The U.S. Capitol rotunda. Photo: Diego M. Radzinschi/ALM
Congress has imposed at least 47 major laws that affect private health insurance, and at least 46 of the laws apply to at least some employer-sponsored health plans.
At least 42 apply to employers' self-insured health plans.
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Analysts at the Congressional Research Service have published a chart listing the laws in a new report on federal requirements for private health insurance plans.
The Congressional Research Service is an arm of Congress that provides background information that members of Congress and aides can use to handle their jobs.
Lawmakers are now drafting major tax policy legislation. The new report does not mention health insurance tax or arrangements such as health savings accounts. But, if policymakers want to change the federal employee health benefits income tax exclusion or find ways to simplify federal health benefits laws, they could start with the new federal health insurance requirements report.
Related: Cap on employer health tax exclusion? New House bill coming soon
The analysts who wrote the report did not provide any recommendations. They simply provided brief summaries of federal provisions and came up with a framework for organizing the summaries.
They provided separate columns for individual coverage; fully insured small-group and large-group coverage; and employers' self-insured health plans.
They put the requirements under the following headings:
Obtaining coverage.
◆ Keeping coverage.
◆ Health insurance premiums.
◆ Covered benefits.
◆ Enrollee cost-sharing and plan payment for benefits.
◆ Health care provider interactions.
◆ Enrollee information and appeals.
◆ Federal and public reporting requirements.
The analysts assume that readers may start with little understanding of how the U.S. health insurance market works, such as the fact that the rules for individual coverage and employer-sponsored coverage are different.
"Federal requirements do not apply uniformly to all types of health plans," the analysts note at one point in an introductory section. "For example, plans offered in the nongroup and small-group markets must comply with the federal requirement to cover the essential health benefits... however, plans offered in the large-group market and self-insured plans do not have to comply with this requirement."
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