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Healthcare Plan Management

Top Five ACA Issues Employers Should Be Following

This September 16, 2014, briefing from law firm Epstein Becker Green highlights the top five ACA issues that it believes employers should be following.  Issues include litigation, employer mandate reporting and the looming Cadillac tax.

Towers Watson 2014 Health Care Changes Ahead Survey Report

Towers Watson’s 2014 Health Care Changes Ahead Survey yields insight into how companies are changing their health care strategies to comply with health care reform, combat escalating costs, avoid the business risks associated with the 2018 excise tax and improve employee engagement.

NAIC Draft White Paper on Stop Loss Insurance, Self-Insurance and the ACA

This August 2014 draft paper by the National Association of Insurance Commissioners (NAIC) explores trends in stop loss insurance seen by state departments of insurance and the regulatory issues they raise. The authors also identify issues about which state insurance departments need to be aware when regulating stop loss insurance policies.

Private Exchanges and the Rise of Retail Health Coverage

This report from PricewaterhouseCooper’s Health Research Institute is based on data from the organization’s 2014 Health and Well-Being Touchstone Survey. (A link to the full survey is also available on this site under Benefits Research & Surveys.)  The report discusses the four types of private exchanges and names the major players in each. It also illustrates factors that influence a company’s interest in moving to a private exchange and touches on the pros and cons of such a move.

Commentary/Analysis of IRS Draft 1094 and 1095 Forms and Instructions

This web page on Practical Law provides helpful discussion and explanation of the IRS’ recently issued draft forms 1094 and 1095 in connection with reporting that employers must provide to the IRS under Sections 6055 and 6066 of the Affordable Care Act.  The article  explains which employers, including those that are self-insured, must file the forms and what sections need to be completed.

EBRI Report on HSA Quality of Care

With an ever-growing number of workers covered by health savings account (HSA) plans, this September 2014 Issue Brief from EBRI examines how HSA health plans—compared with traditional managed care plans—do in terms of health care quality.  The results of the study were based on data collected over a 5-year period from a single large employer in the Midwest with an HSA-eligible health plan for all employees.

IRS Q&A on Information Reporting by Health Care Coverage Providers

This page on the IRS website provides information in Q&A format on information that healthcare coverage providers must report to the IRS under section 6055. Reporting is voluntary for 2014; for 2015, the information is required in early 2016.

IRS Draft Forms 1094 and 1095 with Instructions for ACA Information Reporting

This chronological (newest to oldest) listing of draft tax forms on the IRS website contains links to the various 1094 and 1095 forms associated with the Affordable Care Act. The 1094 and 1095 forms were posted August 28, 2014. The instructions provided with the forms are directed at Exchanges that must report enrollees in qualified health plans as well as at employers and others that provide minimum essential coverage or are subject to the employer mandate.

Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions

The report by the Congressional Research Services provides basic consumer sources, including broad overviews of the ACA law, the individual mandate, private health insurance, and exchanges, as well as public health care programs. The report also sources on employer-sponsored coverage, including sources on employer penalties, small businesses, federal workers’ health plans, and union health plans.

IRS Announces 2015 Rates for ‘Affordable Coverage’ Under ACA

Under the terms of the Affordable Care Act, large employers are required to provide affordable coverage beginning in 2015 or potentially face penalties. For 2014, the definition of affordability was set at 9.5% of the employee’s income. For plan year beginning in 2015, IRS Rev. Proc. 2014-37 sets the new limit at 9.56% of employee income.

Navigating IRS Healthcare Coverage Reporting Requirements

This Benefits Brief by Groom Law Group explains the complex new healthcare coverage reporting requirements for employers and insurers that take effect in 2016 for the year 2015. The detailed chart at the end shows who is responsible for what, when, how and to whom the information is reported.

Checklist for Employers: Upcoming ACA Deadlines

Law firm McDermott, Will & Emory compiled this checklist of upcoming health and welfare compliance initiatives which require action by employers.  It includes preparation for upcoming fees and penalties under the ACA, the filing of required forms and distribution of relevant notices.

Wellness Programs After the Affordable Care Act (Part II)

This article is Part II of a Benefits Law Alert published by Nixon Peabody LLP, with Part I posted on August 8, 2013.  Part I of the series discussed the wellness regulations released under the Affordable Care Act, which went into effect in 2014. Part II discusses compliance with other laws that govern employee wellness programs.

