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 or grandmothered plan and therefore exempt. See Resources, ACA Protections for Private Coverage 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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