Health Care Reform
Affordable Care Act - Interim Procedures for Internal Claims and Appeals
DOL Technical Release No. 2010-02 provides guidelines for the internal claims and appeals process that group health plans and health insurance issuers are required to have under the act.
ACA - Internal Claims and Appeals
Uploaded: October 21, 2010
Affordable Care Act - Clarification of Rules on Coverage for Children to Age 26
This November 2010 publication by Sibson Consulting provides an overview of the age 26 mandate and summarizes several rounds of clarifications issued by regulatory agencies. It also includes a list of action steps for plan sponsors.
Clarification - Age 26 Mandate
Uploaded: November 12, 2010
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.
Uploaded: November 26, 2010
Affordable Care Act - FAQ #7 and Mental Health Parity Implementation
This set of FAQs egard implementation of the market reform provisions of the Affordable Care Act, as well as FAQs regarding implementation of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
Uploaded: April 17, 2012
Affordable Care Act - Preventative 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.
ACA - Guidance on Preventive Benefits
Uploaded: January 25, 2011
Affordable Care Act - Regulations on Appeals Process
This Hewitt Associates report discusses the regulations that the DOL and HHS released in August, 2010, covering the Federal External Review Process and the Model Notices the agencies provided.
Commentary - Regulations on Appeals Process
Uploaded: October 21, 2010
Affordable Care Act Implementation - FAQ # 8 – Summary of Benefits and Coverage
This set of frequently asked questions covers the Summary of Benefits and Coverage document that group health plans and issuers must provide to participants and beneficiaries by September 23, 2012.
FAQ - Summary of Benefits and Coverage
Uploaded: April 17, 2012
Affordable Care Act Implementation - Commentary on Federal Guidance Released in September
This Hewitt article adds clarity to guidance that HHS and the DOL have issued regarding grandfathered status, claims and appeals, dependent coverage to age 26, and out-of-network emergency services.
ACA - Commentary on September 2010 Implementation Guidance
Uploaded: October 21, 2010
Affordable Care Act Implementation – FAQ #1
This is the first of several sets of frequently asked questions that the Department of Labor’s EBSA has available on its website.
Uploaded: October 21, 2010
Affordable Care Act Implementation – FAQ #2
This is the second set of frequently asked questions that the Department of Labor’s EBSA has available on its website.
Uploaded: October 21, 2010
Affordable Care Act Implementation – FAQ #3
This is the third set of frequently asked questions that the Department of Labor’s EBSA has available on its website.
Uploaded: October 21, 2010
Affordable Care Act Implementation – FAQ #6
This is the sixth set of frequently asked questions that the Department of Labor’s EBSA has available on its website.
Uploaded: August 24, 2011
Affordable Care Act Implementation — FAQ #4
This is the fourth set of frequently asked questions that the Department of Labor’s EBSA has available on its website.
Uploaded: November 1, 2010
Affordable Care Act Implementation — FAQ #5 and Mental Health Parity
This fifth set of frequently asked questions about the ACA also includes information on the Mental Health Parity and Addiction Act of 2008.
Uploaded: January 3, 2011
Affordable Care Act – Early Retirement Reinsurance Program
Health and Human Services has developed this website devoted exclusively to the Early Retirement Reinsurance Program created under health care reform.
Early Retirement Reinsurance Program
Uploaded: October 21, 2010
Amendment to Interim Final Regs on Grandfathered Status for Health Plans Under ACA
The modification published November 17, 2010, and linked below states that a group health plan does not lose its grandfathered status merely because the plan (or its sponsor) enters into a new policy, certificate, or contract of insurance after March 23, 2010.
Grandfathered Status Not Lost With Change of Insurers
Uploaded: November 16, 2010
April 2011 Issue Brief—EBRI Examines Employment-Based Health Benefits and Retirement Income Adequacy
EBRI’s April Issue Brief addresses two of the most timely issues in employer-sponsored benefits: employer-driven innovation in health benefits and the ability of employees to generate sufficient retirement. The publication also examines the future of employer-sponsored health care in the wake of PPACA and the November 2010 elections.
CDHP, Wellness, Retirement Income Adequacy
Uploaded: April 27, 2011
Best Practices to Maximize Consumer-Driven Health Plan Effectiveness
This presentation is from a University Conference Services Webinar on August 30, 2011, by Craig N. Hankins of UnitedHealthcare.