2014 Benefits Strategy & Benchmarking Survey Report

This report, published in June 2014 from Arthur J. Gallagher & Co., provides an interesting look at data collected from 1,833 organizations across the country when they were surveyed about their current and future employee benefits strategies.

Health and Well Being Touchstone Survey by PricewaterhouseCoopers

This PricewaterhouseCoopers survey, conducted during the first quarter of 2014, identifies trends in employer-provided benefit plans. Most notable is that employers continue to shift costs for health care to employees. The survey also provides information on wellness plans, employee assistance plans, retiree medical, retirement plans, the ACA and employers’ future plans. Free registration is required to download the report.

What Makes a Good Private Exchange?

This July 2014 article published in Health Insurance Exchange examines differences among private exchanges–what they offer, how they are funded, what support they provide, etc.  The industry is still in its infancy; this article discusses the potential that exists for private exchanges to rein in healthcare spending, but it is important for employers to know, exactly, what the exchanges they are considering have to offer.

Ten Ways to Help Your Employees Make Good Healthcare Decisions

Admit it—sometimes it’s difficult for all of us as plan sponsors to understand all of the healthcare changes, rules and regulations.  But imagine how our employees feel.  This article from PLANSPONSOR offers ten relatively easy and sensible steps to take to communicate the puzzle that is healthcare benefits.

Employee Benefits: Today, Tomorrow, and Yesterday

This Julie 2014 Issue Brief summarizes EBRI’s 35th policy forum held in Washington, DC, on Dec. 12, 2013. The symposium provided expert perspectives on the workplace and work force of the past, the challenges of today’s multi-generational workplace, and the difficulties and opportunities of the future.

Hobby Lobby Decision Breaks New Ground

This alert from Nixon Peabody covers the Supreme Court’s controversial ruling in the Hobby Lobby case.  Read background on the case, the ruling and the far reaching effects for the future.

HSA Savings: Potential Accumulations

A July 2014 analysis in EBRI’s Notes shows that a person contributing for 40 years to an HSA could save up to $360,000 if the rate of return was 2.5 percent, $600,000 if the rate of return was 5 percent, and nearly $1.1 million if the rate of return was 7.5 percent, and if there were no withdrawals.

Text of U. S. Supreme Court Opinion in Burwell v Hobby Lobby

The U.S. Supreme Court ruled in its opinion of June 30, 2014, that a for-profit corporation has free exercise of religion rights, making it lawful for the corporation to be exempt from laws to which it has religious objections.

CMS Fact Sheet: Exchange and Insurance Market Standards for 2015 and Beyond

This CMS Fact Sheet summarizes the final rules regarding consumer notices, quality reporting and enrollee satisfaction surveys, the Small Business Health Options Program (SHOP), standards for Navigators and other consumer assisters, and policies regarding the premium stabilization programs, among other standards.

Final Master FAQs from CMS on Health Insurance Market Reforms and Marketplace Standards

This 7-page document from the Center for Medicare & Medicaid Studies provides guidance in Q&A format on the implementation of the essential health benefits and actuarial value, guaranteed availability, minimum essential
coverage, and transitional policy extensions as established by the Affordable Care Act to reform the insurance market.

Employer Characteristics for Implementing a Private Exchange Approach to Health Care Coverage

An April 2014 article by Healthcare Trends Institute lists five characteristics of employers for which private exchanges may be a viable alternative to traditional employer-provided healthcare.  The characteristics are based on a profile developed by Michael Thompson of PricewaterhouseCoopers, whose organization has banded with four others to form the Private Exchange Evaluation Collaboration.

2014 ADP Annual Health Benefits Report

ADP released its second annual Health Benefits Report. Subtitled “2014 Benchmark and Trends for Large Employers,” the report is based on ADP’s analysis of its own client base and tracks premium, eligibility and participation rates from 2010 to 2014.  Among its findings: participation has consistently been higher among older workers than among younger. The report also notes that between 2010 and 2014, premiums increased 15% but rose only 1.7% between 2013 and 2014.

Group Benefits and the Defined Contribution Model

Findings from Prudential Insurance’s 8th Annual Study of Employee Benefits: Today & Beyond show that six out of 10 (62%) of employers indicated they are likely to adopt a defined contribution model for group benefits in the next two years. The survey also shows that employees would allocate 75% of their benefit dollars to health, dental and vision care.  The survey was conducted online  in August, 2013, and included three distinct groups:  employers, employees and insurance brokers.

