Self-Funded Health Care Plans FAQ Released: Final Regulations Issued on Out-of-Pocket Limits

Impacts all non-grandfathered self-funded plans beginning with the 2014 plan year The FAQ also talks about the out-of-pocket maximum requirements.  Beginning with the 2014 plan year, plans may not have an out-of-pocket maximum that is larger than the allowed out-of-pocket limit for high-deductible health plans (HDHP) issued in connection with a health savings account.  (The […]

Fully Insured Health Care Plans FAQ Released: Final Regulations Issued on Out-of-Pocket Limits

Impacts all nongrandfathered fully insured plans beginning with the 2014 plan year: The FAQ also talks about the out-of-pocket maximum requirements.  Beginning with the 2014 plan year, plans may not have an out-of-pocket maximum that is larger than the allowed out-of-pocket limit for high-deductible health plans (HDHP) issued in connection with a health savings account.  […]

Fully Insured Health Care Plans FAQ Released: Final Regulations Issued on Preventive Care

Impacts all non-grandfathered fully insured plans now: The agencies have received many questions about the requirement to provide first-dollar preventive care.   They have now issued a FAQ that clarifies that: While plans generally do not need to provide out-of-network preventive care if there are no in-network providers able to provide the needed preventive care service, […]

Self-Funded Health Care Plans FAQ Released: Final Regulations Issued on Preventive Care

Impacts all non-grandfathered, self-funded plans now: The agencies have received many questions about the requirement to provide first-dollar preventive care.   They have now issued a FAQ that clarifies that:  While plans generally do not need to provide out-of-network preventive care if there are no in-network providers able to provide the needed preventive care service, out-of-network […]

FAQ Released: Final Regulations Issued on Whistleblowing for Fully Insured Health Care Plans

Impacts all fully insured plans beginning April 2013 PPACA prohibits employers (including insurers) from retaliating against an employee for reporting possible violations of PPACA to his employer or to the government, providing testimony about the possible violation or refusing to violate the law.  It also prohibits retaliating or taking an unfavorable employment action against an […]

FAQ Released: Final Regulations Issued on Whistleblowing for Self-Funded Health Care Plans

Impacts all self-funded plans beginning April 2013 PPACA prohibits employers (including insurers) from retaliating against an employee for reporting possible violations of PPACA to his employer or to the government, providing testimony about the possible violation or refusing to violate the law.  It also prohibits retaliating or taking an unfavorable employment action against an employee […]

Terriann Scheduled to Speak about Health Care Reform at Tri-State HRMA’s 27th Annual Conference

Since the election in November, Terriann Procida has been educating employers about Health Care Reform, specifically the new Play or Pay regulation.  Do you know what you need to do to begin budgeting for the 2013-2014 PPACA Provisions?  Do you understand how potential penalties associated with Play or Pay may affect your bottom line?  Register […]

PPACA’s “Affordability” Requirement is Clarified by the IRS

The IRS finalized a rule that clarified that the health coverage “affordability” requirement (that an employee’s premium contribution not exceed 9.5 percent of household income) under the Patient Protection and Affordable Care Act (PPACA) will be based on self-only coverage, according to a Business Insurance online report. Employers with plans that fail that test face […]

PPACA Update: Women’s Preventive Services

Proposed rules that would make it simpler for religious organizations and religious-affiliated not-for-profit organizations like hospitals and schools that have a religious objection to providing contraceptive services were released by the DOL on Feb. 1, 2013. These employers would notify their insurer of their objection, and the insurer automatically would be required to notify the […]

PPACA Update: Minimum Essential Coverage

On Feb. 1, 2013, HHS and the IRS issued two proposed regulations that provide details on the individual shared responsibility requirement. PPACA requires that non-exempt individuals obtain “minimum essential coverage” or pay a penalty. Minimum essential coverage includes individual insurance, Medicare, Medicaid, CHIP, TRICARE, VA and similar government programs, and employer-sponsored coverage.  The proposed IRS […]