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FAQs Provide Additional Guidance on Essential Health Benefits under Health Reform

The U.S. Department of Health and Human Services (?Ç£HHS?Ç¥) released a set of FAQs providing additional guidance on HHS?ÇÖs approach for defining ?Ç£essential health benefits?Ç¥ under the Affordable Care Act. In December 2011, an HHS bulletin explained that essential health benefits would be defined by a benchmark plan selected by each state, which could be modified so long as the value of coverage is not reduced. The new FAQs supplement that December bulletin by addressing, among other issues, updates to benefits in benchmark plans, the timing for selecting a benchmark plan, and state supplementation of benchmark plans. The FAQs can be found here.

Final Rules on Health Plan Coverage of Preventative Services Issued

The U.S. Departments of Treasury, Labor and Health and Human Services issued final regulations on the health reform requirement that non-grandfathered health plans and health insurance issuers provide first-dollar coverage for certain preventive health services, including, but not limited to, all Food and Drug Administration approved contraceptive methods, sterilization procedures and patient education and counseling for all women with reproductive capacity. These regulations finalize, without change, the interim final regulations?ÇÖ exemption that allows certain religious employers from having to provide coverage for certain preventive health services. A copy of the final regulations is available here.

DOL Releases Final Regulations on Summary of Benefits and Coverage Requirement

The U.S. Department of Labor (?Ç£DOL?Ç¥) released final regulations and a separate guidance document on the summary of benefits and coverage (?Ç£SBC?Ç¥) and uniform glossary requirement under PPACA. The regulations require that employers provide the SBC to group health plan participants and beneficiaries who enroll or re-enroll in group health coverage during the first open enrollment period that begins on or after September 23, 2012. For participants and beneficiaries who enroll in group health plan coverage other than through an open enrollment period, the requirements apply beginning on the first day of the plan year that begins on or after September 23, 2012. The final regulations state that group health plans can provide the SBC separately in a stand-alone document or it can be combined with other plan materials such as a summary plan description as long as the SBC is at the beginning of the materials. The guidance also… Continue Reading

FAQs Clarify Upcoming Guidance Regarding Automatic Enrollment, Employer-Shared Responsibility and Waiting Periods Under Health Reform

The U.S. Departments of Labor, Health and Human Services and the Treasury (the ?Ç£Departments?Ç¥) released a set of frequently asked questions addressing requirements under the Patient Protection and Affordable Care Act (?Ç£PPACA?Ç¥) relating to automatic enrollment, employer shared responsibility, and the 90-day limitation on waiting periods. Prior guidance indicated that the PPACA requirement to automatically enroll new full-time employees in an employer?ÇÖs health plan would not be effective until further regulations were issued. The FAQs provide that the Department of Labor (?Ç£DOL?Ç¥) has concluded that the automatic enrollment guidance will not be ready to take effect by 2014 and, therefore, until the final regulations are issued, employers will not be required to comply with the automatic enrollment requirements. Among other items, the FAQs also provide that the Departments intend to issue further regulations on issues relating to the implementation of the employer shared responsibility requirement, such as methods for determining… Continue Reading

DOL Releases 2011 Form M-1; Proposed Changes to the Form M-1

The Department of Labor recently announced that the 2011 Form M-1 annual report for multiple employer welfare arrangements (MEWAs) is now available for filing. The 2011 Form M-1 is generally the same as the 2010 version, but with some minor changes for laws that became effective in 2011. The 2011 Form M-1 is due March 1, 2012, with an available extension until May 1, 2012. In addition, the DOL recently announced significant proposed changes to the Form M-1. Most notably, the proposed Form M-1 incorporates changes imposed by the Patient Protection and Affordable Care Act, which requires MEWAs to register with the DOL and file at least 30 days prior to operating in a state or expanding their operations in an additional state, and within 30 days of a merger, material change or a participant contribution increase of 50 percent or more. The proposed Form M-1 also requires the provision… Continue Reading

IRS Releases 2011 Form 8941 for Small Employers to Claim Health Care Tax Credit

The IRS recently released the updated version of Form 8941 and its accompanying instructions to be used by eligible small employers to calculate the health care tax credit. Generally, a small employer that offers health insurance coverage under a qualifying arrangement may qualify for a tax credit of up to 35 percent of the contributions it makes towards premium costs. The instructions to the Form 8941 include information about what constitutes a qualifying arrangement for purposes of the credit. A copy of the Form 8941 can be found here. A copy of the Instructions can be found here.

IRS Issues Additional Guidance re: Form W-2 Health Coverage Reporting

The IRS issued additional guidance regarding the employer requirement to report the value of health coverage on employees?ÇÖ IRS Forms W-2. This reporting requirement is mandatory beginning in 2012 for Forms W-2 distributed in January of 2013. The additional guidance clarifies prior guidance and provides additional guidance. For example, the new guidance clarifies that dental and vision coverage does not have to be reported if such coverage is an excepted benefit not subject to HIPAA. It also provides that employers are not required to report the cost of coverage under an employee assistance program (EAP), wellness program or on-site medical clinic if the employer does not charge a COBRA premium with respect to such coverage. The new guidance can be found here.

Definition of Essential Health Benefits Left to States

The Department of Health and Human Services (HHS) outlined its proposal for defining ?Ç£essential health benefits?Ç¥ which must be provided by group health plans beginning in 2014. The Patient Protection and Affordable Care Act directs the Secretary of HHS to define essential health benefits, but provides that it must at least include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services (including behavioral health treatment), prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services (including oral and vision care). Under the HHS proposal, essential health benefits will be defined by a benchmark plan selected by each state. States may choose one of four benchmark plans: one of the three largest small group plans in the state by enrollment, one of the three largest state employee health plans by enrollment, one… Continue Reading

Supreme Court to Hear Oral Argument on Health Reform in March of 2012

The U.S. Supreme Court has announced that oral argument in the collection of cases challenging the constitutionality of the Patient Protection and Affordable Care Act has been set for the last week of March 2012.

Early Retiree Reinsurance Program Ending

The Centers for Medicare and Medicaid Services (CMS) announced that, based on the funding available for the Early Retiree Reinsurance Program (ERRP), CMS will be denying any request for reimbursement for claims incurred after December 31, 2011. The ERRP was established by the health care reform law to reimburse plan sponsors for a portion of the cost of providing health coverage to early retirees. This announcement is available here.

October 2021