QUESTION

I thought prescription drugs were supposed to be covered in all plans, but my plan doesn’t include them. Is that allowed?

Post enrollment issues | Employer-Sponsored Coverage
ANSWER

All new plans sold to small employers must offer essential health benefits, which includes prescription drugs. However, large and self-insured employer group plans do not have to comply with this requirement. It’s also possible your plan is a grandfathered/grandmothered, short-term limited duration insurance, an association health plan, or policy though a Health Care Sharing Ministry, and therefore exempt from some or all of the ACA requirements for health plans. See Resources, ACA Protections for Private Coverage and Alternative Coverage section for more information on how the Affordable Care Act's insurance rules apply to different plans. (45 C.F.R. § 156.155; 45 C.F.R. § 156.122).

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