Uploaded: August 31, 2011
Draft Form W-2 for Reporting the Cost of Health Care Coverage
The IRS has released a preliminary draft of the Form W-2 for reporting the cost of health care coverage.
Draft Form W-2 - Health Care Coverage Reporting
Uploaded: October 21, 2010
EBSA - SBC Instruction Guide for Group Plans
EBSA developed this guide to assist employers in the completion of their Summary of Benefits and Coverage (SBC) based on the SBC Template.
SBC Instructions - Group Plans
Uploaded: February 10, 2012
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.
EBSA Sample Summary of Benefits Coverage
Uploaded: January 26, 2012
EBSA - Summary of Benefits and Coverage - Compliance Guidance
EBSA has provided this document to guide employers on compliance with providing a Summary of Benefits and Coverage to all healthcare plan participants as mandated by PPACA.
Uploaded: February 10, 2012
EBSA - Summary of Benefits and Coverage - Final Regulations
EBSA published the final regulations covering the Summary of Benefits and Coverage mandated by PPACA to be made available to all healthcare plan participants.
Uploaded: February 10, 2012
EBSA - Template for PPACA’s Summary of Benefits and Coverage
The DOL’s EBSA has provided a template for the Summary of Benefits and Coverage mandated under the Patient Protection and Affordable Care Act.
EBSA Template for PPACA’s Summary of Benefits Coverage
Uploaded: January 26, 2012
Early Retiree Reinsurance Program Under the ACA
This link provides information on the Early Retiree Reinsurance Program as well as a full, alphabetical list of participating companies and an interactive state map displaying participating organizations.
Uploaded: November 10, 2010
FAQs on Health Care Reform and COBRA
EBSA has created a list of frequently asked questions about how health care reform affects COBRA.
Uploaded: November 26, 2010
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.
FMLA - DOL Online Elaw Resource
Uploaded: March 8, 2012
Fact Sheet – Amendment to Regulations on Grandfathered Status
This November 2010 HHS publication is a brief synopsis of the amendment of earlier regulations whereby group health plans will be allowed to switch insurance companies and shop for the same coverage at a lower cost while maintaining their grandfathered status, so long as the structure of the coverage doesn’t violate one of the other rules for maintaining grandfathered plan status.
Fact Sheet - Amended Regs, Grandfathered Status
Uploaded: November 16, 2010
Fact Sheet – Coverage of Young Adult Children to Age 26
This fact sheet on the DOL/EBSA website discusses the Affordable Care Act’s provision allowing children up to age 26 to remain on a parent’s health care plan.
Fact Sheet - Health Care Coverage for Adult Children
Uploaded: August 24, 2011
Fact Sheet – Medical Loss Ratio
This November 2010 HHS online publication summarizes provisions in the Affordable Care Act that limit the percentage of insurance premiums that can be used to pay for administrative expenses beginning in 2011. The law requires insurance companies in the individual and small group markets to spend at least 80 percent of the premium dollars they collect on medical care and quality improvement activities. Insurance companies in the large group market must spend at least 85 percent of premium dollars on medical care and quality improvement activities.
Uploaded: November 26, 2010
Fact Sheet – Transparency for Annual Dollar Limits of Mini-Med Plans
This Fact Sheet posted on the HealthCare.gov website December 9, 2010, discusses how health insurers offering mini-med plans must notify consumers in plain language that their plan offers extremely limited benefits and direct them to the HealthCare.gov website where they can get more information about other coverage options.
Fact Sheet - Mini-Med Plan Annual Limits
Uploaded: December 13, 2010
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.
Health Insurance Rate Increases
Uploaded: December 29, 2010
Few Employers Planning to Drop Health Plans After Reform Is in Place
A preview of findings from Mercer’s 2010 National Survey of Employer-Sponsored Health Plans shows that relatively few employers anticipate dropping coverage when state-run insurance exchanges become operational in 2014.
Survey - Employers and Health Care Reform
Uploaded: November 22, 2010
Guidance on Annual Limit Waivers and Minimum Loss Ratio for Mini-Meds
This November 2010 commentary by Aon Hewitt discusses the HHS’s waiver process for mini-med plans whose annual limits for essential services is below those required by the ACA. The article also outlines a new requirement for group health plans and health insurers to issue specific notices to participants of these plans.
