InsuranceNewsNet Magazine May 2010 : Page 10
individuAls And emPloyer grouP PlAns cAn keeP their current Policy on A grAnd- FAthered bAsis if the only plan changes made are to add or delete new employees and any new depen- dents. once a plan loses its grand- fathered status, it will be subject to all of the market reforms in the leg- islation when they take effect. but most of the market-reform provi- sions slated to take effect six months after the bill’s signing will apply to all plans, including grandfathered ones. eligible smAll businesses (those that have no more than 25 FTes, pay average annual wages of less than $50,000 and provide quali- fied coverage) are eligible for phase one of the small business premium tax credit of up to 50 percent of pre- miums for up to two years. employers that provide a medicAre PArt d subsidy to retirees will have to account for the future loss of the deductibility of this subsidy in 2013 on liability and income statements. While the elimination of the deduct- ibility does not take effect until 2013, there could be an immediate account- ing impact. liFetime limits on the dollar value of bene- fits for any participant or beneficiary are prohib- ited. Annual limits will be allowed only through plan years beginning before Jan. 1, 2014, only on federally-defined non-essential benefits, and after that be prohibited. Small businesses that employ less than 50 peo- ple are eligible for A tAx credit equAl to 35% of their health insurance premiums. (50% by 2014.) All grouP And individuAl health plans will have to cover preexisting conditions for chil- dren 19 and under. Grandfathered status applies. heAlth coverAge rescissions Will be Prohibited, except for cases of fraud or inten- tional misrepresentation. All grouP And individuAl PlAns must cover specific preventive care services with no cost-sharing. They must also cover emergency services at the in-network level regardless of provider, allow enrollees to designate any in- network doctor as their primary care physician and have a coverage appeal process. All grouP And individuAl PlAns must cover dePendents uPto Age 26. However, through 2014, grandfathered group plans will only have to cover dependents who do not have another source of employer-sponsored coverage. FederAl grAnt ProgrAm For smAll emPloyers providing wellness programs to their employees begins. All neWheAlth insurAnce PlAns will have to comply with new regulations that lay out an appeals process for when claims are denied. All emPloyers must include on W2s the aggregate cost of employer-sponsored health benefits, for informational purposes. The tax on distributions from a heAlth sAv- ings Account that are not used for qualified medical expenses increases to 20 percent. otc drugs Will no longer be reim- bursAble under HSAs, medical FSAS, HrAs and Archer MSAs unless prescribed by a doctor. smAll emPloyers (less than 100) will be allowed to adopt new “simple cafeteria plans.” All emPloyers would be required to enroll employees in a new national public long-term care program, unless the employee opted out. Temporary reinsurance program for employers that provide retiree health coverage for emPloyees over Age 55 begins. Individuals that had previously been denied coverAge due to A Pre-existing condition will be able to obtain coverage through a high-risk pool. All business oWners will be subject to new expanded federal income tax requirements on payments of fixed or determinable income or compensation. A neWtyPe oF cAFeteriA PlAn available for small employers that is similar to the SIMPle retirement plan. A voluntAry FederAl long term cAre PlAn will be established. seniors enrolled in Medicare Advantage or Prescription Drug Plan will receive a 50% dis- count on brand name drugs immediately with prescription discounts to follow. A smAll business AlternAtive to a cafeteria plan will be presented so they may offer tax free benefits without having to deal with administrative costs. All group and individual plans and insurers must provide a summAry oF beneFits And A coverAge exPlAnAtion that will require substantially more information than current summary plan descriptions. There is a $1,000-per-enrollee fine for willful failure to provide the information. 10 InsuranceNewsNet Magazine May 2010 All group and individual plans and insurers must submit AnnuAl rePorts to the federal government and plan participants on whether the benefits provided under their plans meet federal criteria on improving health outcomes, preventing hospital readmissions, improving patient safety and reducing medical errors. existing heAlth insurAnce PlAns will now be subject to a rule that preventative care may not be subject to co-pay. SOURCE: National Association of Health Underwriters
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