Private Insurance Exchanges Continue to Evolve

This article by Carol Harnett appeared in the April 9, 2014, edition of HR Executive Online. The Q&A format makes for a good “primer” on the topic of private exchanges and explores issues that employers should consider before making the jump to this new model for group benefits.

Incentives to Shape Health Behaviors

This February 2014 article published in the Journal of Workplace Behavioral Health examines the use of incentives to shape health behavior and looks at the differences between “patient-centered” and “person-centered” approaches. The authors conclude that while it isn’t possible to create incentives that will be appealing to everyone, a person-centered approach would  allow individuals to self-match to incentives and engage them in the decision-making process. This could lead to better outcomes.

Value-Based Benefit Design Seen as a Tool to Change Behavior

A study of a large employer by the Academy of Managed Care Pharmacy looking at drug adherence among two populations–those with diabetes and those with high cholesteral–concludes that a value-based benefit design offering zero copay for generic drugs improved adherence.

EBRI Report on Contributions to HRAs and HSAs, 2006-2013

This report published in the February 2014 issue of EBRI Notes looks at the level of employer-employee contributions to HRAs and HSAs between 2006 and 2013. Based on its 2013 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey, this report shows that the percentage of employers who contribute to these plans has increased and that employees with family coverage contributed to the accounts at a steady level while contributions by those with single coverage fell.

IRS Final Regulations on ACA’s Employers’ Shared Responsibility Provide a One-Year Transition to Full Compliance for Large Employers

On February 12, 2014, the IRS published final rules covering employers’ shared responsibility under ACA.  Large employers, those with 100 or more employees, will be subjected to penalties if they fail to cover 70% of full-time employees in 2015. The coverage threshhold moves to 95% in 2016. Employers with 50-99 employees have until 2016 to comply.

Complying with New HIPAA Certification Requirements

This February 2014 Benefits Brief by Groom Law outlines important dates and steps health plans must take to comply with new HIPAA Certification Requirements under recently issued rules by the Department of Health and Human Services.  The Brief also discusses Standard Transaction Rules as amended under the Affordable Care Act.

Explanation of the Affordable Care Act’s December 2013 and January 2014 FAQs

This Aon Hewitt Bulletin discusses the provisions in the December 19, 2013, and January 9, 2014 FAQs released by HHS, DOL and Treasury in connection with implementation of the Affordable Care Act.  Topics covered include cost sharing, wellness, preventive services and the transitional reinsurance fee.

Summary of Final Mental Health Parity Regulations

This Towers Watson Insider offers analysis of the final regulations governing the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and, in particular, how the MHPAE interacts with PPACA.

Explaining Health Care Reform: Risk Adjustment, Reinsurance, and Risk Corridors

The Kaiser Family Foundation offers a clear and detailed explanation of the Affordable Care Act’s risk adjustment, reinsurance and risk corridor provisions, which are intended to promote insurer competition on the basis of quality and value and promote insurance market stability, particularly in the early years of reform.  Using text and, side-by-side comparisons and other graphics, the article offers a basic primer on these provisions.

2013 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey

This Dec. 2013 Issue Brief from EBRI presents findings from its Consumer Engagement in Health Care Survey (CEHCS) done in conjunction with Greenwald & Associates. The CEHCS was an online survey of 3,853 privately insured adults ages 21−64 designed to provide nationally representative data regarding trends in account-based health plans and high-deductible health plans
(HDHPs).

ACA’s 2015 Transitional Reinsurance Fees

This Dec. 30, 2013, Towers Watson publication provides information on HHS’ announcement of the fee and payment schedule for the Transitional Reinsurance Fee assessed on insurers and plan sponsors to stabilize premiums in the individual market. The fee for 2015 has been set at $44 per covered life; self-insured and self-administered plans are exempt for 2015.

Summary of Final Regs for Mental Health Parity and Addiction Act of 2008

Law firm Trucker Huss provides this summary of how the November 2013 final regulations issued by the DOL, Treasury and HHS for the Mental Health Parity and Addiction Act of 2008 affect group health plans. It also provides a link to related Frequently Asked Questions under the ACA. The compliance deadline for calendar year plans is January 1, 2015.