Mini-Meds - Annual Limits and Medical Loss Ratio
Uploaded: November 16, 2010
HHS Fact Sheet on Proposed Regulations on Summary of Benefits and Coverage; Uniform Glossary of Term
The HHS has released a Fact Sheet on rules under the Affordable Care Act provisions that would ensure consumers have access to two forms that will help them understand and evaluate their health insurance choices: an easy-to-understand Summary of Benefits and Coverage; and a uniform glossary of terms commonly used in health insurance coverage.
Uploaded: August 19, 2011
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.
SBC - Sample Benefits Coverage Calculations
Uploaded: March 1, 2012
Health Care Reform – A Primer for Employers
This Benefits Alert from the law firm Nixon Peabody LLP summarizes some of the significant implications of health care reform for employers.
Uploaded: November 4, 2010
Health Care Reform – At-a-Glance Chart of Provisions
Buck Consultants provides a chart of various provisions together with the effective dates and implications for large employers.
Uploaded: November 11, 2010
Health Care Reform – Timeline for Calendar Year Plans
The Segal Company provides this quick reference chart of effective dates for various components of the Affordable Care Act.
Uploaded: October 29, 2010
Health Insurance Exchanges - Initial Guidance to States
In November 2010, the HHS issued the first in a series of guidance documents to be issued over the next three years to give states and territories information on establishing a Health Insurance Exchange in accordance with provisions in the Affordable Care Act.
Uploaded: November 26, 2010
Healthcare Reform in 2012: Blind Curves Ahead, Milliman Insight Article
This February 2012 article published in Milliman’s Insight lays out the various scenarios for healthcare reform, depending upon the Supreme Court’s anticipated ruling on the law in June or July of 2012 and the outcome of the presidential election in November.
Healthcare Reform's Prospects in 2012
Uploaded: March 6, 2012
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.
ACA - Dental and Vision Benefits
Uploaded: December 10, 2010
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.
Uploaded: November 26, 2010
Model Language to Notify Plan Participants of Annual Dollar Limits That Apply to Mini-Med Plans
This December 2010 notice from the Department of Health and Human Services provides model language that mini-med health plans must use to disclose the annual dollar limits of the plan to participants.
Model Language - Mini-Med Plans
Uploaded: December 13, 2010
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.
Reimbursement for OTC Medicines
Uploaded: December 13, 2010
Recommended Preventive Services Under the ACA
The ACA requires new plans and issuers to cover certain preventive services without any cost-sharing for the enrollee when delivered by in-network providers. Interim final regulations, issued in July 2010, do not apply to grandfathered plans and issuers. This website provides links to the items and services that must be covered under the interim final regulation.
Uploaded: January 3, 2011
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.
Uploaded: November 12, 2010
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.
Uploaded: November 10, 2010
Revisions to ACA’s Grandfathering Rules Permit Change in Insurers
This Segal Co. Capital Checkup discusses the revision to the Affordable Care Act’s Grandfathering provision that allows plan sponsors to change health insurance coverage without losing grandfathered status under certain conditions.
Revision of Grandfathering Rules
Uploaded: January 6, 2011
Rules for Coverage on Adult Children Clarified
This June 2010 publication by Sibson Consulting reviews the regulations for the age 26 mandate issued in April and May 2010. Included is an overview of the mandate and who is covered by it as well as discussion of how the mandate interacts with Michelle’s Law and other student health plans.
Uploaded: November 12, 2010
Savings Needed for Health Expenses for People with Medicare Coverage
This December 2010 Issue Brief from EBRI indicates that employees will need to set aside substantial sums to cover their medical expenses despite the changes to Medicare Part D cost sharing that will be phased in under the Affordable Care Act.
Uploaded: December 13, 2010
Summary of Benefits and Coverage - Sample Completed Template
This DOL/EBSA link provides a look at a sample completed Summary of Benefits and Coverage form.
Sample Completed Benefits & Coverage Form
Uploaded: August 22, 2011
Summary of Benefits and Coverage Template
This DOL/EBSA link provides a look at the department’s proposed template for the Summary of Benefits and Coverage required under PPACA.
Summary of Benefits and Coverage Proposed Template
Uploaded: August 19, 2011
Survey – Employer Response to Health Care Reform
This August 2010 Towers Watson survey reveals that, for now, employers are focusing on how to comply with the law but will shift to a more strategic position and develop multi-year approaches in 2011.
Survey - Employers and Health Care Reform
Uploaded: October 29, 2010
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.
Uploaded: November 10, 2010
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.
Glossary - Health Insurance and Medical Terms
Uploaded: August 22, 2011
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.
W-2 - Health Care Coverage Reporting
Uploaded: October 21, 2010
What Does the Public Know About the New Health Care Law?
