The regulatory landscape around the Affordable Care Act is never entirely static, and 2027 is bringing changes that employers and HR leaders should be aware of well before they take effect. The U.S. Department of Health and Human Services recently issued the 2027 Notice of Benefit and Payment Parameters Final Rule, which makes notable adjustments to essential health benefit requirements, Marketplace eligibility verification, and premium tax credit procedures.
Some of these changes will be handled primarily by carriers for employers on fully insured plans. Others carry direct implications for employers who sponsor self-funded plans, offer ICHRAs or QSEHRAs, or have employees purchasing individual market coverage. And regardless of plan type, employers may find themselves fielding employee questions about what these changes mean for their coverage.
This post explains what essential health benefits are, what is changing for 2027, which employers are most directly affected, and what the practical action items look like.
What Are Essential Health Benefits?
Essential health benefits, commonly referred to as EHBs, are a set of ten categories of health care services that the ACA requires certain health plans to cover. The ten categories include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services, and pediatric services including oral and vision care.
It is important to understand which plans are actually required to cover EHBs, because the answer is more limited than many employers assume. Small group fully insured plans are required to cover all EHBs as defined by their state benchmark plan. Large group fully insured plans and self-funded plans are not required to cover EHBs at all. However, if a large group or self-funded plan does cover benefits that fall into an EHB category, ACA rules regarding annual and lifetime dollar limits and cost-sharing maximums continue to apply to those benefits.
Individual and small group market plans sold through the ACA Marketplace are also required to cover EHBs, which is where the changes in the 2027 final rule are most directly felt.
The Most Significant Change: Adult Dental Benefits
The most notable change in the 2027 final rule involves routine adult dental services. This one requires a bit of background to understand why it matters.
Under prior guidance, the federal government had signaled that it would allow issuers to treat routine non-pediatric dental services, meaning dental care for adults, as essential health benefits that could be included within the standard plan structure and subject to EHB cost-sharing rules. That would have represented a meaningful expansion of what Marketplace and small group plans were required or permitted to cover as part of their core benefit package.
The 2027 final rule reverses that direction entirely. Under the new rule, issuers are explicitly prohibited from including routine adult dental services as EHBs. Adult dental benefits remain available as separate standalone dental coverage or as an optional add-on, but they cannot be incorporated into the core health plan as an essential health benefit.
For employers, the practical implication depends on plan type and how their current coverage is structured. Employers whose plan documents or employee communications reference adult dental as an EHB benefit will need to review and update those materials. Employers offering ICHRAs or QSEHRAs whose employees are purchasing individual market coverage should understand that the individual plans their employees are selecting will not include adult dental as an EHB, which may affect how employees are thinking about supplemental dental coverage.
More broadly, this change is a reminder that EHB definitions are not permanent fixtures. They are subject to regulatory revision, and employers who assume their plan design or employee materials remain accurate without periodic review are taking on unnecessary compliance risk.
Changes to Marketplace Eligibility and Premium Tax Credit Verification
The 2027 final rule also makes adjustments to how Marketplace eligibility is verified and how premium tax credit claims are processed. These changes are primarily administrative in nature but carry specific implications for employers offering ICHRAs or QSEHRAs, because the interaction between those arrangements and Marketplace subsidies is one of the more complex areas in ACA compliance.
How This Affects ICHRA and QSEHRA Employers
As we covered in a recent post on ICHRAs, employees who are offered an individual coverage health reimbursement arrangement that meets federal affordability standards are generally not eligible for ACA premium tax credits on the Marketplace. The 2027 rule revises certain verification procedures that the Marketplace uses to confirm eligibility, including verification of whether an employee has been offered an ICHRA or QSEHRA that affects their subsidy eligibility.