Modification of FSA Use-It-Or-Lose-It Rule

This IRS announcement on October 31, 2013, explains modification of the use-it-or lose-it rule for FSAs. Employees may carry over $500 of unused amounts from 2013 to 2014, provided the plan sponsor amends the plan to permit participants to do so.

ACA’s Impact on Account-Based Health Plans

The DOL’s Technical Release No. 2013-03 provides guidance on ACA’s market reforms on HRAs, FSAs, EAPs and certain other employer-provided healthcare arrangements.

Affordable Care Act – FAQ #16

This set of FAQs for implementation of the Affordable Care Act covers notices to employees about coverage available through Exchanges and the 90-day waiting period limitation.

ACA’s Impact on Account-Based Health Plans

The DOL’s Technical Release No. 2013-03 provides guidance on ACA’s market reforms on HRAs, FSAs, EAPs and certain other employer-provided healthcare arrangements.

Definition of “Spouse” and “Marriage” under ERISA and the Supreme Court’s Decision in United States v. Windsor

The DOL’s Technical Release No. 2013-04 provides guidance for employers on the definition of “spouse” and “marriage” in connection with their benefit plans.  The release states that, in general, the two terms in Title I of ERISA and in related department regulations should be read to include same-sex couples legally married in any state or foreign jurisdiction that recognizes such marriages, regardless of where they currently live.

ACA’s Impact on Wellness Programs

This Alert from law firm Nixon Peabody is the first of two dealing with compliance issues for employer-provided  wellness programs. This issue deals with how the ACA’s final rules amended and expanded the HIPAA nondiscrimination and wellness provisions.  These final rules apply to all group health plans, regardless of whether they are grandfathered or non-grandfathered, insured or self-insured, for plan years beginning on or after January 1, 2014.

Buck Consultants’ FYI Alert Comments on Same-Sex Spouse Rights under FMLA

The August 13, 2013, issue of FYI explains that the Supreme Court ruling on DOMA means that same-sex spouses in states that recognize such marriages are entitled to the same rights as opposite sex spouses under FMLA. The article goes on to say that Buck expects the DOL to issue further guidance broadening the rules.

FMLA – Fact Sheet #28F – Qualifying Reasons for Leave

This Fact Sheet on the DOL website clarifies that for purposes of FMLA the definition of spouse includes a same-sex spouse if the marriage is recognized under the laws of the state in which the employee resides.

Corrected Template – Summary of Benefits and Coverage

A revised template of ACA’s Summary of Benefits and Coverage is available on the DOL website. The revision includes two additional questions: “Does this plan provided minimum essential coverage?” and “Does this plan meet the minimum value standard?” The revised template is to be distributed during the open enrollment period for plan year 2014, or 30 days before the beginning of the plan year for plans without an open enrollment period.

Private Exchange Options for Employers

Towers Watson offers an overview of how “next generation” private exchanges provide alternatives to employers to provide health care benefits to current employees, non-Medicare eligible retirees, Medicare eligible retirees, COBRA participants and seasonal and part time workers.

New Rules for Wellness Programs

This issue of Sibson Consulting’s Capital Checkup discusses the final rule regarding wellness programs offered by employers. The rule is effective January 1, 2014 and applies to both grandfathered and non-grandfathered plans.

A Primer on Private Health Insurance Exchanges

This paper from Sibson Consulting, “What You Need to Know Before You Join a Private Exchange,” is a good starting place to learn how private exchanges work and the questions to ask to determine whether this approach to providing healthcare benefits to employees is right for your organization.

Guidance on the Notice to Employees of Marketplace Coverage Options

The Department of Labor issued this May 8, 2013, Technical Release to provide background and instructions on employers’ responsibility to notify employees of healthcare coverage options available through state exchanges or “marketplaces.”

Model Notice of Coverage Options for Employers Who Offer Health Care Benefits

The DOL provides a model notice of coverage options for employers who offer health care benefits, as mandated under the Affordable Care Act, to let employees know about the availability of insurance exchanges, or marketplaces. The notice is in Q/A format. It includes a form that employees who want to buy insurance through an exchange must complete.

Model COBRA Notice Updated for ACA

The DOL has provided a revised model COBRA Notice for use by single employer health plans. The new model includes language to make beneficiaries aware of alternative coverage available through ACA’s marketplaces.

Buck Consultants “Alert” on Marketplace Notice Requirement

This Buck Consultants Alert discusses the DOL’s two Model Notices of Coverage: one for employers who offer health plans and one for those who do not. Notices must be provided to employees by October 1, 2013. There is also information about a modified COBRA notice that includes information on Marketplaces/Exchanges as alternatives to COBRA coverage.