Not much, according to a Fast Facts release of data from EBRI’s 2010 Health Confidence Survey.
Uploaded: November 9, 2010
What Is ‘CLASS,’ and Will It Work?
This issue in Brief from the Center for Retirement Research at Boston College analyzes the Community Living Assistance Services and Supports (CLASS) program created under the Affordable Care Act. Authors Alicia H. Munnell and Josh Hurwitz examine this voluntary, non-subsidized government insurance benefit, weighing its pros and cons and suggesting how it can be improved.
Uploaded: February 1, 2011
Affordable Care Act - Interim Procedures for Internal Claims and Appeals
DOL Technical Release No. 2010-02 provides guidelines for the internal claims and appeals process that group health plans and health insurance issuers are required to have under the act.
ACA - Internal Claims and Appeals
Uploaded: October 21, 2010
Affordable Care Act - Clarification of Rules on Coverage for Children to Age 26
This November 2010 publication by Sibson Consulting provides an overview of the age 26 mandate and summarizes several rounds of clarifications issued by regulatory agencies. It also includes a list of action steps for plan sponsors.
Clarification - Age 26 Mandate
Uploaded: November 12, 2010
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.
Uploaded: November 26, 2010
Affordable Care Act - FAQ #7 and Mental Health Parity Implementation
This set of FAQs egard implementation of the market reform provisions of the Affordable Care Act, as well as FAQs regarding implementation of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
Uploaded: April 17, 2012
Affordable Care Act - Preventative 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.
ACA - Guidance on Preventive Benefits
Uploaded: January 25, 2011
Affordable Care Act - Regulations on Appeals Process
This Hewitt Associates report discusses the regulations that the DOL and HHS released in August, 2010, covering the Federal External Review Process and the Model Notices the agencies provided.
Commentary - Regulations on Appeals Process
Uploaded: October 21, 2010
Affordable Care Act Implementation - FAQ # 8 – Summary of Benefits and Coverage
This set of frequently asked questions covers the Summary of Benefits and Coverage document that group health plans and issuers must provide to participants and beneficiaries by September 23, 2012.
FAQ - Summary of Benefits and Coverage
Uploaded: April 17, 2012
Affordable Care Act Implementation - Commentary on Federal Guidance Released in September
This Hewitt article adds clarity to guidance that HHS and the DOL have issued regarding grandfathered status, claims and appeals, dependent coverage to age 26, and out-of-network emergency services.
ACA - Commentary on September 2010 Implementation Guidance
Uploaded: October 21, 2010
Affordable Care Act Implementation – FAQ #1
This is the first of several sets of frequently asked questions that the Department of Labor’s EBSA has available on its website.
Uploaded: October 21, 2010
Affordable Care Act Implementation – FAQ #2
This is the second set of frequently asked questions that the Department of Labor’s EBSA has available on its website.
Uploaded: October 21, 2010
Affordable Care Act Implementation – FAQ #3
This is the third set of frequently asked questions that the Department of Labor’s EBSA has available on its website.
Uploaded: October 21, 2010
Affordable Care Act Implementation – FAQ #6
This is the sixth set of frequently asked questions that the Department of Labor’s EBSA has available on its website.
Uploaded: August 24, 2011
Affordable Care Act Implementation — FAQ #4
This is the fourth set of frequently asked questions that the Department of Labor’s EBSA has available on its website.
Uploaded: November 1, 2010
Affordable Care Act Implementation — FAQ #5 and Mental Health Parity
This fifth set of frequently asked questions about the ACA also includes information on the Mental Health Parity and Addiction Act of 2008.
Uploaded: January 3, 2011
Affordable Care Act – Early Retirement Reinsurance Program
Health and Human Services has developed this website devoted exclusively to the Early Retirement Reinsurance Program created under health care reform.
Early Retirement Reinsurance Program
Uploaded: October 21, 2010
Amendment to Interim Final Regs on Grandfathered Status for Health Plans Under ACA
The modification published November 17, 2010, and linked below states that a group health plan does not lose its grandfathered status merely because the plan (or its sponsor) enters into a new policy, certificate, or contract of insurance after March 23, 2010.
Grandfathered Status Not Lost With Change of Insurers
Uploaded: November 16, 2010
Best Practices to Maximize Consumer-Driven Health Plan Effectiveness
This presentation is from a University Conference Services Webinar on August 30, 2011, by Craig N. Hankins of UnitedHealthcare.
