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

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 or grandmothered plan; short-term, limited duration insurance; an association health plan; or a policy though a health care sharing ministry—these arrangements are exempt from some or all of the ACA requirements for health plans. See ACA Protections for Private Coverage and the Coverage Outside the Marketplace section of the Navigator Resource Guide for more information on how the Affordable Care Act's insurance rules apply to different plans. (45 C.F.R. §§ 156.122, 156.155.)

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Post enrollment issues