EGWP Coverage Must Be Wary of Discrimination Under ACA

Coverage for EGWP Retirees Need to Consider Transgender Retirees

EGWP Coverage for transgender retirees should be considered by health plans and employers.Egg Whips (Employer Group Waiver Plans) that have transgender retirees must ensure that they provide EGWP coverage under the Affordable Care Act according to a new post by Snell & Wilmer’s Matthew Chiarello.

Because EGWP coverage can satisfy both requirements of the nondiscrimination rule under the ACA the plans must consider that they can exclude transgender retirees from the program.  Under the ACA final discrimination rule if either of the following conditions (below) exist for a group health plan or employer receiving federal financial assistance (FFA) from the Department of Health and Human Services (HHS) they are subject to the nondiscrimination rule:

1) A group health plan receiving federal financial assistance
2) An employer that receives both FFA and provides employee health benefit programs

The 2nd condition can extend to both self-insured or insured plans.  It also includes wellness programs, clinics, adult care or insurance.  For more comprehensive article on compliance with updated ACA legal requirements from Segal Consulting, click here.

Basically, if and employer or health plan is providing any health or prescription benefit they need to be aware of the nondiscrimination rule and ensure they are applying benefits equally across all retiree EGWP coverage.

Snell & Wilmer nondiscrimination rule EGWP coverage landscape under the ACA

Snell & Wilmer also lay out many benefits of providing transgender benefits on their March blog posts.

The transgender rule under ACA is administered by the Office of Civil Rights.  The office even has a publicly available sample form to use to notify retirees under EGWP coverage about their rights under the nondiscrimination rule.

For more from Snell & Wilmer’s coverage, click here.

If you are an insurance broker looking for additional services to offer your corporate, municipal, union and government clients, consider Employer group Waiver Plans, see more how brokers can work with our team of EGWP plan experts.