Coverage of Preventive Services Update The interim final rules have been released on coverage of preventive services. This particular provision of the health reform only applies to non-grandfathered plans. These provisions take effect for non-grandfathered plans with plan years on or after September 23, 2010 (January 1, 2011 for calendar year plans). Below are links: Interim Final Rule on Coverage of Preventive Services Regulation: Fact Sheet: Recommended Preventive Services: Recommended Websites to Bookmark Regulations: The Office of Consumer Information and Insurance Oversight works with the Department of Health and Human Services to issue regulations and implement many of the provisions of the legislation that address private health insurance. This page contains links to proposed regulations, requests for comment, and other updates. DOL site for Patient Protection and Affordable Care Act information: Model Notices Now Available: Model Notice on Patient Protections, available at: Model Notice on Lifetime Limits No Longer Applying and Enrollment Opportunity, available at: Model Notice of Opportunity to Enroll in Connection with Extension of Dependent Coverage to Age 26, available at: Model Notice on Grandfathered Health Plans, available at: HHS Announces Opening of Retiree Reinsurance Program, Posts New Guidance on HHS Website to Assist Applicants Early Retirement Reinsurance Program HHS has now released the Official ERRP Program Application that has the mailing address for the original hard copy. HHS has also posted new Official ERRP Application Instructions and Application Submission Dos and Don’ts. Updated Early Retiree Reinsurance Materials and Forms (June 29, 2010): Information: Materials: News Release: Annual and Lifetime Limits Interim Final Rules Released Regulations: Fact Sheet: This topic was addressed in our recent Heath Reform WebEx. We recommend you listen to that presentation for a comprehensive overview of this topic. Please contact Leigh Ann Furr, Compliance Analyst, at extension 3158 for more information regarding this presentation. Interim final rules have been released on lifetime and annual limits, preexisting condition exclusions and other patient protections. Annual Limits: The rules adopt a three year phase-in approach for restricted annual limits. There is also a waiver program if the lifetime and annual limits would result in a significant decrease in access to benefits or if a significant increase in premiums results. The guidance on the wavier program, however, is still pending. Alert Issues for Our Clients: The Community Living Assistance Services & Support Act (CLASS) is Title VIII, sections 8001 and 8002 of health reform. It is a self-funded and voluntary long-term care insurance choice. Workers will pay in premiums in order to receive a daily cash benefit if they develop a disability. Effective October 1, 2012. A consumer fact sheet can be found at: While this is not a TPA issue, we wanted to alert the Human Resource staff and Financial Officers of our client groups to watch this issue carefully. If you are offering this for workers, it appears that enrollment (and deductions) will be automatic unless the employee specifically says that he or she does not want to participate. One of the early goals of supporters was to start withholding 1/1/11. The final regulations and implementation timing have not been set yet. This is just a reminder for our clients that this is an issue they will want to monitor carefully so they can be prepared for this new government benefits program. PREPARING EMPLOYEES FOR WAYS HEALTHCARE REFORM WILL IMPACT THEM In addition to the above issue of the voluntary long term care insurance option, another issue employers might begin to prepare employees for is the fact that their total household income will need to be known for insurance reasons. The new healthcare reform regulations require that beginning in 2014, a health plan will need to know the TOTAL income of the WHOLE household (this includes every one that resides in that household). The reason? To determine if the employee cost of the health plan is over 9.5% of the household income. If that is found true, then there are ramifications for the employer. Workers would have the option to purchase coverage on the new health insurance exchanges, and receive a tax credit to make it easier to get coverage they need. The employer (if they offered an insurance option) would then not be paying benefits to the employee, but instead, would offer coverage up to $3,000 (as it stands now) to help support the cost of the tax credit provided by the government. So, it will be vital for an employer to have a true estimate of total household income. There is no formal guidance out yet, but employers need to be giving this thought and working out processes that protect the privacy of their employees. Some employees may feel this is an intrusion in their lives. So employers may want to begin to think how they will start making employees aware of this coming requirement, so when the time comes to ask for income of spouses and family members, they will be prepared. As we mentioned, there is no formal guidance out yet, but something to be thinking about for the future. The Affordable Care Implementation timeline: