Atlanta – If you’re wondering what the new federal health care legislation has in store for you or your employees, you are not alone. Few have read the 2,700-page Patient Protection and Affordable Care Act (PPACA) and even fewer are able to absorb its full implications.
Each week brings new regulations from the U.S. departments of Labor, Health and Human Services and the Treasury. With so much happening so fast how can employers, insurance agents, consultants, lawyers or insurance companies keep up with the myriad decisions to set strategies, make rational choices and be legally compliant?
Several regulatory pronouncements have recently been released. In particular, two important Interim Final Regulations necessitate employers making key financial and strategic decisions regarding their health plans:
1. On June 14, 2010, an Interim Final Regulation was released for group health plans to qualify as “grandfathered.” Plans applying for grandfathered status can avoid some mandated benefits required by the new law.
2. On June 28, 2010, another regulation was released for preventive care. The new preventive care coverages are effective for plan years beginning on or after Sept. 23, 2010. Plans that are not grandfathered must cover – without cost-sharing – preventive services rated “A” or “B” by the U.S. Preventive Services Task Force. They must also cover certain immunizations and other preventive services for infants, children, adolescents and women in guidelines developed by the Department of Health and Human Services.
Even if a plan claims grandfathered status, it will have to comply with several new mandates beginning in 2011. These plans must offer dependent coverage to children until age 26. They cannot impose pre-existing conditions on children under age 19. They cannot have annual and lifetime dollar limits on benefits. To keep their grandfathered status, plans will be limited in changing insurance companies, benefit designs and employee cost-sharing. The new rule requires plans to provide employees notice of its decision to be a grandfathered plan.
What does a plan save by being grandfathered? The main savings are in avoidance of the mandated preventive care services at 100 percent. A secondary issue is avoidance of the mandated guaranteed access requirements to OB-GYNs and pediatricians.
The mandated preventive care services are complex; there are exceptions and limits for many of the coverages. The general understanding is coverage identified by the task force with an “A” or “B” rating is mandated. But that is only one source of required coverages. The new law mandates:
(1) U.S. Preventive Services Task Force evidence-based items or services rated “A” or “B”
(2) The Advisory Committee on Immunization Practices recommendations for immunizations
(3) Health Resources and Services Administration recommendations on infant, child and adolescent screenings
(4) Health Resources and Services Administration recommendations on screenings for women.
Each company will need to assess its situation and strategic goals to determine what is in its own best interests. Companies have critical cost-benefit calculations to make regarding their plans. What are the costs or savings of the new preventive care services in the short and long term? What new services not now covered voluntarily are mandated? What limitations are allowed? How do the plan demographics (e.g. male/female, single/family) affect the costs?
To make those determinations, many will rely on the insurer, third party administrator, broker or consultant. To know the right questions to ask advisors, many benefit managers need to independently study these and other mandates in the new law.
Volumes of information are being produced. It is important to research original source documents, to read the actual legislation, regulations and government-produced guidelines, to hear respected legal opinions, and to study independent consultant observations. It can be time-consuming and confusing to find direct answers for a plan’s specific situation.
That’s where the GPPF Health Reform Navigator comes in. An inexpensive source that provides easy point-and-click researching for insurance and tax/penalty topics contained in the new law, the Health Reform Navigator guides you through the shifting maze of federal health reform regulations. It includes Web links to knowledgeable independent legal briefs and national consultants’ analyses and surveys. The Navigator’s dashboard highlights hot topics and provides hyperlinks directly to relevant sections of the law.
After initial purchase, updates as released are provided free of charge for a limited period. As a bonus, purchase entitles you to a free download of the “Preventive Care Navigator” from theGPPF Health Reform Navigator site. The Preventive Care Navigator is a free download whether or not you buy the Health Reform Navigator.
Don’t be without these creative tools to current resources. Optimize the chances that your benefit managers are informed enough to make the important decisions and choices required by the Patient Protection and Affordable Care Act. Get the Health Reform Navigator; get the knowledge to protect your business, your employees and you.
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