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Final Guidance on Summary of Benefits and Coverage
On Feb. 9, 2012, the Departments of Health and Human Services, Labor and Treasury (Departments) released much-anticipated final guidance on the requirement for health plans and health insurance issuers to provide a summary of benefits and coverage to applicants and enrollees.
News Alert: February 10, 2012
The Affordable Care Act: Final Regulations Issued for Summary of Benefits and Coverage
The Departments of Health and Human Services, Labor and Treasury released the final rule and related documents for the uniform Summary of Benefits and Coverage (SBC) provision of the Affordable Care Act. This provision requires all insurers and group health plans to provide consumers with an SBC at certain specified times, including upon request for information, at the time of application, at enrollment and annually upon re-enrollment. The provision also requires that consumers have access to a uniform glossary of terms commonly used in health care coverage.
The applicability dates were set forth in the rule:
• Group market – If there is an open enrollment period – First day of the first open enrollment period that begins on or after 9/23/2012
• Group market – If enrollment in group health plan is other than through an open enrollment period – First day of the first plan year that begins on or after 9/23/2012
• Individual market & disclosures to plans – Applies to health insurance issuers beginning 9/23/2012
Some changes to the proposed rule were reflected in the final regulations, such as:
• Flexibility in the instructions for completing the SBC
• The omission of premium (or cost of coverage) information from the SBC
• The reduction in the number of coverage examples from three to two — they now include having a baby (normal delivery) and managing type 2 diabetes (routine maintenance of a well-controlled condition), although this number may increase in the future
• Greater flexibility for electronic disclosures
• With respect to group health plans, the SBC may be provided either as a stand-alone document or in combination with other summary materials (e.g., summary plan description), if the SBC information is intact and prominently displayed at the beginning of the materials
• For individual plans, the SBC must be provided as a stand-alone document, although it may be included in the same mailing as other plan materials
The rule also clarifies that self-insured group health plans (i.e., ASO accounts) must provide the SBC. There is no exemption for large or self-insured plans in the final rule.
Summer 2011
Workers’ Compensation and Health Care Reform
In the wake of sweeping changes in the U.S. health care system, employers are forced to evaluate the way reform will affect their bottom lines. One factor that was largely left out of the focus of health care reform - but is certainly linked to it - is workers’ compensation. The program represents less than 2 percent of U.S. medical spending, and thus was fundamentally ignored in the 2010 legislation that overhauled the nation’s health care system. Employers are left to wonder what change to expect in future workers’ compensation claims. Read more
In 2010, health care reform became a reality with the passage of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010. The U.S. Department of Labor has issued Frequently Asked Questions on how the health care reform law affects COBRA and the COBRA premium subsidy. Read more
Health Care Reform: General Q&A for Employees
I've heard about a number of different health care proposals over the last year. Which one did Congress pass? The health care reform law is a combination of two bills: Read more
Health Care Reform: Open Enrollment Compliance Checklist
Health care reform, in the form of the Patient Protection and Affordable Care Act, brings many changes for employers and their health plans. As sponsors of group health plans prepare to comply with health care reform’s many requirements, they need to be aware of how health care reform will affect their plans for the coming plan year. Many changes are effective on the first day of the first plan year beginning on or after Sept. 23, 2010. Read more
Health Care Reform: Compare Your Health Care Options
The Affordable Care Act makes many changes to the health care system in an effort to control costs, but that is not its only objective. Health care reform legislation was also designed to improve quality of care for patients. Read more
April, 2011
Voucher Provision Cut from Health Care Reform Law
On April 15, 2011, after weeks of intense negotiations between Democrats and Republicans in Congress, President Obama signed a budget bill that would fund the federal government through the end of Sept. 2011 and avoid the threatened federal government shutdown. Read More.
Health Care Reform: HHS Issues CLASS Act FAQs
The Patient Protection and Affordable Care Act established a voluntary, consumer-funded long-term care insurance program known as the Community Living Assistance Services and Supports Program (CLASS Act or Program). The goal of the program is to provide additional options for people who are disabled and require assistance to continue living as independently as possible.Read more.
Health Care Reform: Grandfathered Plans Implementation FAQs
The Patient Protection and Affordable Care Act (PPACA) was enacted on March 23, 2010. The health care reform legislation includes many changes related to health care coverage and raises a number of questions for employers. Read more.
Health Care Reform: Early Retiree Reinsurance Program to be Closed to New Applications
CMS Announces Deadline for ERRP Applications
The Patient Protection and Affordable Care Act (PPACA) established the Early Retiree Reinsurance Program (ERRP). The ERRP is a temporary program designed to provide reimbursement to eligible employers (and employment-based plans) for part of the cost of providing health care coverage to early retirees and their families. The ERRP has $5 billion in funding and is set to expire no later than Jan.1, 2014. Read more.
Health Care Reform: Potential Penalties for Employers Under the"Pay or Play" Rules
EXECUTIVE SUMMARY
The Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act(together, PPACA), brings many changes to employers and health plans. One such change essentially amounts to arequirement for some employers to offer health care coverage to employees.PPACA does not explicitly mandate an employer to offer employees acceptable health Read More.
Congress Repeals 1099 Reporting Requirements
On April 5, 2011, the Senate voted to repeal the Form 1099 tax reporting requirement that was included in last year's health care reform law. The Senate passed the Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011 (H.R. 4) by a vote of 87-12, showing overwhelming support for the repeal. The House of Representatives previously passed H.R. 4 on March 4, 2011, by a vote of 112-15. The repeal measure was supported by the White House and was signed by President Obama on April 14, 2011. Read More
March, 2011
Health Care Reform and COBRA-Questions and Answers (Q&A)
On The Patient Protection and Affordable Care Act (PPACA) was enacted on March 23, 2010 and amended by the Health Care and Education Reconciliation Act of 2010 on March 30, 2010. Continuation coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA) were minimally affected by the health care reform legislation. Read more.
January, 2011
Health Care Reform: IRS Q&As on OTC Drugs and Debit Cards
The Patient Protection and Affordable Care Act (PPACA) changed the rules for reimbursement of over-the-counter (OTC) medicines and drugs through plans such as health flexible spending arrangements (FSAs) and health reimbursement arrangements (HRAs). After December 31, 2010, OTC medicines and drugs (except insulin) may only be reimbursed with a prescription. Read More.
IRS Delays Nondiscrimination Rules for Fully Insured Health Plans
Nondiscrimination Rules Delayed
Under the health care reform law, non-grandfathered, fully insured group health plans were set to be subject to federal nondiscrimination rules for the first time. These rules, which have historically applied only to self-insured health plans, prohibit discrimination in favor of highly compensated individuals (HCIs). They are found in Section 105(h) of the Internal Revenue Code (the Code). Read More.
Health Care Reform: HHS Issues Medical Loss Ratio Rules
Executive Summary
The Department of Health and Human Services (HHS) has issued an interim final rule on the medical loss ratio (MLR) requirements of the Patient Protection and Affordable Care Act (PPACA). The interim final rule is effective January 1, 2011. Read More.
December, 2010
Health Care Reform: Annual Limit Waiver Model Notice Issued
Background
Under the Patient Protection and Affordable Care Act (PPACA), annual limits for health plans are being eliminated. Annual limits will be prohibited in 2014, but "restricted annual limits" are permitted for essential health benefits for plan years beginning before January 1, 2014. Plans that impose annual limits until 2014 must meet requirements for minimum limits. Read More.
Health Care Reform: Annual Limit Waiver Application Instructions
Background
The Patient Protection and Affordable Care Act (PPACA) is phasing out annual limits for health plans. Annual limits will be prohibited in 2014, but "restricted annual limits" are permitted for essential health benefits for plan years beginning before January 1, 2014. Read More.
Health Care Reform: DOL Issues December 2010 FAQ Guidance
The Patient Protection and Affordable Care Act (PPACA) was enacted on March 23, 2010 and amended by the Health Care and Education Reconciliation Act of 2010 on March 30, 2010. The health care reform legislation includes many changes related to health care coverage and raises a number of questions for employers. Read More.
November, 2010
Health Care Reform: Grandfathered Plans Can Change Insurance Carriers
New Rule for Grandfathered Plans
Under the Patient Protection and Affordable Care Act (PPACA), health plans that existed on March 23, 2010 are generally considered "grandfathered plans." Grandfathered plans are exempt from some of the health care reform requirements, including coverage of preventive care services with no cost-sharing and patient protections such as guaranteed access to OB-GYNs and pediatricians. More
Health Care Reform: DOL Issues Implementation FAQ Guidance
The Patient Protection and Affordable Care Act (PPACA) was enacted on March 23, 2010 and amended by the Health Care and Education Reconciliation Act of 2010 on March 30, 2010. The health care reform legislation includes many changes related to health care coverage and raises a number of questions for employers. More
Health Care Reform: Federal External Review and Model Appeals Notices
The Patient Protection and Affordable Care Act (PPACA) requires non-grandfathered group health plans and health insurance coverage to adopt an improved internal claims and appeal process and to follow minimum requirements for external review. On August 23, 2010, interim procedures for external review of claim appeals were issued by the Departments of Treasury, Labor and Health and Human Services. The Departments also announced the availability of model notices related to internal claims and appeals and external review. More
Clarification on grandfathering for off-cycle renewals
Plans are required to implement changes required by health care reform starting with their first renewal on or after September 23, 2010. If a group makes off-cycle plan changes before its first renewal after September 23, 2010, grandfathered status will not be affected until the next renewal date. The only exception would be if the plan change resulted in a new contract. For example, if a group moved from an HMO legal entity to a PPO legal entity, this would cause its grandfathered status to be lost immediately.
Clarification on tax treatment of adult dependent coverage
To align with the health care reform law, the IRS has clarified that health care coverage for employees' young adult dependents is not taxable. However, the rules have not changed for health savings account (HSA) expenses. That means employees can use HSA funds tax-free only for eligible expenses of family members who meet the IRS's definition of a "tax dependent."
August, 2010
Health Care Reform: CLASS Act Long-Term Care Benefits
The Patient Protection and Affordable Care Act establishes a voluntary, consumer-funded long-term care insurance program known as the Community Living Assistance Services and Supports Program (CLASS program). This Legislative Brief highlights key points of the CLASS program. Read More
Health Care Reform: Interim Final Rules on New Appeals Process
The Patient Protection and Affordable Care Act requires non-grandfathered group health plans to adopt an improved internal claims and appeal process and follow minimum requirements for external review, effective for plan years beginning on or after September 23, 2010. This Legislative Brief summarizes regulations that were issued on July 23, 2010, implementing these requirements. Read More
July, 2010
Health Care Reform: New Form W-2 Reporting Requirements
Beginning with the 2011 tax year, the health care reform law requires employers to report the cost of employer-sponsored health coverage on employees' Forms W-2. This Legislative Brief explains the new disclosure requirement. Read More
Health Care Reform: Interim Final Rules on a Patients' Bill of Rights
This Legislative Brief describes the interim final regulations regarding prohibitions of preexisting condition exclusions, lifetime and annual limits, rescissions and other patient protections under health care reform. Most of these provisions are effective for plan years beginning on or after September 23, 2010. Read More
Health Care Reform: Transition Relief Available For Grandfathered Plans
The health care reform regulations regarding grandfathered health plans include transition relief with respect to changes made before the regulations were issued. This Legislative Brief details the relief available. Read More
Health Care Reform Applications for Early Retiree Reinsurance Program Now Being Accepted
The Early Retiree Reinsurance Program was implemented as part of the health care reform law. The program officially began accepting applications on June 29, 2010. This Legislative Brief provides resources for applying to the program. Read More
Health Care Reform: Grandfathered Plans
This Legislative Brief provides information regarding grandfathered plans and the health care reform provisions from which they are exempt.It includes the regulations issued on June 14, 2010, and the special rule for collectively-bargained plans. Read More
Health Care Reform: Early Retiree Reinsurance Program Frequently Asked Questions
The Early Retiree Reinsurance Program was established by the health care reform law to provide reimbursement to participating employer-based plans that provide coverage to early retirees. HHS has issued these FAQs to assist employers in applying for the program. Read More
Health Care Reform: Potential Penalties For Employers Under the "Pay or Play" Rules
Beginning in 2014, some employers will be subject to penalties if they do not provide health coverage to employees, or if the coverage they provide is not affordable or does not provide minimum value. This Legislative Brief describes the potential penalties and when they can be assessed. Read More
