Employee Benefit Security Administration
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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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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Department of Labor releases FAQs on mental health parity compliance
Posted on May 10, 2012
The Department of Labor’s Employee Benefits Security Administration published a set of frequently asked questions (FAQs) regarding implementation of the Mental Health Parity and Addiction Equity Act of 2008.
Amongst other topics, the FAQs address…
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Three federal agencies release request for information on stop-loss coverage
Posted on April 30, 2012
On April 27, 2012, the Department of the Treasury’s Internal Revenue Service (IRS), the Department of Labor’s Employee Benefits Security Administration, and the Department of Health and Human Services’ (HHS) Centers for Medicare & Medicaid Services (CMS) issued a request for information (RFI) regarding the use of stop loss insurance by group health plans and their plan sponsors, with a focus on the prevalence and consequences of stop loss insurance at low attachment points, or the point at which excess insurance or reinsurance limits apply.
Concerns have circulated that the practice could lead to higher costs in small group health insurance exchanges. Stop-loss insurance protects self-insured companies against claims above the attachment point. Employers and plans that purchase stop-loss insurance generally are not subject to state health insurance laws regarding coverage, rating policies, and other state and federal consumer protections, and thus could prove financially risky in the exchange market. Specifically, if the practice is widespread, it could worsen the risk pool and increase premiums in the insured small group market, including the Small Business Health Options Program (SHOP) exchanges.
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Final rule released requiring insurers to use plain language in describing benefits, coverage
Posted on February 9, 2012
Today the Department of Health and Human Services, the Department of Treasury, and the Department of Labor released a final rule requiring insurers to use plain language in describing health plan benefits and coverage under the Affordable Care Act (ACA). The regulations mandate health insurers and group health plans to provide concise and comprehensible information about health plan benefits and coverage to Americans with private health coverage. The new rules will also facilitate easier plan comparison for individuals and employers. The new explanations, available on or soon after September 23, 2012, will be a critical resource for the roughly 150 million Americans with private health insurance. Specifically, these rules will ensure consumers have access to two key documents that will help them understand and evaluate their health insurance choices…
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HHS issues amended preventive services IFR
Posted on August 1, 2011
The U.S. Department of Health and Human Services (HHS) has issued an amended version of the previous Interim Final Rule on the coverage of preventive services by group health plans and health insurance issuers under the Affordable Care Act (ACA). The amended rule reflects recent recommendations by the Institute of Medicine (IOM) regarding particular preventive services for women that should be covered at no cost by insurance companies. Services include screening and counseling for certain sexually transmitted infections, screening for gestational diabetes, and among others, counseling and contraception to prevent unintended pregnancies. The Internal Revenue Service has also issued an amended rule that reflects the coverage of these preventive services.
*** On August 3, 2011, HHS issued an amendment to the amended IFR, further clarifying the expemption of religious organizations from the contraception coverage requirement.
For more information on prevention, click here.
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DOL/IRS issue amendments to IFR on claims appeals
Posted on June 22, 2011
The US Department of Labor (DOL) and the Internal Revenue Service (IRS) have issued separate amendments to the July 23, 2010 Interim Final Rule (IFR) on internal claims and appeals and external review processes for group health plans and health insurance issuers offering coverage in the group and individual markets. The Employee Benefits Security Administration (EBSA) of the Department of Labor has also issued new guidance on the subject.
The IFR, recent amendments, and recent guidance do not apply to grandfathered plans.
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