PPACA’s Out-of-Pocket Maximums and Preventive Services

This analysis from Towers Watson examines the implications of the 20 questions included in the DOL’s Frequently Asked Questions #15.  The analysis focuses on out-of-pocket limits for 2014, preventive services without cost sharing and changes that may be necessary for most plans in order to be compliant.

Affordable Care Act – FAQ #15

This set of frequently asked questions from the DOL addresses annual limit waiver expiration date based on a change to a plan or policy year, provider non-discrimination, coverage for individuals participating in approved clinical trials and transparency reporting.

PPACA’s Out-of-Pocket Maximums and Preventive Services

This analysis from Towers Watson examines the implications of the 20 questions included in the DOL’s Frequently Asked Questions #15. The analysis focuses on out-of-pocket limits for 2014, preventive services without cost sharing and changes that may be necessary for most plans in order to be compliant.

Impact of ACA’s 90-Day Enrollment Waiting Period Rules

This March 2013 commentary from Aon Hewitt discusses the ACA’s proposed regulations limiting enrollment waiting periods for group health plans to no more than 90 days. The article also highlights the fact that after 2014 there will no longer be a need to issue HIPAA Creditable Coverage Certificates.

Affordable Care Act – FAQ #14

This set of frequently asked questions on the DOL website covers updates to the Summary of Benefits and Coverage (SBC) that include information on minimum essential coverage and minimum value of the plan’s benefits.

Is a Private Health Exchange in Your Organization’s Future?

This article by Sibson Consulting sheds light on how private exchanges work and suggests questions employers may want to resolve before coming to a decision about this alternative method of providing healthcare benefits to employees.

Summary of HIPAA Privacy Rule

The Department of Health and Human Services provides a summary of the HIPAA privacy rule on its website.

Complying with HIPAA Privacy Provisions

This issue of Sibson Consulting’s Capital Checkup discusses actions group health plans and business associates should take to ensure compliance with the Department of Health & Human Services recently issued rules on HIPAA privacy provisions.

DOL Self-Compliance Tool for ERISA Part 7 – HIPAA

This self-compliance tool issued by the DOL is useful for group health plans, plan sponsors, plan administrators, health insurance issuers, and other parties to determine whether a group health plan is in compliance with some of the provisions of Part 7 of ERISA.

Affordable Care Act – FAQ #13

This set of frequently asked question (FAQ) clarifies the extent expatriate group health insurance coverage is subject to the provisions of the Patient Protection and Affordable Care Act.

HRAs Under the Affordable Care Act

This March 2013 issue of Sibon Consulting’s Health Care Reform Insights discusses how HRAs are affected by the Affordable Care Act.

Impact of ACA’s 90-Day Enrollment Waiting Period Rules

This March 2013 commentary from Aon Hewitt discusses the ACA’s proposed regulations limiting enrollment waiting periods for group health plans to no more than 90 days. The article also highlights the fact that after 2014 there will no longer be a need to issue HIPAA creditable coverage certificates.

Final Rule for Health Insurance Market Reforms

This overview on the Department of Health and Human Services website explains the final rules on health insurance market reforms: Guaranteed Availability of Coverage; Fair Health Insurance Premiums; Single Risk Pool; Guaranteed Renewability of Coverage; Catastrophic Plans; and Updating Rate Review.

Essential Health Benefits: Fact Sheet

The Department of Health and Human Services issued final rules on February 20, 2013, outlining standards for coverage of essential health benefits (EHB) and the determination of actuarial value (AV). This fact sheet provides an overview.

Affordable Care Act – FAQ #12

This set of FAQs on the DOL website addresses the limitations on cost-sharing and coverage of preventive services.

2013/2014 Towers Watson NGBH Employer Survey on Purchasing Value in Health Care

The 18th annual Employer Survey on Purchasing Value in Health Care, a survey by Towers Watson and the National Business Group on Health, examines how “best performing” companies in the study, those with average trend of 2.2%, have managed to contain costs for themselves and their employees.

Affordable Care Act – FAQ #11

This set of FAQs on the DOL website addresses the employer notice of coverage options, health reimbursement arrangements, disclosure of information related to firearms, employer group waiver plans supplementing Medicare Part D, fixed indemnity insurance and payment of PCORI fees.

