March 31 , 2011

Extension of Enforcement Grace Period for Internal Claims and Appeals Under ACA

On March 18, 2011, the Department of Labor issued Technical Release 2011-01 which provides a non-enforcement period with respect to various notice, content and timing requirements applicable to group health plans under the Affordable Care Act. 

For more details on this recent release...

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February 1 , 2011

Federal Court in Florida Declares the Patient and Affordable Care Act as Unconstitutional

Federal Court Judge Vinson in the U.S. District Court for the Northern District of Florida on January 31 declared the Patient Protection and Affordable Care Act to be unconstitutional. The case, brought by 26 different states and a few interest groups and individuals, is the latest of the leading cases to be decided. This is the first case to find the entire act unconstitutional. Read this alert released by our legal experts affiliated with Benefits Advisors Network to learn more about the recent ruling.

A district judge finding a federal law this large to be unconstitutional is virtually unprecedented. In the coming days and weeks, judicial and legislative action will be taken.

For the time being, you are being advised NOT to do anything differently than you have been doing. As the situation further clarifies, we will advise you on the latest developments. For now, no quick decisions should be implemented.

If If you have any questions regarding this recent ruling, please call your Dominion Benefits consultant or client manager.

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December 28 , 2010

IRS Defers Nondiscrimination Rules for Insured Plans

On December 22, 2010, the IRS released Notice 2011-1, which defers application of certain nondiscrimination requirements applicable to insured group health plans under the Affordable Care Act.  This comes as great relief to plan sponsors, who would have been subject to substantial penalties with no regulatory guidance to inform them of their obligations.

For more details on this recent deferral...

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December 7 , 2010

Guidance on Medical Loss Ratio Requirement

On November 22, 2010, the Secretary of the Department of Health and Human Services ("HHS") released an interim final rule that implements the medical loss ratio ("MLR") requirement for health insurance issuers in accordance with the Affordable Care Act (the "Act"). 

The interim final rule implements those provisions of the Act that are intended to bring down the cost of health care and ensure that consumers receive value for their premium payments. 

To find out what this means to employers and their employees...

>>Download the full update (PDF)

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November 19 , 2010

Change Made To Grandfathering Regulations

On November 15, 2010, the Departments of Labor, Health and Human Services, and Treasury issued an amendment to the interim final regulations relating to the status of grandfathered health plans under the Patient Protection and Affordable Care Act.  This allows for group health plans to switch insurance companies without forfeiting grandfathered status, so long as the plan is not otherwise changed in a manner that violates one of the other rules for maintaining grandfathered plan status. 

For additional details on this recent amendment...

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October 14 , 2010

Cost of Health Coverage Reporting Deferred

The IRS has issued a draft Form W-2 for 2011, which employers use to report wages and employee tax withholding.  The IRS also announed that it will defer the new requirement for employers to report the cost of overage under an employer-sponsored group health plan, making that reporting by employers optional in 2011. 

For more details on the draft Form W-2 and deferral of the new reporting requirements...

>> Download the full update (PDF)

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October 6 , 2010

Year-End Roundup

The recent enactment of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively, the "Affordable Care Act") includes changes that require implementation before year-end and, in some cases, these changes will require notices during upcoming open enrollment.  The impact of many of these changes will depend on whether the relevant group health plan is grandfathered. 

For details on these required changes...

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September 27 , 2010

New Nondiscrimination Rules

In recent months, Dominion Benefits has kept our clients informed on Health Care Reform related developments and emerging employer responsibilities.  We realize this information can sometimes be overwhelming but we'd rather risk over-communicating. Today, we want to send a brief reminder on one key aspect of Health Care Reform that can significantly impact your medical program - nondiscrimination rules now apply to any "non-grandfathered" fully insured medical plan.

For further details on these new rules...

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September 13 , 2010

HHS Releases Guidance Regarding the Annual Limit Waiver Program

On September 3, 2010, the U.S. Department of Health and Human Services (HHS) issued a bulletin regarding the program under which a health plan or insurer may obtain a waiver from the minimum annual limit requirements contained in the Affordable Care Act (the Act).[1]  In general, the waiver program is designed to provide relief to individuals who are covered under “limited benefit” or “mini-med” plans by permitting low annual limits to remain in place notwithstanding the Act’s requirements, so that the covered individuals do not incur a significant reduction in benefits or increase in premiums.

For more details on these guidelines...

