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Public Health Service Act (PHSA)
Practical Law Glossary Item w-001-2359 (Approx. 4 pages)
Glossary
Public Health Service Act (PHSA)
A federal law that, in the employee benefits context, includes requirements applicable to certain health plans including—subject to an opt-out provision—nonfederal, governmental health plans (42 U.S.C. Ch. 6A, Subchapter XXVII). In 1996, Title XXVII of the PHSA was added by the Health Insurance Portability and Accountability Act (HIPAA), and frequently amended after that to reflect additional provisions (for example, the Women's Health and Cancer Rights Act of 1998 (WHCRA)).
In March 2010, the Patient Protection and Affordable Care Act (PPACA), as amended by the Health Care and Education Reconciliation Act of 2010 (HCERA) (collectively, the Affordable Care Act (ACA)), made significant changes to the requirements under PHSA Title XXVII. Those changes also were incorporated into the Employee Retirement Income Security Act of 1974 (ERISA) (29 U.S.C. § 1185d) and Internal Revenue Code (Code) (26 U.S.C. § 9815(a)(1)) so that the PHSA amendments extended to:
- Private sector group health plans.
- Health insurers providing health insurance coverage in connection with group health plans.
- Health plans and insurers in the individual market.
Specifically, PHSA Sections 2701 through 2728, as amended and renumbered under the ACA, were incorporated by reference into ERISA and the Code. These sections include numerous ACA provisions, for example:
- Coverage of preventive health services (PHSA § 2713; 42 U.S.C. § 300gg-13) (see Practice Notes, Preventive Health Services Under the ACA, Other Than Contraceptives and Contraceptives Coverage Under the ACA).
- Summaries of benefits and coverage (PHSA § 2715; 42 U.S.C. § 300gg-15) (see Practice Note, Summaries of Benefits and Coverage Under the ACA).
- Nondiscrimination requirements for insured health plans (PHSA § 2716; 42 U.S.C. § 300gg-16) (see Practice Note, Nondiscrimination Requirements for Insured Health Plans Under the ACA).
- Internal claims and appeals, and external review (PHSA § 2719; 42 U.S.C. § 300gg-19) (see Practice Notes, Internal Claims and Appeals Under the ACA and External Review Under the ACA).
PHSA Sections 2701 through 2719A are substantially new, though they incorporate some provisions of pre-ACA law. PHSA Sections 2722 through 2728 are sections of prior law renumbered, with mostly minor changes. For more information regarding the various PHSA provisions, as reorganized, amended, and updated under the ACA, see Practice Note, Grandfathered Health Plans Under the ACA: Applicability of ACA Rules to Grandfathered Plans.
More recently, federal spending legislation enacted in December 2020—the Consolidated Appropriations Act, 2021 (CAA-21)—amended the PHSA (and the Code and ERISA) to add numerous provisions applicable to group health plans and health insurers (Pub. L. No. 116-260 (2020)). These requirements include extensive rules to prevent surprise medical billing (see Legal Update, Year-End COVID-19 Stimulus Legislation Includes Numerous Employee Benefit and Executive Compensation Provisions, Including Surprise Medical Billing Requirements for Health Plans).