Innovative Benefit Planning Blog

New Regulations Give Patients Right To Appeal Health Plan Decisions; New Grants Program Strengthens State and Territory Consumer Assistance Programs The Obama Administration is announcing both new regulations to empower consumers to appeal decisions made by their health plans or insurance companies and the availability of resources that will be used to help give consumers more control of their health care decisions. These provisions of the Affordable Care Act will help support and protect consumers and help end some of the worst insurance company abuses. For more detailed information visit these links: Regulation: http://www.dol.gov/federalregister/HtmlDisplay.aspx?DocId=24056&AgencyId=8&DocumentType=2 Fact Sheet: http://www.dol.gov/ebsa/newsroom/fsaffordablecareact.html Related Press Release: http://www.dol.gov/ebsa/newsroom/2010/ebsa072210.html NAIC Uniform External Review Model Act: http://www.dol.gov/ebsa/pdf/externalreviewmodelact.pdf

Close on the heels of their regulations concerning grandfathered plans, the Departments of Labor, Health and Human Services (HHS), and Treasury have now released interim final regulations relating to preexisting condition exclusions, lifetime and annual limits, rescissions, and other patient protections under the Affordable Care Act (the "Act").  Lifetime Limits Under the Act, a group health plan may not establish any lifetime limit on the dollar amount of "essential health benefits" provided to any individual. This requirement is effective for plan years beginning on or after September 23, 2010. It applies to both grandfathered and non-grandfathered plans, although not to health FSAs or health savings accounts. According to the Act, essential health benefits include, at a minimum, items and services in the following categories: 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…

While the Affordable Care Act requires all health plans to provide new mandated benefits under the law, plans that existed on March 23, 2010 are exempt from some new requirements. The U.S. Departments of Health and Human Services, Labor, and Treasury issued new regulations on “Grandfathered” health plans under the Affordable Care Act. In order for a plan to keep its “Grandfathered” status the plan must abide by the stipulations outlined below when making plan changes. Cannot Significantly Cut or Reduce Benefits.  For example, if a plan decides to no longer cover care for people with diabetes, cystic fibrosis or HIV/AIDS. Cannot Raise Co-Insurance Charges. Typically, co-insurance requires a patient to pay a fixed percentage of a charge (for example, 20% of a hospital bill).  Grandfathered plans cannot increase this percentage. Cannot Significantly Raise Co-Payment Charges. Frequently, plans require patients to pay a fixed-dollar amount for doctor’s office visits and other…

Terriann Procida, one of our  founding partners, had the privilege of delivering an informative talk about Healthcare Reform on Wednesday, June 9th in Philadelphia.  She covered topics such as The Patient and Affordable Care Act as well as the Health Care and Education Reconciliation Act of 2010, both of which have become the most sweeping legislation since Medicare.  Kenneth  R. Gilberg, a shareholder of Flaster/Greenberg also presented at this event about Employee Handbooks.  Based on the feedback everyone found it very timely and beneficial.

Innovative Benefit Planning attended the annual HopeWorks Charity Golf Classic on Monday, June 7th at the Laurel Creek Country Club in Moorestown, NJ.  HopeWorks seeks to achieve D.R.E.A.M.S. (Dynamic Realizable Efforts to Attain and Maintain Success) for inner-city Camden, NJ youth by expanding the learning opportunities available to them.  Innovative, which was one of the sponsors for this event,  has been a supporter of this worthy cause for many years. To learn more about HopeWorks and their mission, visit their website or watch this great video which introduces them on a more personal level.

Innovative is pleased to announce the launch of our new website.  The site will make it easier for clients to register for events, locate previous compliance alerts and most importantly provide us with feedback for our services.  So please stop by the site and let us know what you think!