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July 30 , 2010

Health Care Reform: Interim Final Regulations For Internal Claims and Appeals; External Review Processes For Group Health Plans and Health Insurance Coverage

Group health plans and health insurance issuers (other than “grandfathered health plans” must begin complying with new internal claims and appeals and external review procedures for plan years commencing on or after September 23, 2010.  The new procedures were issued under authority created by the Patient Protection and Affordable Care Act (“PPACA”), in the form of interim final regulations jointly issued July 22, 2010, by the Department of Treasury’s Internal Revenue Service, the Department of Labor’s Employee Benefits Security Administration (“EBSA”), and the Department of Health and Human Services (“HHS”).[1]  Unlike proposed regulations, interim final regulations are binding upon the effective date.[2]  The agencies have requested comments regarding the new claims review procedures by September 21, 2010, but any changes to these procedures likely would be prospective only.  Accordingly, plan sponsors likely need to update their claims review procedures before their next plan year begins.

For more details on these interim final regulations...

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July 27 , 2010

Health Care Reform Preventive Services Interim Final Rules Released

On July 14, 2010, the Departments of Labor, Health and Human Services and Treasury released final interim rules implementing the preventive health services provisions under the Affordable Care Act (the “Act”).[1] The agencies also released a Fact Sheet. The rules were published in the July 19, 2010 Federal Register.

For more details on these final regulations...

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July 8 , 2010

Regulations Released for Pre-existing Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections

On June 23, 2010, the Departments of Labor, Health and Human Services and Treasury released final interim regulations relating to preexisting condition exclusions, lifetime and annual limits, rescissions, and other patient protections under the Affordable Care Act. The Regulations were published in the June 28, 2010 Federal Register.

For more details on these final regulations...

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June 25 , 2010

Grandfathered Health Plan Provisions: e-Bulletin

On June 14, 2010, the Departments of Labor, Health and Human Services, and Treasury released final interim regulations relating to the status of grandfathered health plans under the Affordable Care Act (the “Act”). These regulations, published in the June 17, 2010 Federal Register, explain the rules for determining whether a group health plan or health insurance coverage qualifies as a grandfathered health plan, how that status is maintained, and how a grandfathered health plan may lose its grandfathered status. In addition, the preamble to the regulations provides helpful and important guidance for plans that are not subject to the Act’s mandates, such as those that cover fewer than two participants who are current employees and those that provide excepted benefits.

>> Download the full update (PDF)

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June 25 , 2010

Reform Topic Summary: Grandfathered Health Plan Provisions

HHS has published the guidelines for health plan sponsors to maintain the “grandfathered” status of their health plans. As you will recall, grandfathering a health plan allows employers to delay implementation of some of the mandated reform changes.  The key items that could be delayed include:

• Coverage requiring emergency service at in-network cost sharing level with no prior authorization
• A narrow exemption to the requirement that dependent coverage must be provided for adult children up to the age of 26 - allows grandfathered plans to enroll only those who do not have access to other employer-sponsored coverage (other than through their parents)
• No cost sharing on preventative services and immunizations
• The requirement for Plans to maintain an external appeals process and continue benefits while the appeal is pending
• An expansion of the primary care designation for in-network providers
• Application of nondiscrimination rules to fully insured plans that prohibit discrimination in favor of highly compensated employees
• Community rating
• Limits on plan deductibles and co-pays
• Clinical trial coverage
• Individual plans are exempt from the children to age 19 pre-ex provision
• Coverage requiring emergency service at in-network cost sharing level with no prior authorization

>> Download the full update (PDF)

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June 15 , 2010

Health Care Reform FAQs for Employers

INTRODUCTION:

This FAQ is offered for informational purposes only. The information provided herein is not intended to be a comprehensive legal review of the issues covered and does not constitute legal advice. Dominion Benefits and/or Proskauer assume no responsibility for clearly interpretative information and undertake no responsibility to update these FAQs as more information is available.
 
The FAQs for the Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010 (the “Reform Act” and “Reconciliation Act,” respectively, and, collectively, the “Act”) focus on certain issues of immediate interest to employers.

Many of the Act’s provisions remain unclear.  This FAQ represents our understanding of the law as of April 30, 2010 and our interpretation of the law as it exists to date (based on analysis, as well as informal guidance from Washington, D.C.). 

Congress may pass Technical Amendments to the Act and the federal agencies charged with implementing the Act’s provisions will issue formal guidance over the coming months.  The answers to many of the FAQs included herein may change—sometimes dramatically—based on future anticipated guidance.   

>> Download the full update (PDF)

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June 10 , 2010

Reform Topic Summary: Early Retiree Reinsurance Program

Program Overview:

• Self-insured and fully insured private plans that offer early retiree coverage (age 55 to Medicare eligible) can qualify for claims refunds.
• Applicable to 80% of discounted claims amounts between $15k and $90k per contract (including co-pay/OOP amounts) incurred beginning in 2010 through 2013 or until money runs out
• Payments will be on a first come first serve basis.

