Form Hhs-699 - Discrimination Complaint - Department Of Health And Human Services - Office For Civil Rights (Ocr) Page 6
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13imposed annual and lifetime caps on benefits, which disproportionately affected people living
with HIV. The ACA was designed, in part, to put an end to these discriminatory practices. The
ACA requires guaranteed issue of coverage in the individual and small group health insurance
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markets so that no one can be denied health insurance due to a preexisting condition.
Health
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insurers may no longer exclude coverage of a preexisting condition.
The ACA further prohibits
discrimination against individual participants and beneficiaries based on health status or medical
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condition,
and it prevents insurers from imposing annual or lifetime limits on benefits.
The ACA contains additional provisions barring discriminatory plan benefit design, establishing
that a Qualified Health Plan may "not employ marketing practices or benefit designs that have the
effect of discouraging the enrollment in such plan by individuals with significant health
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needs."
ACA regulations prohibit discrimination on the basis of on race, color, national origin,
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disability, age, sex, gender identity, or sexual orientation.
The ACA requires all QHPs to provide prescription drug coverage as an essential health benefit
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(EHB).
Under HHS regulations, health plans that provide EHBs "must cover at least the greater
of (1) one drug in every United States Pharmacopeial Convention (USP) category and class or (2)
the same number of prescription drugs in each USP category and class as the state's EHB -
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benchmark plan."
A QHP fails to meet the essential health benefits standard and can be
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decertified if the insurer employs a discriminatory benefits design.
1. Section 1557 Protections
Most significantly, the ACA applies several existing federal anti-discrimination and civil rights
statutes, including the Rehabilitation Act, to the QHPs offered through the health insurance
Marketplaces. Prior to the ACA, private health insurance plans were not subject to the
Rehabilitation Act, which prohibits discrimination in federal programs against persons living with
disabilities, including HIV and AIDS. Under the ACA's Section 1557, the Rehabilitation Act now
expressly applies to the "contracts of insurance" available in the Marketplaces:
An individual shall not, on the ground prohibited under title VI of the Civil Rights
Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the Education Amendments of
1972 (20 U.S.C. 1681 et seq.), the Age Discrimination Act of 1975 (42 U.S.C.
6101 et seq.), or section 794 of title 29 [the Rehabilitation Act], be excluded from
participation in, be denied the benefits of, or be subjected to discrimination under,
any health program or activity, any part of which is receiving Federal financial
assistance, including credits, subsidies, or contracts of insurance, or under any
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42 U.S.C. § 300gg-1.
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Id.
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42 U.S.C. § 300gg-4.
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42 U.S.C. § 300gg-11.
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42 U.S.C. § 18031 (c)(1)(a)( emphasis added); see also 45 C.F.R. §156.225(b).
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45 C.F.R. § 156.200(e).
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42 U.S.C. § 18022.
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45 C.F.R. § 156.122.
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45 C.F.R. § 156.125(a).
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