2014 Reporting and Disclosure Calendar

The Segal Company offers this convenient, single employer reporting and disclosure calendar for healthcare and retirement benefits.

Affordable Care Act Implementation Timeline

This page on the government website devoted to healthcare reform, provides a timeline of when provisions of the Affordable Care Act go into effect. There are also links to additional information for consumers.

FAQ – ACA’s Transitional Reinsurance Program

The IRS has published frequently asked questions in connection with the transitional reinsurance program that is part of the Affordable Care Act. This three-year program (2014-2016) assesses a per participant fee on fully insured and self-insured plans to support payments to individual market issuers that cover high-cost individuals .

The Affordable Care Act’s Early Retiree Reinsurance Program

This page on the federal government’s website is devoted entirely to the Early Retiree Reinsurance Program (ERRP), a component of the Affordable Care Act that provides reimbursement to participating employer-based plans for a portion of cost of coverage for early retirees, their dependents and beneficiaries.

Proposed New Wellness Program Rules

This report by Aon Hewitt discusses proposed rules on wellness programs under ACA and their interaction with HIPAA’s nondiscrimination rules.

2013 Segal Health Plan Cost Trend Survey

The Segal Company’s 16th annual survey of managed care organizations, insurers, PBMs and TPAs projects that trend will be under 10% for all medical plan types except fee-for-service indemnity plans.

Affordable Care Act – FAQ #10

FAQ #10 provides additional clarification on the implementation of the summary of benefits and coverage (SBC) for Medicare Advantage Plans.

Are Private Health Insurance Exchanges the Wave of the Future?

This EBRI Issue Brief examines the growing interest among employers in private health insurance exchanges as an alternative to the traditional model of employer-sponsored healthcare benefits. The article provides a good explanation of how private exchanges might operate.

How to Determine Your Organization’s Response to the Affordable Care Act

This article in the July 2012 issue of Sibson Consulting’s Perspectives discusses a step-by-step process employers can use to determine how ACA will affect the health and welfare benefits they offer and whether they will continue to offer healthcare as part of their organization’s overall compensation package in the future.

FMLA – DOL’s Online Access to Information About Rights and Responsibilities

This page on the DOL’s Wage and Hour Division website is part of the elaws program. This Family and Medical Leave Act Advisor provides information about the basic rights and responsibilities of employees and employers under FMLA. It includes information about the 2012 expansion of rights for military families and airline flight crews.

HHS Resources for Creating a Summary of Benefits and Coverage

This page on the HHS website provides access to a whole host of additional information for preparing a Summary of Benefits Coverage. Included are links to instructions and guides for the sample benefit calculations for common scenarios that are a requirement of the regulations.

EBSA – Sample Completed Summary of Benefits and Coverage

The DOL’s EBSA has provided a sample completed Summary of Benefits and Coverage (SBC) using the template the agency developed. The SBC is the four-page summary mandated by the Patient Protection and Affordable Care Act.

Affordable Care Act – FAQ #6

This is the sixth set of frequently asked questions about the Affordable Care Act that the Department of Labor’s EBSA has available on its website.

Uniform Glossary of Health Insurance and Medical Terms

This DOL/EBSA website has created a four-page glossary of health insurance and medical terms as a companion to the Summary of Benefits Coverage that must be provided to all plan participants under PPACA.

Affordable Care Act – Preventive Care Benefits Guidance and RFI

This January 2011 edition of the Segal Company’s Health Care Reform Insights examines the federal government’s clarification that value-based insurance design is permitted with respect to preventive care benefits and that further guidance will be forthcoming based on responses to the government’s RFI.

Fact Sheet—Shining a Light on Health Insurance Rate Increases

This December 21, 2010, online publication discusses the provision in the Affordable Care Act that requires insurers to justify “unreasonably high” health insurance premium increases, which, in 2011, is those of 10% or more.

New Rules on Paying for Over-the-Counter Medications

This Sibson Consulting Capital Checkup summarizes the IRS guidelines on the provision in the Affordable Care Act that limits reimbursement for over-the-counter medications to those that are prescribed.

Impact of the Affordable Care Act on Dental and Vision Benefits

This December 2010 publication by Sibson Consulting discusses the impact that health care reform has on dental and vision benefits, particularly with respect to whether these benefits are considered “excepted benefits.” The article also includes a suggested list of action steps.