For employers who have implemented or are considering an ICHRA or QSEHRA, these verification changes underscore the importance of understanding and correctly documenting the affordability of the arrangement. If the HRA offer is affordable under federal standards, employees are not eligible for Marketplace subsidies. If it is not affordable, employees can opt out and pursue Marketplace coverage with subsidies. The rules around how that determination is made and how it is reported to the Marketplace are part of what the 2027 final rule adjusts, and getting it right matters both for compliance and for the employee experience.
Premium Tax Credit Verification Procedures
The final rule also revises certain procedures the Marketplace uses to verify premium tax credit claims. These changes are primarily relevant to employees who purchase individual market coverage, but they may generate questions from employees who are navigating Marketplace enrollment and encounter new documentation requests or verification steps. Employers offering ICHRAs or QSEHRAs in particular should be prepared to explain to employees how the HRA offer affects their subsidy eligibility and what documentation they may need when enrolling through the Marketplace.
What Remains Unchanged
Amid the changes it is worth being clear about what the 2027 final rule does not change, because consistency in the core framework matters for compliance planning.
Small group fully insured plans continue to be required to cover all state-defined essential health benefits. The ten EHB categories remain the same. Large group fully insured plans and self-funded plans continue to be exempt from the EHB coverage requirement but remain subject to ACA cost-sharing and dollar limit rules for any benefits they do cover that fall within an EHB category. The fundamental structure of the ACA’s coverage requirements for employer-sponsored plans has not changed with this rule.
Who Needs to Pay Attention and Why
The level of attention this rule requires depends significantly on your plan type and benefit structure. Here is a practical breakdown.
Small Group Fully Insured Employers
Your carrier is primarily responsible for ensuring your plan complies with EHB requirements, including the adult dental change. However, you should confirm with your carrier or broker that any plan documents or employee-facing materials that reference covered benefits accurately reflect the 2027 changes. If your summary plan description or open enrollment materials describe adult dental as a covered EHB, those references need to be reviewed and updated before the 2027 plan year begins.
Large Group Fully Insured Employers
Large group fully insured plans are not required to cover EHBs, but if your plan covers benefits in EHB categories you remain subject to ACA cost-sharing and dollar limit rules. Review your plan documents with your carrier to confirm that any references to EHBs are accurate and that your plan design remains compliant with applicable cost-sharing requirements under the current rules.
Self-Funded Employers
Self-funded employers carry direct responsibility for understanding the limits of their plan design and applicable ACA compliance requirements. While you are not required to cover EHBs, you need to ensure that the benefits you do cover comply with ACA dollar limit and cost-sharing rules. Review your plan documents and summary plan description with your TPA and benefits advisor to confirm accuracy and compliance, particularly if your plan makes any reference to essential health benefits in the context of covered services.
Employers Offering ICHRAs or QSEHRAs
The Marketplace eligibility and premium tax credit verification changes in the 2027 rule are most directly relevant to you. Confirm that your ICHRA or QSEHRA is structured to meet federal affordability standards if you intend for it to affect employee Marketplace subsidy eligibility. Make sure your employee communications clearly explain how the arrangement interacts with Marketplace coverage and subsidies, and be prepared to support employees who encounter new verification steps when enrolling through the individual market.
The Broader Point: Compliance Requires Ongoing Attention
The 2027 NBPP final rule is a useful reminder that ACA compliance is not a one-time exercise. The regulatory framework around essential health benefits, Marketplace eligibility, and premium tax credits is revised periodically, and the changes that come through in any given year can affect plan documents, employee communications, and benefit designs that employers have not revisited in some time.
For employers who are busy running their businesses, staying current on these changes is genuinely difficult without a knowledgeable benefits advisor who is tracking the regulatory environment and flagging what matters before it becomes a problem. That is one of the core ways a good advisor earns their relationship year-round, not just at renewal time.
At Cypress Benefit Solutions, monitoring regulatory developments like the 2027 NBPP final rule and helping employers understand their practical implications is a fundamental part of what we do. If you have questions about how these changes affect your specific plan, or if you are not sure whether your current plan documents and employee materials are up to date, we would welcome the opportunity to take a look together. Reach out anytime.
