On Dec. 16, the Department of Health and Human Services (HHS) issued a bulletin outlining the approach (and proposed policies) that HHS intends to pursue in rulemaking to define essential health benefits. The bulletin can be found at http://www.healthcare.gov/news/factsheets/2011/12/essential-health-benefits12162011a.html.
The Early Retiree Reinsurance Program will cease to be operational in short order. The $5 billion program was created in July of 2010 to help offset employer costs associated with providing health coverage benefits to early retirees and their eligible spouses, surviving spouses, and dependents. From the get-go, experts predicted that the program would exhaust its funding quickly, and that is exactly what occurred. With the reinsurance funds depleted, it is expected that the Dec. 13 edition of the Federal Register will include an announcement that HHS will not accept claims incurred after Dec. 31, 2011.
On Nov. 29, HHS released 13 Q&As addressing implementation issues for state and federally facilitated Exchanges. The Q&As cover a range of topics including funding responsibility and resources, information exchanges through federally managed data "hubs," and shared eligibility verification services. Among them are Q&As focused on issues raised by federally facilitated Exchanges, highlighted below. 1)One Q&A addresses the coordination of federally facilitated Exchanges and state insurance departments. The Q&A explains that HHS intends to work with states to preserve the traditional responsibilities of state insurance departments (e.g., licensure, solvency, and network adequacy standards) when establishing a federally facilitated Exchange. 2)A second Q&A raises issues regarding eligibility determinations made by state versus federally facilitated Exchanges. It concludes that the proposed Exchange rules currently do not distinguish between a state-established Exchange and a federally facilitated Exchange, but based on comments it has received, HHS intends to modify the rules to permit additional…
Requires all employers (including government entities) to include the aggregate cost (whether paid by the employer or the employee) of employer-sponsored health benefits on the employees' annual Form W-2. The specific value attributable to each benefit is not required. If an employee receives health insurance coverage under multiple plans, the employer must disclose the aggregate value of all such health coverage. The coverage costs that must be reported (whether under an insured or self-insured plan) include: o Medical plans o Prescription drug plans o Dental and Vision plans (unless they are each stand-alone plans) o Executive physicals o On-site clinics if they provide more than "de minimis" care (example: an on-site nurse who provides only emergency services) o Medicare supplemental policies o Employee assistance programs Not required to be reported: o Long-term care, accident, or disability income benefits o Specific disease or illness policies, and hospital or other indemnity…
On Dec. 2, the Centers for Medicare & Medicaid Services (CMS) issued a final regulation that will ensure health insurance companies spend at least 80 percent of consumers' health insurance premiums on medical care, not income, overhead and marketing. Insurance companies that fail to meet the new standard are required to provide a rebate to consumers. MLR rules under the Patient Protection and Affordable Care Act (PPACA) took effect on Jan. 1, 2011, but the new final rule makes modifications and provides certainty to how the medical loss ratio (MLR) is calculated. These modifications are based on public comments solicited in an earlier version of the rule published by CMS in the spring. The modifications made in the new rule (effective date of Jan. 1, 2012): • Rather than having insurers send checks that could be taxed, workers in group health plans can receive rebates tax-free. • The new regulation proposes that…
Need a Flu Shot? With all that’s going on at this time of year, getting vaccinated against seasonal flu may be the last thing on your mind. But you don’t want to come down with the flu when you’re away from home. And you certainly don’t want to spread the flu to more vulnerable family members. The Centers for Disease Control and Prevention recommends that everyone six months and older get a flu vaccine. Many pharmacies offer flu shots on a walk-in basis. Bring Your Insurance I.D. Card Check your wallet now to prevent anxiety later. If you can’t find your card, try to print one out from your insurer’s website. Make sure you’re also carrying information about your prescription drug plan. Make a List of Your Current Medications Ideally, you should bring all your bottles with you. That way, if you end up in the emergency room and are…
Innovative would like to thank all of our guests that attended the Fiduciary Luncheons that we hosted last week in Princeton, Parsippany and Philadelphia. Innovative’s own Mark Sulpizio, Accredited Investment Fiduciary®, discussed the impact of the new 408(b)(2) and 404(a) fee disclosure regulations. Mark also touched on what fiduciary best practices employers need to implement now in order to properly address employee questions next April when the regulations go into effect. If you were unable to attend but are interested in learning more about 408(b)(2) and 404(a) please contact us at 856-786-4300. We would be happy to schedule time to meet with you to review these important new regulations and what they mean to you.
