Contents

Mark Your Calendar To Comply With Healthcare Reform

Polls: Employers Will Stay With Health Care Benefits, Need More Information

Quick Poll – Review

April Quick Poll – Vote

Further Reading

Contact Information

NIHP Home

MARK YOUR CALENDAR TO COMPLY WITH HEALTHCARE REFORM

Healthcare reform has passed and — deep breath — whether you approve or disapprove, some provisions become effective six months after the bill's passage date of March 23, 2010. Of course, plans that renew in October will be affected first.

At NIHP, we recommend you move slowly but deliberately to absorb the details of the legislation, evaluate impacts to your plan, and ensure compliance. (Remember, many elements of the reform package are not effective until 2014.) More guidance and regulation will be forthcoming from many sources. In the meantime, use this timeline to help you prepare for what is most imminent.

March 23, 2010
Date of enactment. Plans in effect on this date are considered "grandfathered" and get some exemptions.

June 23, 2010
Early retiree reinsurance program to provide availability of reimbursement for large claims.

September 23, 2010:
Plan Years beginning on or after September 23, 2010 (typically your Plan renewal date), become subject to the following "insurance" reforms.

• Lifetime dollar limits on essential benefits prohibited.
• Annual dollar limits on essential benefits prohibited (subject to exceptions defined by HHS).
• Rescissions prohibited except in cases of fraud or intentional misrepresentation.
• Pre-existing condition exclusions prohibited for children under age 19.
• Coverage for dependent children must remain available until age 26 (until 2014, grandfathered plans may exclude children who are eligible for other employment-based coverage).
• Benefits provided to children under age 26 for whom plans are required to make coverage available are non-taxable regardless of dependent status.
• Cost sharing on preventive care expenses prohibited (grandfathered plans exempt).
• Insured plans become subject to non-discrimination rules that currently apply only to self-insured plans (grandfathered plans exempt).
• Plans must allow participants to choose any primary care provider available to accept them (grandfathered plans exempt).
• Choice of pediatrician as a child’s primary care provider must be allowed (grandfathered plans exempt).
• Access to emergency services must be provided (grandfathered plans exempt).
• Access to obstetrical and gynecological care must be provided (grandfathered plans exempt).
• Internal and external appeals procedures must be implemented (grandfathered plans exempt).

• Source: Willis North America – Human Capital Practice

Medical loss ratios must be reported by health insurers to HHS. Rebates must be provided to enrollees if medical loss ratio is less than 85% (or 80% for small groups).

Over-the-counter medications are not considered qualifying medical expenses for purposes of health flexible spending accounts (FSAs), health reimbursement arrangements, and health savings accounts (HSAs), unless prescribed by a provider.

Penalty for using HAS or Archer MSA funds for items other than qualifying medical expenses increases to 20%.

Employers with fewer than 25 employees may qualify for a tax credit if they provide health insurance.

"Simple cafeteria plans" may be established by qualifying small employers.

Many good articles provide more detailed information about this landmark legislation, and we urge you to peruse our FURTHER READING section. But if you’d like to discuss direct impacts to your plan, give us a call. We are working hard to understand reform implications and pledge to stay on top of government guidelines.

POLLS: EMPLOYERS WILL STAY WITH HEALTH CARE BENEFITS, NEED MORE INFORMATION

After federal health care reform was voted into law, a new survey of almost 3,700 executives by Crain Communications Inc. shows a strong majority – nearly 70% – believe it is better for their respective organizations to continue offering health care benefits. Over 90% believe it is crucial to their recruiting and retention efforts. However, most are hungry for information to squelch uncertainty and are concerned about costs, especially in the short-term.

Starting in 2014, employers with 50 or more full-time workers must offer health care coverage or pay a fine of $2,000 per employee per year under the health care reform law.

See FURTHER READING for full survey results.

A Quick Review of Last Issue's "Quick Poll"

April Quick Poll – Vote

FURTHER READING

Dissecting the health reform legislation, Part 1
Dissecting the health reform legislation, Part 2
Employee Benefit News, March/April 2010

Healthcare reform implementation timeline for self-funded plans
HCC Life Insurance Company, April 2010

Most employers won’t drop health care benefits: Poll
Business Insurance, April 11, 2010

What do we do now? Health care reform timeline
Employee Benefits Alert, March 2010