Uploaded: August 31, 2011
Draft Form W-2 for Reporting the Cost of Health Care Coverage
The IRS has released a preliminary draft of the Form W-2 for reporting the cost of health care coverage.
Draft Form W-2 - Health Care Coverage Reporting
Uploaded: October 21, 2010
EBSA - SBC Instruction Guide for Group Plans
EBSA developed this guide to assist employers in the completion of their Summary of Benefits and Coverage (SBC) based on the SBC Template.
SBC Instructions - Group Plans
Uploaded: February 10, 2012
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.
EBSA Sample Summary of Benefits Coverage
Uploaded: January 26, 2012
EBSA - Summary of Benefits and Coverage - Compliance Guidance
EBSA has provided this document to guide employers on compliance with providing a Summary of Benefits and Coverage to all healthcare plan participants as mandated by PPACA.
Uploaded: February 10, 2012
EBSA - Summary of Benefits and Coverage - Final Regulations
EBSA published the final regulations covering the Summary of Benefits and Coverage mandated by PPACA to be made available to all healthcare plan participants.
Uploaded: February 10, 2012
EBSA - Template for PPACA’s Summary of Benefits and Coverage
The DOL’s EBSA has provided a template for the Summary of Benefits and Coverage mandated under the Patient Protection and Affordable Care Act.
EBSA Template for PPACA’s Summary of Benefits Coverage
Uploaded: January 26, 2012
Early Retiree Reinsurance Program Under the ACA
This link provides information on the Early Retiree Reinsurance Program as well as a full, alphabetical list of participating companies and an interactive state map displaying participating organizations.
Uploaded: November 10, 2010
FAQs on Health Care Reform and COBRA
EBSA has created a list of frequently asked questions about how health care reform affects COBRA.
Uploaded: November 26, 2010
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.
FMLA - DOL Online Elaw Resource
Uploaded: March 8, 2012
Fact Sheet – Amendment to Regulations on Grandfathered Status
This November 2010 HHS publication is a brief synopsis of the amendment of earlier regulations whereby group health plans will be allowed to switch insurance companies and shop for the same coverage at a lower cost while maintaining their grandfathered status, so long as the structure of the coverage doesn’t violate one of the other rules for maintaining grandfathered plan status.
Fact Sheet - Amended Regs, Grandfathered Status
Uploaded: November 16, 2010
Fact Sheet – Coverage of Young Adult Children to Age 26
This fact sheet on the DOL/EBSA website discusses the Affordable Care Act’s provision allowing children up to age 26 to remain on a parent’s health care plan.
Fact Sheet - Health Care Coverage for Adult Children
Uploaded: August 24, 2011
Fact Sheet – Medical Loss Ratio
This November 2010 HHS online publication summarizes provisions in the Affordable Care Act that limit the percentage of insurance premiums that can be used to pay for administrative expenses beginning in 2011. The law requires insurance companies in the individual and small group markets to spend at least 80 percent of the premium dollars they collect on medical care and quality improvement activities. Insurance companies in the large group market must spend at least 85 percent of premium dollars on medical care and quality improvement activities.
Uploaded: November 26, 2010
Fact Sheet – Transparency for Annual Dollar Limits of Mini-Med Plans
This Fact Sheet posted on the HealthCare.gov website December 9, 2010, discusses how health insurers offering mini-med plans must notify consumers in plain language that their plan offers extremely limited benefits and direct them to the HealthCare.gov website where they can get more information about other coverage options.
Fact Sheet - Mini-Med Plan Annual Limits
Uploaded: December 13, 2010
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.
Health Insurance Rate Increases
Uploaded: December 29, 2010
Few Employers Planning to Drop Health Plans After Reform Is in Place
A preview of findings from Mercer’s 2010 National Survey of Employer-Sponsored Health Plans shows that relatively few employers anticipate dropping coverage when state-run insurance exchanges become operational in 2014.
Survey - Employers and Health Care Reform
Uploaded: November 22, 2010
Guidance on Annual Limit Waivers and Minimum Loss Ratio for Mini-Meds
This November 2010 commentary by Aon Hewitt discusses the HHS’s waiver process for mini-med plans whose annual limits for essential services is below those required by the ACA. The article also outlines a new requirement for group health plans and health insurers to issue specific notices to participants of these plans.
