Changing Plan Years Won’t Extend Health Plan’s Affordable Care Act Annual Limit Waiver Eligibility


Employer and other group health plan sponsors, insurers, fiduciaries and administrators should brace to cope with difficulties in upcoming 2014 health plan enrollment challenges in light of sweeping health plan changes, process and system disruptions complicated by incomplete and delayed guidance, and other changes arising from the rollout of the Patient Protection & Affordable Care Act (ACA), particularly with the deadline to provide ACA-required Summary of Benefits and Coverage (SBC) disclosures by the first day of the annual enrollment period for the 2014 plan year rapidly approaching. 

Confusion and indecision about health plan choices is a common challenge for employees and participants that historically has plagued efforts by employer and other group health plans, their sponsors, administrators and insurers to efficiently conduct annual enrollment.  Sweeping health plan changes and other simultaneous changes to the U.S. health care system resulting from the reforms enacted as part of ACA promise to add significant complexity and confusion to the process.  

Recent polls confirm that American workers generally are unfamiliar and confused about ACA, its status and its implications for them.  See Kaiser Tracing Poll:  April 2013 ;  See also Kaiser Foundation Poll Finds Confusion Over ACA Abounds With Open Enrollment Six Months Away.

Amid this confusion, employer and other group health plans and insurers are struggling to finalize decisions and begin preparations as a result in delays in guidance, delayed or slow implementation of exchanges, and other challenges arising in response to the ACA reforms that obstruct plan sponsor decision-making and health plan’s ability to implement these decisions.  Much guidance group health plans, their sponsors and insurers need to make decisions and implement arrangements is only now emerging, and that in largely late-breaking and/or transitional form.  These delays, in turn, are making group health plans, their sponsors, insurers, fiduciaries and administrators ability to finalize arrangements and contracts, amend plan documents, prepare newly required Summary of Benefits & Coverage (SBC) disclosures (required to be distributed by first day of enrollment period), summary plan descriptions (SPDs), enrollment materials and other communications and processes.  With SBCs due to be distributed by the first day of any enrollment period for 2014, the time to prepare is running extremely short.  Deadline To Send ACA Summary of Benefits & Coverage Adds Pressure To Finalize 2014 Plan Designs As Agencies Add MEC & MV Disclosures To SBC.

In the face of these challenges, Federal regulators are looking to shift many of the burdens of dealing with enrollment difficulties on employers and insurers.  See Insurers Prepare, Reluctantly, To Help With Obamacare Enrollment.

While employer and other plan sponsors, insurers, fiduciaries and administrators may not have all of the information and rules they might need or ideally like to finalize all arrangements and documents, they generally must get moving on those preparations that they can begin now to allow adequate time to deal with late-breaking guidance and finalize other arrangements.   To minimize the risk of running outof time and to allow time to smooth out confusion and other arrangements, employer and other health plans, their sponsors, insurers, fiduciaries and administrators should get started preparing draft contracts, plan amendments or restatements, draft SBC, SPD and other enrollment and coverage materials and processes to position themselves to be able to timely finalize and launch these arrangements.

For Help or More Information

If you need help with the SBC or other 2014 health plan decision-making or preparation, or with reviewing and updating, administering or defending your group health or other employee benefit, human resources, insurance, health care matters or related documents or practices, please contact the author of this update, Cynthia Marcotte Stamer.

A Fellow in the American College of Employee Benefit Council, immediate past Chair of the American Bar Association (ABA) RPTE Employee Benefits & Other Compensation Group and current Co-Chair of its Welfare Benefit Committee, Vice-Chair of the ABA TIPS Employee Benefits Committee, 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, Ms. Stamer is recognized, internationally, nationally and locally for her more than 25 years of work, advocacy, education and publications on cutting edge health and managed care, employee benefit, human resources and related workforce, insurance and financial services, and health care matters. 

A board certified labor and employment attorney widely known for her extensive and creative knowledge and experienced with these and other employment, employee benefit and compensation matters, Ms. Stamer continuously advises and assists employers, employee benefit plans, their sponsoring employers, fiduciaries, insurers, administrators, service providers, insurers and others to monitor and respond to evolving legal and operational requirements and to design, administer, document and defend medical and other welfare benefit, qualified and non-qualified deferred compensation and retirement, severance and other employee benefit, compensation, and human resources, management and other programs and practices tailored to the client’s human resources, employee benefits or other management goals.  A primary drafter of the Bolivian Social Security pension privatization law, Ms. Stamer also works extensively with management, service provider and other clients to monitor legislative and regulatory developments and to deal with Congressional and state legislators, regulators, and enforcement officials about regulatory, investigatory or enforcement concerns. 

Recognized in Who’s Who In American Professionals and both an American Bar Association (ABA) and a State Bar of Texas Fellow, Ms. Stamer serves on the Editorial Advisory Board of Employee Benefits News, the editor and publisher of Solutions Law Press HR & Benefits Update and other Solutions Law Press Publications, and active in a multitude of other employee benefits, human resources and other professional and civic organizations.   She also is a widely published author and highly regarded speaker on these matters. Her insights on these and other matters appear in the Bureau of National Affairs, Spencer Publications, the Wall Street Journal, the Dallas Business Journal, the Houston Business Journal, Modern and many other national and local publications.   You can learn more about Ms. Stamer and her experience, review some of her other training, speaking, publications and other resources, and register to receive future updates about developments on these and other concerns from Ms. Stamer here.

Other Resources

If you found this update of interest, you also may be interested in reviewing some of the other updates and publications authored by Ms. Stamer available including:

For important information about this communication click here. THE FOLLOWING DISCLAIMER IS INCLUDED TO COMPLY WITH AND IN RESPONSE TO U.S. TREASURY DEPARTMENT CIRCULAR 230 REGULATIONS.  ANY STATEMENTS CONTAINED HEREIN ARE NOT INTENDED OR WRITTEN BY THE WRITER TO BE USED, AND NOTHING CONTAINED HEREIN CAN BE USED BY YOU OR ANY OTHER PERSON, FOR THE PURPOSE OF (1) AVOIDING PENALTIES THAT MAY BE IMPOSED UNDER FEDERAL TAX LAW, OR (2) PROMOTING, MARKETING OR RECOMMENDING TO ANOTHER PARTY ANY TAX-RELATED TRANSACTION OR MATTER ADDRESSED HEREIN.

©2013 Cynthia Marcotte Stamer, P.C.  Nonexclusive license to republish granted to Solutions Law Press, Inc.  All other rights reserved

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