H.R. 9798: Employer Health Plan Flexibility Act

This bill would change federal health plan rules so that certain employer-sponsored group health plans covered by ERISA would no longer have to include the Affordable Care Act’s Essential Health Benefits just because of federal law.

What would change

• It would exempt qualifying employer-sponsored group health plans from the ACA requirement to cover Essential Health Benefits.
• It would also amend the Public Health Service Act so that this specific Essential Health Benefits requirement would not apply to employer-sponsored group health plans governed by ERISA.
• Federal agencies, including the Department of Health and Human Services, would have to update regulations to reflect this exemption.

What would still apply

The bill says it would not remove several other federal rules that already apply to these plans. These include:

• HIPAA portability and nondiscrimination rules
• mental health and addiction parity requirements
• COBRA continuation coverage rules
• ERISA fiduciary duties
• tax code rules for employer health plans
• federal nondiscrimination requirements
• preventive services requirements, unless another law changes them

Notice requirements

Employers using the exemption would have to send plan participants an annual notice that includes:

• a description of the benefits the plan does cover
• which Essential Health Benefits are not covered
• information about cost-sharing
• instructions for getting the Summary Plan Description

Other provisions

• Employers would still be allowed to voluntarily provide some or all Essential Health Benefits.
• The bill says it would not change ERISA preemption rules.
• It would not change state regulation of health insurance issuers except where the bill specifically says otherwise.

Effective date

The changes would apply to plan years beginning on or after January 1, 2028.

Relevant Companies

None found