Employers have more time to comply with rules dictated by the health care reform law that will require them to revamp how they communicate and explain their health care plans. In a notice published Nov. 17, the Department of Labor (DOL) said the reporting requirements would not go into effect until after final rules are published. "It is anticipated that the...final regulations, once issued, will include an applicability date that gives group health plans and health insurance issuers sufficient time to comply," the Labor Department said. At the time the proposed rules were issued by the Health and Human Services (HHS), Labor and Treasury departments, federal regulators said they would go into effect on March 23, 2012. Among other things, the proposed rules would require employers to provide employees with an "easy-to-understand" summary of benefits and coverage (SBC) and, upon request, a glossary of commonly used health care coverage terms,…
The NJ Department of Labor and Workplace Development issued a new regulation concerning employer obligations and their record keeping. For employees hired after November 7, 2011 a written copy of the form notification of these regulations must be distributed at the time of hiring. For existing employees a document must be posted in a conspicuous location and distributed to all employees by December 7, 2011. This document serves as a notification that employers must maintain and report records regarding wages, benefits, taxes and other contributions and assessments under New Jersey's wage, benefit and tax laws. Summarized in the notification are the record-keeping requirements under the following New Jersey statutes: the Wage Payment Law, the Wage and Hour Law, the Unemployment Compensation Law, the Prevailing Wage Act, and the Gross Income Tax Act. Important to note, in the event that an employer has an internet or intranet site to…
The health reform law could undermine marriage because once people tie the knot, they may no longer be eligible for tax incentives for insurance. The law links the tax credit to household income, so two people whose combined income goes above a certain level will not be able to get a tax credit if they are married and file together. But if they get divorced or stay single they might, individually, be eligible for a premium credit. Giving people pause about marriage could be a big "unintended consequence" of the law. Under the law, families as well as individuals can qualify for subsidies on a sliding scale, up to 400 percent of the poverty level. The proposed rule issued by the administration disqualifies a family from claiming the credit if either spouse is offered an insurance plan at work with an out-of-pocket premium less than 9.5 percent of household income…
There are a series of notices regarding retirement plans that must be provided to participants as the end of 2011 approaches. Included in these notices are the following: 1)If a plan sponsor makes “safe harbor” 401(k) contributions, the plan sponsor must provide the participants with a safe harbor notice at least 30 (but not more than 90) days prior to the beginning of the plan year. 2) If a plan includes “automatic enrollment”, a participant must receive a notice of the automatic enrollment before the participant is initially enrolled in the plan and again on an annual basis. The notice should explain that, in the absence of an affirmative election, the plan will make automatic deferrals on behalf of the participant into specified investments. It should also contain all other pertinent information regarding the right to stop or change deferrals and investments. The annual notice must be provided at least…
Screening tests are one important element of cancer prevention. Healthy lifestyle choices are another. Your cancer prevention strategy should include these positive choices: Don’t neglect cancer screenings: Early detection saves lives. Avoid tobacco: Cutting out tobacco will immediately reduce your risk for cancer of the lung, throat, bladder, kidney, pancreas and mouth Get moving: Regular physical activity – about 30 minutes on most days – decreases the risk of breast, colon, prostate and uterine cancers. Limit alcohol: Moderate to heavy alcohol use is linked to breast cancer in women and to cancers of the liver, mouth and throat in both sexes. Protect your skin: Nine of every ten skin cancers could be prevented by proper use of sun protection. Maintain a healthy weight: Obesity is estimated to cause 14 percent of cancer deaths in men and 20 percent of cancer deaths in women. Obesity also can make tumors more difficult…
The Obama administration on Friday pulled the plug on a voluntary long-term care program that was part of the health care reform law. “We have not identified a way to make CLASS work at this time,” Health and Human Services Secretary Kathleen Sebelius said. Because the program was voluntary, critics say it would have resulted in adverse selection, a point Ms. Sebelius conceded. “This could have led to a vicious cycle where premiums would have to be set higher and higher to cover the likely costs of the benefits, leading fewer and fewer healthier people to sign up for the program,” she said. Employer groups welcomed the decision. “Since employers did not have to offer the plan, it didn’t really affect them directly, but if the government set it up, employers might have had to waste time explaining it and answering questions. Plus, if the government put it in and…
Beginning now, consumers across the country can click their state on a federal webpage to see if a health insurer has raised its rates, as well as the company's reason for doing so. The new site will also include a section where consumers can comment about rate increases. Beginning Sept. 1, insurers who wanted to raise their rates 10 percent or more for individual or small group plans had to say why. If a company has not raised its rates, it will not be listed on the web application at Healthcare.gov. Insurers now must also pay consumers rebates if at least 85 percent of the money spent on a plan does not go directly to health costs. Those rebates will begin next year and that information would be included on the website as it becomes available.
