 2010-69;
Form W-2 Reporting of Employer
Sponsored Health Coverage
webpage:
http://www.irs.gov/uac/Form-W-2Reporting-of-Employer-SponsoredHealth-Coverage; IRS Q&As
Comments to IRS, 7/18/2011
(comments on Notice 2011-28)
Employers that contribute to
multiemployer plans are temporarily
exempt from the W-2 requirement for
plan participants. Further guidance
regarding how this requirement will
apply to multiemployer plans is
expected.
IRS Notice 2012-32 (request for
Plan reporting under § 6055
comments), and IRS Notice 2012-33 78 FR 54986 (9/9/13)
(request for comments)
IRS Notice 2013-45 announced
delay of one year
Notice 2015-68 addressed SSN
reporting
Prepared by The Segal Company April 8, 2016
NCCMP Comments
Employer reporting under §
6056 78 FR 54996 (9/9/13)
Final rule on plan
reporting 79 FR 13220
(3/10/14)
Final rule on employer
reporting 79 FR 13231
(3/10/14)
Final forms and
Instructions published
September 16, 2015
NCCMP has previously requested
guidance on how employer reporting
rules apply when there is a
multiemployer plan providing
coverage
Comments on NPRM filed November
8, 2013; public hearing November
18, 2103
NCCMP has requested meeting with
IRS/Treasury on information
reporting requirements
The final instructions confirm how
contributing employers should
complete the Form 1095-C, so that
data is not required from the plan.
However, the rule is only applicable
for 2015 reporting, so further
guidance is necessary
11
Verification of EmployerSponsored Coverage
(for purpose of Premium Tax
Credit Eligibility, ACA §1411)
Verification of Access to EmployerSponsored Coverage Bulletin
(CCIIO) (4/26/2012)
There are additional HHS
rules not included here
Quality Reporting (applies to
non-gf plans; reporting relates to
improved health outcomes, patient
safety and wellness, etc)
Transparency in Coverage
(applies to non-gf plans; reporting
relates to claims information,
financial disclosures, enrollment
data)
FAQ XV (reporting will not be
required before 2015)
HIPAA EDI Certification
Prepared by The Segal Company April 8, 2016
179 Fed. Reg. 298 (January 2,
2014).
Certification was initially
required by 12-31-13, but
HHS delayed certification until
guidance is issued
April 3, 2014 NCCMP comments
requesting EDI certification
requirements be reasonable and not
administratively burdensome
12
V. Exchanges
ACA Provision
Informal Guidance: Notices,
Bulletins, FAQs
NPRM
IFR
Final
Establishment of Exchanges
 Establishment of Exchanges and
 78 FR 47, 15553 (HHS,
and QHPs; Exchange
Qualified Health Plans, Exchange
3/11/2013) (amends
Standards for Employers
Standards for Employers, and
enrollment rules and
Standards Related to Reinsurance,
implements transition rule
(includes provisions re: Individual
Risk Corridors and Risk
re: SHOP)
Exchanges and SHOP
Adjustment, Regulatory Impact
Exchanges)
 76 FR 159, 51202 (HHS,
Analysis (CCIIO, March 2012)
8/17/2011) (Exchange
(We did not include the guidance

HHS
FAQs
Functions in Ind Mkt;
that relates only to how States
Eligibility Determinations;

Guidance
unique
to
QHPs
is
not
should set up their Exchanges, or
Exchange Standards for
included here
to Medicaid)
Employers)
 76 FR 136, 41866 (HHS,
7/15/2011) (Exchanges
and QHPs)
 77 FR 103, 31513
(HHS, 5/29/2012)
(Final Rule:
Correction)
Exchange market rules,
premium rules for QHPs
Guidance unique to QHPs is not
included here
78 FR 13406 (HHS,
2/27/2013)
Valuation of Exchange Plans
Actuarial Value and Cost-Sharing
Reductions Bulletin (2/24/2012);
Actuarial Value Calculator and related
Methodology
Premium Assistance
Tax Credit
77 FR 70584 (HHS,
11/26/2012)
Comments to HHS, 10/4/2010
 77 FR 59, 18310
(HHS, 3/27/2012)
(Final Rule, IFR)
76 FR 159, 50931
(IRS/Treasury, 8/17/2011)
 78 FR 22, 7264
(IRS/Treasury,
2/1/2013)
(Affordability for
related individuals)
 77 FR 100, 30377
(IRS/Treasury,
5/23/2012)
78 FR 22, 7348
(IRS/Treasury, 2/1/2013)
79 FR 4302 (IRS/Treasury,
1/27/14)
78 FR 53646 (8/30/13)
Q&A January 30, 2013
Notice 2013-42 on transition relief
Essential Health Benefits
Essential Health Benefits Bulletin
77 FR 227, 70644 (HHS,
(CCIIO, 12/16/2011); FAQs
11/26/2012)
(2/17/2012); List of Largest 3 Small
Group Products by State (7/3/2012);
Additional Information on EHB
Benchmark Plans:
http://cciio.cms.gov/resources/data/eh
b.html
Prepared by The Segal Company April 8, 2016
Comments to CMS/HHS, 10/31/2011
78 FR 37, 12834 (HHS
2/25/2013)
Individual Mandate
Certified Application Assisters
NCCMP Comments
78 FR 14, 4594 (HHS,
Comments to CMS/HHS, 10/31/2011
78 FR 37, 12834 (HHS
2/25/2013)
Comments filed February 21, 2013
13
1/22/2013) (related to
Certified Application
Counselors at 45 CFR §
155.225, and
Authorized
Representatives at 45 CFR
§ 155.227)
Navigators
Additional rules on navigators not
included here
 78 FR 66, 20581 (HHS,
4/5/2013)
8355265v1/01666.001
Prepared by The Segal Company April 8, 2016
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