Wpbsa pocket template

Several legal developments affect the designs of group health plans in 2016. This brief refresher of those developments may be helpful to employers whose open enrollment is just around the corner.New preventive care services. Starting in 2016, calendar year plans must cover additional preventive services that were recommended in 2014. Employers must offer a required preventive service or item without cost-sharing starting in the plan year that begins after the first anniversary of the date the coverage requirement is issued. The additional preventive services recommended by the US Preventive Services Task Force are available here. The complete list of preventive services that are currently required to be covered is available here. The preamble to recently published final regulations indicates the federal government intends to update the Healthcare.gov website to include (a) the dates that each preventive item or service was recommended and (b) new recommendations and … [Read more...] about Legal Developments Affect Open Enrollment for 2016

The out-of-pocket costs of compliance with the SEC conflict minerals rule have been lower than those originally estimated by industry and by the SEC. But, it’s not because the original estimates were over-stated or inflated.  And, these lower than expected out-of-pocket costs don’t mean that business’ concerns about compliance were misplaced.  These lower costs have resulted mostly (but not completely) from tools and approaches developed by industry.So, borrowing from late night TV, here are (in reverse order) 11 reasons why the out-of-pocket costs of compliance with the SEC conflict minerals rule have been lower than originally estimated:11.  Scoring and benchmarking by only one group. The most significant and visible scoring and benchmarking of conflict minerals disclosure has been done by one group — initially the group was at Tulane University and now that group is known as Development International. … [Read more...] about Costs of Conflict Minerals Compliance (1 of 3) – Why lower than expected?

On December 30, 2014, the Departments of Health and Human Services, Labor, and the Treasury (collectively, “Departments”) issued a proposed rule (“Proposed Rule”) regarding the summary of benefits and coverage (“SBC”) for use by group health plans and health insurance coverage in the group and individual markets. The Proposed Rule, which would amend the SBC regulations that were issued in 2012, also includes proposed revisions to materials related to the SBC, such as the SBC templates, an instruction guide, a uniform glossary of certain insurance and medical-related terms, and other supporting materials.The Departments are accepting comments on the Proposed Rule through March 2, 2015.BackgroundThe SBC regulations and supporting materials provide standards by which group health plan and health insurance issuers offering group or individual health insurance coverage communicate certain plan-specific information to the plan, to beneficiaries, or to … [Read more...] about Obama Seeks Comments on Proposed Changes to Summary of Benefits and Coverage

On December 2, 2015, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule titled “Patient Protection and Affordable Care Act; CMS Notice of Benefit and Payment Parameters for 2017” (“Proposed Rule”)[1] containing proposals to create regulatory standards for a new health insurance exchange (“Exchange”) model. The Proposed Rule also provides new network adequacy requirements and changes to requirements relating to, among other things, (i) qualified health plan (“QHP”) standards; (ii) cost sharing; (iii) medical loss ratio (“MLR”) requirements; (iv) the rate review program; and (v) the risk adjustment, reinsurance, and risk corridors programs. These proposals would continue to strengthen the federal requirements imposed on QHPs and, in some circumstances, compel states to strengthen their standards as well or defer to federal rules. CMS will be accepting comments on the Proposed Rule … [Read more...] about CMS Continues to Strengthen Federal-Level Requirements for Qualified Health Plans

On April 6, 2016, the Department of Health and Human Services, Department of Labor and Department of the Treasury (collectively, the Departments) issued changes to the Summary of Benefits and Coverage (SBC) template and glossary.  What are some of the major changes?New Coverage Example – The current form includes examples to show cost-sharing that would apply for diabetes care and childbirth. The new form also includes an emergency situation caused by a foot fracture.Out-of-Pocket Limits – The new form requires that plans describe the individual and overall out-of-pocket limits that apply. The new form includes standard language to use for “embedded” and “non-embedded” out-of-pocket limits.Preventive Services – A description of preventive services that are covered without cost-sharing must be included in the SBC.Abortion Services – If covered under the plan, abortions should be listed in the … [Read more...] about Updates to the Summary of Benefits and Coverage