With comprehensive health care reform a reality, plan sponsors are dealing with the unfolding compliance requirements. The International Foundation provides information and educational opportunities to help you navigate the new law.
Comprehensive health care reform, known as the Affordable Care Act (ACA), was enacted with the passage of two new laws: the Patient Protection and Affordable Care Act (PPACA), signed into law on March 23, 2010 and the Health and Education Reconciliation Act of 2010, signed on March 30, 2010. What the final bill means to private and public employers, multiemployer health and welfare plans, small businesses and others will continue to be revealed via regulations in the months ahead.
Keep an eye on this site for news updates and regularly updated resources (choose your topic of interest from the column on right) . The International Foundation has followed the health care debate since day one. And now we'll help you make sense of it all.
Latest Developments
Agencies Release ACA Final Rule, Guidance and Templates for Summary of Benefits and Coverage (SBC) and Uniform Glossary of Terms
The Departments of Labor, Treasury and Health and Human Services have released final regulations under the Affordable Care Act (ACA) that require health insurers and group health plans to provide concise and comprehensible information about health plan benefits and coverage to those with private health coverage. The goal is to make it easier for individuals and employers to directly compare one plan to another. The rule ensures consumers have access to a short, easy-to-understand Summary of Benefits and Coverage (SBC) and a uniform glossary of terms. In conjunction with the rule, the agencies released guidance and templates. 2/9/12 (New)
DOL, HHS and Treasury Issue Technical Release on Automatic Enrollment, Waiting Periods and Employer Shared Responsibility, Comments Accepted Until April 9th
The Employee Benefits Security Administration (EBSA) has issued Technical Release 2012-01, which provides information on questions from employers and other stakeholders regarding the provisions of the Affordable Care Act (ACA) governing automatic enrollment, employer shared responsibility, and the 90-day limitation on waiting periods. These provisions are scheduled to become effective in 2014. Also outlined in the release are various approaches that the three regulatory agencies (Departments of Labor, Treasury and Health and Human Services) are considering proposing in future regulations or other guidance. The technical release is being issued in substantially identical form by all three Departments. 2/9/12 (New)
IRS Issues Guidance on Form W-2 Health Coverage Value Reporting
The IRS has issued Notice 2012-9 to provide additional guidance on the informational reporting to employees of the cost of their employer-sponsored group health plan coverage on Form W-2. The IRS requested public comments on the W-2 reporting requirement in Notice 2011-28. Notice 2012-9 responds to these comments and amends, restates and supersedes Notice 2011-28. Specifically, the new notice includes guidance on the W-2 reporting as it relates to small employers, flexible spending accounts, dental and vision plans, COBRA and health reimbursement arrangements. 1/3/12 (New)
HHS Releases Essential Health Benefits Bulletin
HHS has released a document that provides benchmarks for states to use when they design their essential health benefits packages. 1/25/12 (New)
The Department of Health and Human Services (HHS) released a bulletin outlining the items and services known as "essential health benefits." The bulletin describes the approach that HHS intends to pursue in rulemaking to define these essential health benefits.
Under the HHS approach, states would be able to select an existing health plan to set as a benchmark for the items and services included in the package. The options would be:
•one of the three largest small group lans in the state;
•one of the three largest state employee health plans;
•one of the three largest federal employee health plan options;
•the largest HMO plan offered in the state's commercial market.
Plans could modify coverage as long as they do not reduce the value of coverage. States must also ensure the essential health benefits package covers items and services in at least ten categories of care, including preventive care, emergency services, maternity care, hospital and physician services and prescription drugs. 12/16/11
Early Retiree Reinsurance Program Ceasing Reimbursements at End of Year
Based on the projected availability of funding, the Centers for Medicare & Medicaid (CMS) have released a notice announcing that they will cease reimbursement of claims for the Early Retiree Reinsurance Program (ERRP) that are incurred after December 31, 2011. 12/13/11
HHS Releases Final Rule on CO-OP Program Under ACA
The Department of Health and Human Services (HHS) has issued a final rule under the Affordable Care Act (ACA). The rule implements the Consumer Operated and Oriented Plan (CO-OP) program, which provides loans to foster the creation of consumer-governed, private, nonprofit health insurance issuers to offer qualified health plans in the Affordable Insurance Exchanges (exchanges). 12/9/11
Medical Loss Ratio Rules Modified
The Centers for Medicare & Medicaid Services (CMS) issued final regulations on the Medical Loss Ratio (MLR) provisions of the ACA. These final rules modify and clarify the rules that took effect on January 1, 2011. Some of the modifications include: making the MLR rebates tax fee to workers, providing consumers with an explanation of the MLR and rebates, and phasing down the adjustments for mini-med plans. The new rules are effective January 1, 2012. Public comments on some of the modifications will be accepted until January 6, 2012. 12/2/11
Delay in Compliance Date for Summary of Benefits and Coverage Statements
The EBSA released an FAQ addressing the timing of the final Summary of Benefits and Coverage (SBC) regulations. Until final regulations are issued and applicable, plan sponsors are not required to comply with the SBC requirements. It is anticipated that the final regulations, once issued, will include an applicability date that gives group health plans and health insurance issuers sufficient time to comply. Therefore this FAQ implies that the compliance date for the SBC requirements will be later than the original date (March 23, 2012) specified. 11/17/11
Supreme Court to Decide Constitutionality of Individual Mandate
The U.S. Supreme Court has agreed to consider various issues being disputed in the Affordable Care Act, most notably the constitutionality of the individual mandate. 11/14/11
HHS Stops Implementation of Long Term Care Insurance Program
The HHS announced that it is halting plans to implement the long term care insurance portion of the ACA known as the Community Living Assistance Services and Supports (CLASS) Act due to funding concerns. 10/14/11
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