Many employers and insurers that act quickly may qualify for a temporary reprieve from the obligation to redesign their group health plans and health insurance policies to comply with the annual benefit limitations on health plan benefits imposed under the Patient Protection and Affordable Care Act (Affordable Care Act) applicable to most health insurance plans and policies beginning with post-September 22, 2010 plan years.
On September 3, 2010, the U.S. Department of Health & Human Service published rules that enable qualifying employers and insurers to obtain a waiver of the application of ACA’s annual limits to their health plan for 2011 (Annual Limit Waiver). In addition to the Annual Limit Waiver relief, HHS on October 1, 2010 also announced plans in the near future to publish additional guidance to provide some relief for mini-meds and certain other plans from the medical loss ratio rules of ACA. Plan sponsors and insurers struggling to redesign their benefit programs to meet ACA’s annual limit and medical loss ration mandates for their 2011 plan year should act quickly to evaluate and where applicable take advantage of the added flexibility that this new guidance may afford regarding their 2011 plan design.
With compliance deadlines impending, however, plan sponsors and insurers must act quickly to leverage these opportunities and make other necessary arrangements to update their health programs to meet new federal requirements. When deciding how to respond to ACA and other new federal health plan rules, plan sponsors and insurers who maintain plans that can qualify as grandfathered plans under ACA should carefully consider all alternatives before deciding to forego this status. Many plan sponsors and insurers feel soaring health coverage costs require that they make cost-saving plan design changes that preclude them from maintaining a grandfathered plan. Creative use of the new Annual Benefit Limitation Waiver, grandfathered plan and other guidance may help mitigate the cost and other challenges of complying with these new federal rules. Read more details.
If your organization needs assistance to apply for an ACA Annual Limit Waiver, reviewing or updating your heath care program design, documentation, policies or procedures in response to ACA or other requirements or with other employee benefit, insurance or human resources matters, please contact the author of this update, Board Certified Labor & Employment attorney Cynthia Marcotte Stamer at (469) 767-8872 or via e-mail here.
Other Resources
If you found this information of interest, you also may be interested in reviewing other recent Solutions Law Press updates including:
- New Insured Group Health Plan Non-Discrimination Rules Create Significant Liability For Employers & Insurers; Prompt IRS Also To Review Self-Insured Group Health Plan Rules
- Affordable Care Act’s Health Plan External & Internal Review Safe Harbor & Other Regulations Require Health Plan Updates
- New Regulations & Court Decisions Require Health Plan Claims & Appeal Updates & Strengthening
- Small Employers Sponsoring Health Coverage May Qualify For New Tax Credit, Must Act Quickly To Comply With Other New Federal Health Plan Mandates Under Affordable Care Act & Other Laws
- Rite Aid Pays $1 Million HIPAA Privacy Settlement As OCR Tightens HIPAA Regulations
- New Affordable Care Act Mandated High Risk Pre-Existing Condition Insurance Pool Program Regulations Prohibit Plan Dumping of High Risk Members, Set Other Rules
- Testimony Highlights Growing Exposure of Businesses Misclassifying Workers; Businesses Should Act to Minimize Risks
- New Affordable Care Act Health Plan Appeals Regulations Require Health Plan Updates
- Agencies Release Regulations Implementing Affordable Care Act Health Plan Preventative Care Mandates
- Office of Civil Rights Proposes Changes To HIPAA Privacy, Security & Civil Sanctions Rules
- HHS, DOL & IRS Rules Define “Grandfathered” Group Health Plans & Health Insurance Coverage under the Patient Protection and Affordable Care Act
- Defined Contribution Plans Investing In Publically Traded Employer Securities Face New Requirements
- CBO Raises Estimated Cost of Health Care Reforms As Employers, Health Plans Brace Costs Of Newly Effective & Impending Mandates
- Labor Department FMLA Guidance Signals Need For Employer Care Determining Who Qualifies As Child
- Small Employers Sponsoring Health Coverage May Qualify For New Tax Credit, Must Act Quickly To Comply With Other New Federal Health Plan Mandates Under Affordable Care Act & Other Laws
- Join Project COPE: Help Develop Real Tools To Meaningfully Empower Patients & Improve Health Care Access, Affordability & Quality
About Ms. Stamer
Chair of the American Bar Association (ABA) RPTE Employee Benefit & Other Compensation Group, a Council Member of the ABA Joint Committee on Employee Benefits and Past Chair of the ABA Health Law Section Managed Care & Insurance Interest Group, Cynthia Marcotte Stamer is nationally recognized for her extensive work helping clients develop, implement and defend innovative, practical, legally defensible solutions to their particular health and other employee benefit, employment and insurance needs. Ms. Stamer has more than 23 years experience advising and representing employer, association and other plan sponsors, health and other employee benefit plans, their fiduciaries, plan administrators, consultants, vendors, outsourcers, insurers, governments and others about health plan and product design; administration, legal and operational risk management, vendor and fiduciary credentialing, managed care and vendor contracting, cost-containment, documentation, public policy, enforcement, privacy, technology, litigation and other concerns. Ms. Stamer also publishes, conducts client and other training, speaks and consults extensively on these and other health and managed care program concerns and practices for the ABA, American Health Lawyers Association, Institute of Internal Auditors, Society for Professional Benefits Administrators, HCCA, Southwest Benefits Association and many other organizations. Her insights on these and related topics have appeared in Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, Managed Healthcare, Health Leaders, various ABA publications and a many other national and local publications. To learn more about Ms. Stamer, her experience, involvements, programs and publications, see here or contact Ms. Stamer.
About Solutions Law Press
Solutions Law Press™ provides business risk management, legal compliance, management effectiveness and other resources, training and education on human resources, employee benefits, compensation, data security and privacy, health care, insurance, and other key compliance, risk management, internal controls and other key operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press resources available for review here. If you or someone else you know would like to receive future updates and notices about other upcoming Solutions Law Press events, please be sure that we have your current contact information – including your preferred e-mail- by creating or updating your profile at here. For important information concerning this communication click here.
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