A new Institute of Medicine (IOM) report provides the U.S. Department of Health and Human Services (HHS) with a set of criteria and methods to develop a package of essential health benefits that will cover many health care needs, promote medically effective services and be affordable to purchasers. Certain insurance plans, including those participating in the state-based health insurance exchanges to be established under the Patient Protection and Affordable Care Act (PPACA), must cover a package of preventive, diagnostic and therapeutic services and products in areas that have been defined as essential by HHS. The package will establish the minimum benefits that plans must cover; insurers may offer additional benefits. The report neither recommends a list of essential benefits nor comments on whether any particular service should be included or excluded, as doing so would have been beyond the committee's charge. The study was sponsored by HHS, and IOM offers…
The National Labor Relations Board (NLRB) has postponed the implementation date for its new notice-posting rule by more than two months in order to allow for enhanced education and outreach to employers, particularly those who operate small and midsize businesses. The new effective date of the rule is Jan. 31, 2012. No other changes in the rule, or in the form or content of the notice, will be made. Most private-sector employers will be required to post the 11-inch-by-17-inch notice, which is available at no cost from the NLRB through its website, either by downloading and printing or ordering a print by mail. For further information about jurisdiction and posting requirements, please see frequently asked questions at the nlrb.gov website, which will be updated frequently as new questions arise.
The Centers for Medicare and Medicaid (CMS) has issued 298 pages of proposed revisions to the Medicare Advantage program and prescription drug benefit program (Part D) that would implement new benefits under the Patient Protection and Affordable Care Act (PPACA) and increase patient protections. The proposals would codify provisions providing new benefits including the 50 percent discount on covered brand name drugs in the Part D coverage gap known as the "donut hole" as well as new tools to fight fraud and abuse in Medicare and improve patient protections. Once final, the proposed rule will be effective for calendar year 2013 operations. CMS will accept comments from all stakeholders through the close of business 60 days following the publication of the proposed rule in the Federal Register (scheduled for Oct. 11, 2011). The full text can be found at http://www.ofr.gov/OFRUpload/OFRData/2011-25844_PI.pdf.
The release of President Barack Obama's deficit reduction plan comes just a week after the President submitted to Congress the actual text of his proposed jobs legislation. The bill, S.1549 , would change the tax treatment of employer-sponsored health insurance. Section 401 of the bill limits the value of all itemized deductions for married couples filing jointly with adjusted gross income of at least $250,000 and single taxpayers with adjusted gross income of at least $200,000 to 28 percent. This would include the cost of employer-sponsored health coverage and deductions for health savings accounts (HSAs and HRAs). The amount that is reported by the employer for the employee is not excludable by the taxpayer.
The Obama administration proposed a new rule that would allow patients to have direct access to electronic medical records, including lab results without waiting to hear them from a doctor. At present, patients can only obtain lab results if their physicians provide authorization, or if they reside in a few states which allow such access. The rules proposed by the Department of Health and Human Services are part of a broader effort to give patients greater access to medical data electronically so they can become more engaged in their care. They would replace a confusing patchwork of state laws and privacy statutes and affect more than 6 billion lab tests a year.
The Centers for Medicare and Medicaid Services (CMS) has announced several changes to improve and streamline the process of submitting claims data for Early Retirement Reinsurance Program (ERRP) reimbursement requests. On Monday, Oct. 3, 2011, CMS will begin providing specific, claim line-level feedback to sponsors who submit claim lists through a new, fully automated review system. Given this expedited feedback, all claim lists submitted on or after October 3 must be error-free (it must pass the automated review) in order for the plan sponsor to be able to submit a reimbursement request, and then be approved for payment. If a claim list is determined to be invalid as a result of the automated review and cancelled from the system, the sponsor may resubmit a corrected claim list. Similarly, before the automated processing system becomes effective in October 2011, claim lists and reimbursement requests that have errors will be cancelled from…