Benefits updates for 2025 in compliance with the ACA Section 1557 final rule

October 22, 2024

Section 1557 of the Affordable Care Act (ACA) prohibits discrimination based on race, color, national origin, sex, age or disability. The Department of Health and Human Services (HHS) final rule regarding Section 1557, issued May 6, 2024, updated the definition of discrimination on the basis of sex to include sex characteristics including intersex traits, pregnancy or related conditions, sexual orientation, gender identity and sex stereotypes. The rule also includes new provisions prohibiting discrimination based on association or marital, parental or family status.

All our standard plan and benefit designs comply with existing Section 1557 rules. For 2025, we’re implementing the following updates to comply with the Section 1557 final rule, which takes effect beginning with Jan. 1, 2025, new and renewal effective dates. Some updates will specifically affect our nonmarketed Transitional plans in Idaho and Utah.

• Removal of age limits on general dental anesthesia, hearing aids, neurodevelopmental therapy and orthodontia from all applicable products in Idaho, Oregon, Utah and Washington

• Removal of age limits on acne medication and congenital anomalies in Idaho and Utah
• Removal of maternity coverage based on subscriber or spouse only (Idaho HSA products)
• Removal of optional maternity coverage that excluded dependent daughter maternity (Idaho Innova products)

• Addition of adoption coverage, if maternity is covered (Utah)
• Addition of maternity coverage (Idaho Evolve HSA products and Utah Evolve HSA and RealValue products)
• Removal of age limits on congenital anomalies (Idaho and Utah)
• Removal of separate maternity deductible option (Idaho Evolve Core and Evolve Plus products and Utah Evolve Core and Evolve Core 2.0 products)

We’re informing members about these changes through Summary of Change (SOC) documents and benefit booklets.

While our standard benefit designs comply with all ACA requirements, ASO groups can retain any customizations that deviate from the Section 1557 final rule. Groups wishing to retain these customizations must direct us to administer their benefits in a way that varies from the Section 1557 final rule. Groups’ account representatives will provide guidance for documenting these directives. We must receive all benefits decisions for groups with Jan. 1, 2025, effective dates by Nov. 15, 2024.

Section 1557 also requires us to update our nondiscrimination notices and taglines to include the availability of language assistance; accessibility for those with vision, hearing and other disabilities; nondiscrimination in access to care and services, including telehealth and decision support tools; and clarification that discrimination based on sex includes gender identity and pregnancy or related conditions. The updated nondiscrimination notice will be disclosed on regence.com and included with applicable communications to members beginning in November.

Questions? Please contact your account representative.