Health Care Reform: Preventive Care Coverage Guidelines Issued
The Patient Protection and Affordable Care Act requires new health plans to cover preventive health services without imposing cost-sharing requirements. This Legislative Brief summarizes the interim final rules issued on this topic on July 14, 2010. Read More
Health Care Reform: Regulations Issued on Grandfathered Plans
On June 14, 2010, the Departments of Health and Human Services (HHS), Labor and Treasury issued regulations regarding grandfathered plans. This Legislative Brief offers an overview, including updated information on transition relief provided under the regulations. Read More
June, 2010
Health Care Reform: General Questions & Answers for Employers
This Legislative Brief provides answers to common questions from employers about the newest health care laws and how they affect a business. Read More
Health Care Reform: Q&A Regarding Coverage for Adult Children up to Age 26
This Legislative Brief provides answers to common questions about health care coverage for dependents up to age 26. Read More
Small Businesses Eligible for Health Care Tax Credit
This Legislative Brief gives an overview of the tax credit available under the health care reform law to small businesses that provide health insurance coverage. For more information see the Legislative Brief "Small Business Health Care Tax Credit: Questions and Answers." Updated to include links to tax credit calculators. Read More
Health Care Reform: General Questions & Answers for Employees
This Legislative Brief provides employees answers about changes to their plans due to health care reform. Read More
Health Care Reform: Questions & Answers Regarding Coverage for Seniors
This Legislative Brief answers four common questions seniors have about their health care coverage after its reform. Read More
May, 2010
Health Care Reform: Extension of Dependent Coverage
Under the recently enacted health care reform law, group health plans and health insurance issuers offering health insurance coverage that provides dependent coverage of children must now make coverage available for adult children up to age 26. This Legislative Brief gives an overview of the new mandate. Read More
Health Care Reform Break Time for Nursing Mothers
Under the recently enacted health care reform law, employers are required to provide rest breaks and accommodations to employees who are nursing mothers to express breast milk. This Legislative Brief gives an overview of the new mandate. Read More
Health Care Reform: Changes to Health Accounts
Health care reform means changes for accounts such as health FSAs and HSAs. This Legislative Brief discusses some of the law's major provisions and their effective dates. Read More
Health Care Reform: Implications on Wellness Programs
Under the recently passed health care reform legislation, employers can offer increased incentives to employees for participating in a workplace wellness program or meeting certain health status targets starting in 2014. Read More
Health Care Reform: Interim Final Rule on Retiree Reinsurance Program
HHS has issued an interim final rule implementing the Early Retiree Reinsurance Program established by the health care reform legislation. This Legislative Brief explains the HHS guidance for plan sponsors. Read More
Health Care Reform: Interim Final Rules on Dependent Coverage of Children Up to Age 26
The health care reform law requires certain health plans and issuers to offer dependent coverage to children until age 26. This Legislative Brief describes the interim final rules relating to this requirement, which were published on May 13, 2010. Read More
Health Care Reform: IRS Guidance on the Small Employer Health Care Tax Credit
The health care reform law provides a tax credit to certain small employers that provide health care coverage to their employees. This Legislative Brief provides a detailed summary of IRS Notice 2010-44, which was issued on May 17, 2010. Updated to include links to tax credit calculators. Read More
Health Care Reform: Reinsurance for Early Retirees
The health care reform law includes a reinsurance program for early retirees that will be available to businesses by June 23, 2010. This Legislative Brief provides helpful information about the upcoming reinsurance program and how business can apply. Read More
Health Care Reform: Upcoming HR Implications
The landmark health care reform bills that were passed this year will undoubtedly affect how businesses provide and administer health care benefits to their employees. Read More
Health Care Reform: Upcoming Plan Design Issues
Employers need to be aware of plan design changes required by the new health care reform law. This Legislative Brief reviews the changes effective in the next year. Read More
Do you have a Healthcare Reform Question?
Health Care Reform: IRS Q&As on Form W-2 Reporting
Executive Summary
The Patient Protection and Affordable Care Act (PPACA) added Internal Revenue Code (Code) section 6051(a)(14),which requires employers to report the aggregate cost of employer-sponsored group health plan coverage on theiremployees' Forms W-2. This requirement was originally effective for the 2011 tax year and the W-2 Forms thatwould be provided in January 2012. However, the IRS later made reporting optional for 2011. Read more.
The information on our website is only a summary of the law. It is intended for general information purposes only and is not legal advice. We do not guarantee or warrant accuracy of the content above as it does not contain complete statements of the law. Always contact an attorney to get complete, accurate and up-to-date legal advice.