Application Process/Plan Requirements:

• HHS is expected to release the application in June.
• Applications will be reviewed on a first come first serve basis.
• Any errors in the application and it will be rejected – you go to the back of the line.
• Your plan must be certified by HHS.
• In the application you will likely be required to describe your expected use of funds, project your anticipated level of claims filings, as well as address other (yet to be determined) items.
• Carriers will have to provide claims data for filing purposes (carrier may need to file for fully insured plans) and plan sponsors will need written agreements with their carrier.
• Since these are federal funds the company will be subject to audit and perhaps other requirements.
• Funds must be used to reduce plan participant costs and cannot be used as general funds.
• You will be required to demonstrate that your plan has programs in place to address high cost disease categories.
• You must attest that you have procedures in place to reduce fraud.

>> Download the full update (PDF)

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June 1 , 2010

Reform Topic Summary: Employee Free Choice Voucher

The following is a more detailed summary of the Employee Free Choice Voucher and how it will be administered:

• Employee has a household income less than 400% of the FPL (i.e. family of four with an income of $88k)
• Employer pays 100% of individual premium and 0% for dependents
• Employer must offer a free choice voucher if the employee’s contribution to the health care premium falls between 8-9.8% (9.8% could change to 9.5%) and the employee does not enroll in the company’s health plan
• The voucher must be for the amount the employer would have paid toward the employee’s health plan had he/she enrolled in the company plan.

>> Download the full update (PDF)

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June 1 , 2010

Reform Topic Summary: Employer Penalty

The following is a more detailed summary of the employer penalty and how it will be administered:

• Employer has more than 50 full time equivalents, but 40 actual full time employees
• Employer pays 100% of the employee’s individual premium for full time employeesand the coverage is qualified
• Employee’s household income is below 400% of the federal poverty level at $60,000
• Employee coverage cost is $300, family is $1,000 per month
• Employee picks family coverage
• Is the employer penalized and if so for how much?

Calculation:

• Employee’s cost is $700 per month ($1,000-$300) or $8,400 per year
• $8,400 is 14% of family’s household income exceeding the 9.5% threshold; the employee is eligible for the premium tax credit through the exchange; so, the employer is subject to the penalty

>> Download the full update (PDF)

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June 1 , 2010

Reform Topic Summary: Small Business Tax Credit Calculation

Small Business Tax Credit Calculation
Lesser of employer portion of premium paid on behalf of employee (must be at least 50%) in a qualifying arrangement or the amount the employer would have paid of the average premium of the small market for the region (HHS to define)

Example:  For 2010 tax year employer has nine FTEs with average annual wages of $23k per FTE. The employer pays $72,000 in employee health premiums (which does not exceed the state’s average small group premium). All other required provisions are met. The credit for 2010 equals $25,200 (35% x $72,000).

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June 1 , 2010

Reform Topic Summary: Dependent to Age 26

The following is more detailed guidance (not necessarily “high level” but certainly “elevated”) on the age 26 dependent issue. Routine disclaimers should apply here, i.e. this is our current interpretation, get legal advice, etc.

As it relates to early adoption, my advice would be as follows: 
It’s good social policy, but recognize that in many cases this will likely increase plan costs (the 1-1.5% is an average and will be apportioned differently due to actual experience and carrier underwriting). While adopting the provision early doesn’t appear to affect a plan’s grandfathered status, early adoption will likely exclude plans from recapturing the limited restrictions on enrollment afforded grandfathered plans, which could extend to 2014.

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May 10 , 2010

Benefits for Women & Responsibilities for Employers

The Reform Act adds a new provision to the Fair Labor Standards Act (FLSA) that addresses the needs of working women who breastfeed their infant children. Effective immediately, employers covered by the FLSA must provide "reasonable" breaks to mothers to express milk for their infants who are up to one year old.

>> Download the full update (PDF)

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March 23 , 2010

Health Care Reform Update

Dominion Benefits is carefully reviewing the newly enacted health reform bill and the reconciliation process that is underway so that we will be ready to advise our clients.  Our goal is to be fully prepared to be your advisor so that you understand your options and responsibilities as an employer and that we are positioned to provide as much consultative and administrative support as possible. This process is not likely to have a clear end date even when the legislative process is complete, as future regulatory clarifications will likely provide important direction.
 
In summary, the legislative action provides sweeping change to the provision of health insurance in our country and employers’ roles in the process.  Attached is a document that summarizes key provisions of the bill signed by the President this week.  This information will provide you with a good start in understanding the scope of the bill.  Additionally, we are providing a report from the Kaiser Foundation that provides greater detail.

>> Download the full update (PDF)

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