Department of Labor
EBSA preliminary guidance requires employers to notify employees about insurance options
Posted on May 10, 2013
The Employee Benefits Security Administration (EBSA), a division of the Department of Labor, published guidance concerning employer notification of insurance options in the health insurance marketplaces established by the Affordable Care Act (ACA), including model language for employers to notify their employees on marketplaces and employer-sponsored coverage. Technical Release Number 2013-02 states that employers must begin to inform their employees about available insurance options beginning October 1st, and the guidance contains a model notice for employers to utilize. EBSA released this guidance in advance of the proposed rule so that employers are equipped with the appropriate knowledge so they may begin to notify employees as soon as they desire.
IRS and EBSA issue next set of ACA FAQs
Posted on April 30, 2013
In the 15th set of Affordable Care Act (ACA) FAQs, the Internal Revenue Service (IRS) and the Employee Benefit Security Administration (EBSA) answer questions posed by the public and stakeholders to demystify the implementation of various components of the ACA. This particular set discusses annual limit waivers, stating that an alteration to a health plan or policy year will not impact the expiration of an annual limit waiver. The FAQs also indicate that IRS, EBSA and the US Department of Health and Human Services (HHS) will not issue guidance on provider nondiscrimination prior to January 1st, 2014, because the statutory language on the topic is “self-implementing.” In regards to transparency reporting, the FAQs clarify that plans are not beholden to the transparency provisions of the ACA until the plans have been certified as a qualified health plan (QHP) for one benefit year.
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EBSA posts FAQs on summaries of benefits and coverage
Posted on April 25, 2013
The US Department of Labor Employee Benefits Security Administration (EBSA) published their 14th set of frequently asked questions regarding the implementation of the Affordable Care Act (ACA). One key topic covered by the FAQs addresses disclosure requirements for individual or group plan summary of benefits coverage (SBC). In regards to disclosure of minimum essential coverage and the attainment of minimum value requirements, the guidance does not make notable changes for the SBC during 2014, the second disclosure year. The FAQs also state that plans unable to alter their SBC for 2014 are permitted to use the authorized year template without penalty if they also provide a cover letter stating whether or not the minimum value requirements are met.
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Federal regulations limit wait for employer health plan to 90 days
Posted on March 19, 2013
A proposed rule issued yesterday by the US Department of Labor, US Department of Treasury, and the US Department of Health and Human Services (HHS) implements a provision in the Affordable Care Act (ACA) that requires employer-sponsored health plans to be activated for employees within 90 days. In addition, employers cannot require employees to accrue a minimum number of hours before the 90 day wait period starts. The rules specifically state the 90 day wait limit in and of itself is not an employer mandate.
Comments on the proposed rules will be due by May 20, 2013.
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HHS, Labor and Treasury extend temporary state external review process standards
Posted on March 18, 2013
In a guidance issued Friday, the US Department of Health and Human Services (HHS), US Department of Labor, and US Department of the Treasury extended the interim standards for state external review processes. These standards are meant to make health care claim denials easier for patients to appeal, as set forth in the Affordable Care Act (ACA). Under the new guidance, health insurance issuers will be deemed compliant as long as their external review processes meet the National Association of Insurance Commissioner (NAIC) interim process standards established by Technical Release No. 2011-02. The transitional period expires January 1, 2016, and issuers will then have to meet the standards from the July 2010 regulations issued by the federal government.
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DOL publishes whisteblower interim final rule
Posted on February 23, 2013
The Department of Labor (DOL) yesterday published an interim final rule that would provide regulations governing the employee protection (whistleblower) provision of section 1558 of the Affordable Care Act (ACA). The provision provides protections to employees of health insurance issuers or other employers who may have been subject to retaliation for reporting potential violations of the law’s consumer protections or affordability assistance provisions. This interim rule establishes procedures and time frames for the handling of retaliation complaints under section 18C.
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Departments of Labor, Treasury, and HHS release ACA FAQs Part XII
Posted on February 20, 2013
The Departments of Labor, Health and Human Services (HHS) and Treasury have jointly prepared a new set of Frequently Asked Questions (FAQs) regarding implementation of various provisions of the Affordable Care Act (ACA). The twelfth installment of the set, these FAQs answer questions from stakeholders to help people understand the new law and benefit from it, as intended. This round of FAQs covers cost-sharing limitations and coverage of preventive services. The FAQs state that employers cannot limit contraceptive coverage to oral contraceptives only. The Obama administration also specifies that over-the-counter contraceptives that are FDA-approved and prescribed by a doctor are included as required coverage.
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DOL/CMS issue joint FAQ extending deadline for employers to notify workers about exchange options
Posted on January 24, 2013
The Employee Benefit Securities Administration (EBSA) of the U.S. Department of Labor (DOL) and the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) have jointly released a Frequently Asked Questions (FAQ) document addressing multiple issues related to Affordable Care Act (ACA) implementation. Most notably, the FAQs extend the deadline by which employers must notify their employees about coverage options in the Exchanges from March 1, 2013, to sometime in “the late summer or fall of 2013, which will coordinate with the open enrollment period for Exchanges.” DOL made the determination in part because they feel the notifications should coincide with HHS outreach and educational efforts and IRS guidance on Exchange Qualified Health Plan (QHP) minimum value. Furthermore…
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IRS issues notice on full-time employee determination and guidance on waiting periods
Posted on September 4, 2012
Last week, the Internal Revenue Service (IRS) issued a notice regarding safe harbor methods that employers may use to determine which employees will be considered as full-time employees for purposes of the shared employer responsibility provisions under the Internal Revenue Code, as added by the Affordable Care Act (ACA). The guidance expands on the previous guidance by including a safe harbor method that may apply to newly-hired employees. The notice provides employers with the option to use a look-back measurement period of up to 12 months to determine whether new employees are full-time employees, without being subject to a payment for this period with respect to those employees.
Also last week, the IRS, Department of Health & Human Services (HHS), and Department of Labor (DOL) issued a notice regarding the 90-day waiting period limitation in Public Health Service Act (PHS Act). The PHS Act provides that, for plan years beginning on or after January 1, 2014, a plan or issuer offering group health insurance coverage shall not apply any waiting period that exceeds 90 days.
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Departments of Labor, HHS, and Treasury issue summary of benefits and coverage FAQs
Posted on May 17, 2012
The departments of Labor, Health and Human Services, and Treasury issued a set of 14 frequently asked questions (FAQs) and answers regarding implementation of the summary of benefits and coverage (SBC) provisions of the Affordable Care Act (ACA). Importantly in the FAQs, the departments announced that they would not take enforcement action against insurers in a number of circumstances for failure to fully comply with requirements that they provide a standardized SBC during the first year of applicability of the new rules.
The departments issued a final rule in February requiring insurers to use plain language in describing benefits and coverage. With the final rule, the departments released a uniform glossary of terms.
The guidance is the ninth set of FAQs posted regarding ACA compliance. This set of FAQs also addresses when plans and issuers can provide SBC electronically, circumstances that will trigger the requirement for an issuer to provide an SBC, and whether issuers are required to provide SBCs to group health plans or their sponsors that are shopping for coverage but have yet to submit an application.
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