Mini-Meds - Annual Limits and Medical Loss Ratio
Uploaded: November 16, 2010
HHS Fact Sheet on Proposed Regulations on Summary of Benefits and Coverage; Uniform Glossary of Term
The HHS has released a Fact Sheet on rules under the Affordable Care Act provisions that would ensure consumers have access to two forms that will help them understand and evaluate their health insurance choices: an easy-to-understand Summary of Benefits and Coverage; and a uniform glossary of terms commonly used in health insurance coverage.
Uploaded: August 19, 2011
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.
SBC - Sample Benefits Coverage Calculations
Uploaded: March 1, 2012
Health Care Reform – A Primer for Employers
This Benefits Alert from the law firm Nixon Peabody LLP summarizes some of the significant implications of health care reform for employers.
Uploaded: November 4, 2010
Health Care Reform – At-a-Glance Chart of Provisions
Buck Consultants provides a chart of various provisions together with the effective dates and implications for large employers.
Uploaded: November 11, 2010
Health Care Reform – Timeline for Calendar Year Plans
The Segal Company provides this quick reference chart of effective dates for various components of the Affordable Care Act.
Uploaded: October 29, 2010
Health Insurance Exchanges - Initial Guidance to States
In November 2010, the HHS issued the first in a series of guidance documents to be issued over the next three years to give states and territories information on establishing a Health Insurance Exchange in accordance with provisions in the Affordable Care Act.
Uploaded: November 26, 2010
Healthcare Reform in 2012: Blind Curves Ahead, Milliman Insight Article
This February 2012 article published in Milliman’s Insight lays out the various scenarios for healthcare reform, depending upon the Supreme Court’s anticipated ruling on the law in June or July of 2012 and the outcome of the presidential election in November.
Healthcare Reform's Prospects in 2012
Uploaded: March 6, 2012
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.
ACA - Dental and Vision Benefits
Uploaded: December 10, 2010
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.
Uploaded: November 26, 2010
Model Language to Notify Plan Participants of Annual Dollar Limits That Apply to Mini-Med Plans
This December 2010 notice from the Department of Health and Human Services provides model language that mini-med health plans must use to disclose the annual dollar limits of the plan to participants.
Model Language - Mini-Med Plans
Uploaded: December 13, 2010
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.
Reimbursement for OTC Medicines
Uploaded: December 13, 2010
Recommended Preventive Services Under the ACA
The ACA requires new plans and issuers to cover certain preventive services without any cost-sharing for the enrollee when delivered by in-network providers. Interim final regulations, issued in July 2010, do not apply to grandfathered plans and issuers. This website provides links to the items and services that must be covered under the interim final regulation.
Uploaded: January 3, 2011
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.
Uploaded: November 12, 2010
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.
Uploaded: November 10, 2010
Revisions to ACA’s Grandfathering Rules Permit Change in Insurers
This Segal Co. Capital Checkup discusses the revision to the Affordable Care Act’s Grandfathering provision that allows plan sponsors to change health insurance coverage without losing grandfathered status under certain conditions.
Revision of Grandfathering Rules
Uploaded: January 6, 2011
Rules for Coverage on Adult Children Clarified
This June 2010 publication by Sibson Consulting reviews the regulations for the age 26 mandate issued in April and May 2010. Included is an overview of the mandate and who is covered by it as well as discussion of how the mandate interacts with Michelle’s Law and other student health plans.
Uploaded: November 12, 2010
Summary of Benefits and Coverage - Sample Completed Template
This DOL/EBSA link provides a look at a sample completed Summary of Benefits and Coverage form.
Sample Completed Benefits & Coverage Form
Uploaded: August 22, 2011
Summary of Benefits and Coverage Template
This DOL/EBSA link provides a look at the department’s proposed template for the Summary of Benefits and Coverage required under PPACA.
Summary of Benefits and Coverage Proposed Template
Uploaded: August 19, 2011
Survey – Employer Response to Health Care Reform
This August 2010 Towers Watson survey reveals that, for now, employers are focusing on how to comply with the law but will shift to a more strategic position and develop multi-year approaches in 2011.
Survey - Employers and Health Care Reform
Uploaded: October 29, 2010
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.
Uploaded: November 10, 2010
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.
Glossary - Health Insurance and Medical Terms
Uploaded: August 22, 2011
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.
W-2 - Health Care Coverage Reporting
Uploaded: October 21, 2010
What Does the Public Know About the New Health Care Law?
Not much, according to a Fast Facts release of data from EBRI’s 2010 Health Confidence Survey.
Uploaded: November 9, 2010
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