General News

ACA Section 1557

General News|Aug 27, 2019

Section 1557 of the Affordable Care Act provides that an individual cannot, on the basis of race, color, national origin, sex, age, or disability, be excluded from participation in, be denied the benefits of, or otherwise be subjected to discrimination under any covered health program or activity.

Covered Health Programs & Activities

Section 1557 covers:

  • Any health program or activity, any part of which receives federal financial assistance (such as hospitals that accept Medicare or doctors who accept Medicaid);
  • Any health program that the U.S. Department of Health and Human Services itself administers; and
  • Health Insurance Marketplaces and issuers that participate in those Marketplaces.

Limited Applicability to Employer-Sponsored Health Benefit Programs

Employers will be held accountable under Section 1557 for discrimination in the employee health benefit programs they provide in three circumstances:

  1. The employer receives federal financial assistance and is principally engaged in providing or administering health services, health insurance, or other health coverage;
  2. The employer receives federal financial assistance a primary purpose of which is to fund the entity’s employee health benefit program; or  
  3. The employer is not principally engaged in providing or administering health services, health insurance, or other health coverage, but operates a health program or activity, which is not an employee health benefit program, that receives federal financial assistance (in this case, the employer is liable only with respect to employees in that health program or activity).

For example, a hospital that provides health benefits to its employees is covered by Section 1557 in the health benefits it provides to all employees, including employees who work in the cafeteria, because the hospital is principally engaged in providing health services. By contrast, where a housing program receives federal financial assistance to operate a diabetes-screening program for housing residents, but is not principally engaged in providing health services or coverage, its employee health benefits are covered by Section 1557 only with respect to the employees of the diabetes-screening program.

Note: Section 1557 does not apply to employment practices such as hiring and firing; however, an employer may be subject to other employment discrimination laws.

Notice & Tagline Requirements

Covered entities are required to post notices of nondiscrimination and taglines that alert individuals with limited English proficiency to the availability of language assistance services.

The U.S. Department of Health and Human Services’s Office of Civil Rights has translated a sample notice and taglines for use by covered entities into 64 languages—click here to access.

Notices and taglines are generally required to be posted in:

  • Significant publications and significant communications targeted to beneficiaries, enrollees, applicants, and members of the public;
  • Conspicuous physical locations where the entity interacts with the public; and
  • A conspicuous location on the covered entity’s web site accessible from the home page of the site.

Penalties

The enforcement mechanisms available for employment discrimination under existing federal laws also apply for purposes of section 1557. Click here for a list of remedies where discrimination is found under these laws (refer to section XIII). Compensatory damages for violations of section 1557 are also available in appropriate administrative and judicial actions.

Additional Resources

Published by

Jessica Cheney

Jessica Cheney

Jessica Cheney is the Vice President of Benefits for Arcwood Consulting. She is responsible for overseeing all aspects of our clients from quoting, onboarding, renewal, compliance and ensuring we are meeting and exceeding our client and company goals. Her vast knowledge of the industry and employers allows her to oversee the processes and ensure our clients’ needs are met. Jessica began her career in 1993 at BlueCross and BlueShield of Arizona and then joined Black Gould and Associates, a large general agency where she worked with carriers, agents and clients implementing and servicing large employers. Jessica joined Arcwood in 2005. In addition to holding her Accident/Health and Life Producer license she has the REBC (Registered Employee Benefits Consultant) designation and certifications in HIPAA (Privacy and Security), Benefits Account Management, Patient Protection and Affordable Care Act (PPACA), Self-Funding, Voluntary Worksite and Wellness. Jessica also serves as President on the board of the Greater Phoenix Association of Health Underwriters (GPAHU). Personally, Jessica, being an Arizona native enjoys outdoor activities such as hiking, biking, camping and attending sporting events with her family.