['Employee Benefits']
['Patient Protection and Affordable Care Act']
10/01/2024
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(a) Definitions. The following definitions apply to this section, unless the context indicates otherwise:
Health benefits means benefits for medical care, as defined at §144.103 of this subchapter, which may be delivered through the purchase of insurance or otherwise.
Health plan has the meaning given to the term “Portal Plan” in §159.110 of this subchapter.
State has the meaning given to that term in §155.20 of this subchapter.
Treatment limitations include limits on benefits based on the frequency of treatment, number of visits, days of coverage, or other similar limits on the scope or duration of treatment. Treatment limitations include only quantitative treatment limitations. A permanent exclusion of all benefits for a particular condition or disorder is not a treatment limitation.
(b) Reporting requirement. A State that selects a base-benchmark plan or an issuer that offers a default base-benchmark plan in accordance with §156.100 must submit to HHS the following information in a form and manner, and by a date, determined by HHS:
(1) Administrative data necessary to identify the health plan;
(2) Data and descriptive information for each plan on the following items:
(i) All health benefits in the plan;
(ii) Treatment limitations;
(iii) Drug coverage; and
(iv) Exclusions.
[80 FR 10871, Feb. 27, 2015]
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