Interim Final Rules – Coverage of Preventive Services Under ACA

This link to the Federal Register provides the text of the interim final rules for group health plans and health insurance issuers regarding the coverage of preventive services under the Patient Protection and Affordable Care Act. The publication also includes a request for comments.

Affordable Care Act – DOL/EBSA Web Page

This page on the DOL/EBSA website provides links to guidance, regulations, Fact Sheets and Model Notices for provisions of the Patient Protection and Affordable Care Act that are of particular interest to employers. Among the topics for which links are provided are grandfathered status, external review, coverage of preventive care, extension of coverage to adult children, preexisting condition exclusions, lifetime and annual limits, rescissions, patient protections and early retiree reinsurance. The page also provides links to related websites.

Regulations on Grandfathering Under the Affordable Care Act

This June 2010 Bulletin by Sibson Consulting discusses the federal government’s initial regulations on grandfathered plans. It contrasts provisions that apply to all plans versus those that are grandfathered, as well as changes that can cause a plan to lose its grandfathered status.

Genetic Information Discrimination – EEOC

This EEOC link discusses the prohibition against using genetic information under the Genetic Information Nondiscrimination Act of 2008 (GINA) to discriminate against employees and applicants.

GINA – Final Regulations

On November 9, 2010, the EEOC published a final rule in the Federal Register to implement Title II of the Genetic Information Nondiscrimination Act of 2008 (GINA).

CHIP – New Health Benefit Eligibility Notice for Employees by May 1, 2010

This Benefits Alert from Nixon Peabody concerns a DOL model information notice on CHIP eligibility notification that all employers with group health plans must issue to employees as early as May 1, 2010. The notice informs employees of potential state financial assistance with paying for employer-provided health insurance.

Regulations on Preventive Care Under the Affordable Care Act

This Sibson Consulting Bulletin analyzes the July 2010 interim final regulations covering the specific list of preventive services that ACA requires certain group health plans to cover with no cost sharing. The Bulletin also looks at the implications for plan sponsors.

Third Set of Regulations Under the Affordable Care Act

This Sibson Consulting Bulletin examines the third set of regulations published by the federal agencies charged with implementing the new health care reform law. This set, issued in July 2010, covers rules that apply to all group health plans and those that apply only to non-grandfathered plans. The Bulletin also looks at implications for plan sponsors.

Affordable Care Act – FAQ #4

This is the fourth set of frequently asked questions that the Department of Labor’s EBSA has available on its website. These FAQs cover market reform issues.

FMLA for Military Families

Hewitt Consulting explains the October 2009 amendment to the Family and Medical Leave Act that expands FMLA provisions for military families.

Affordable Care Act – FAQ #3

This is the third set of frequently asked questions that the Department of Labor’s EBSA has available on its website.

Affordable Care Act – FAQ #2

This is the second set of frequently asked questions issued by EBSA.  Topics covered include grandfathered plans, dental and vision, rescission and preventative health as well as ACA’s effective date for individual health insurance policies.

W-2 Health Care Coverage Reporting Relief

The IRS notice states that it is not mandatory for employers to report the cost of health care coverage on W-2 forms for 2011 as initially proposed under the Affordable Care Act.

Affordable Care Act – FAQ #1

This is the first of a number of sets of frequently asked questions that the Department of Labor’s EBSA has available on its website.  These FAQs address implementation topics covering compliance, grandfathered plans, claims, internal appeals, external reviews, dependent child coverage, out-of-network emergency services and highly compensated employees.

Compliance Assistance for Health and Retirement Plans

This section of the EBSA site provides useful tools and a wealth of information for ensuring that your health and retirement plans adhere to federal regulations.  It also includes FAQs, Model Notices and other information on a broad array of plan management issues.

CHIP/Medicaid–Employee Notice Now Required

This March 2010 Sibson Consulting article provides background and information on the Department of Labor’s Model Notices about health insurance premium assistance that is available for low-income children. All employers who offer health care benefits are now required to notify employees about the assistance that is available through their state CHIP/Medicaid programs.

Department of Labor/EBSA Fact Sheets

This page on the EBSA website is a listing of Fact Sheets on various aspects of healthcare benefits, such as the Affordable Care Act, COBRA, HIPAA and Mental Health Parity and on Retirement issues, such as Selecting and Monitoring Pension Consultants, Default Investment Alternatives, the definition of “fiduciary”, etc.