Agency Guidance Released on Health Care Reform Issues, Including Wellness, Essential Health Benefits, and Insurance Market Rules

Advance copies of agency guidance on a variety of health care reform issues have been released and are scheduled for future publication in the Federal Register.

• Wellness Programs. The IRS, DOL, and HHS have jointly released proposed regulations regarding nondiscriminatory wellness programs in group health plans that would increase the maximum permissible reward from 20% to 30% of the cost of coverage and permit a reward of up to 50% for wellness programs designed to prevent or reduce tobacco use. Proposed clarifications of the reasonable design and reasonable alternative standards are also included, as well as new sample language for the required notice. (See Federal Register and fact sheet.)
• Essential Health Benefits, Actuarial Value, Accreditation Standards. HHS has released proposed regulations outlining the essential health benefits (EHB) standards that insurers would have to meet in coverage offered in the individual and small-group markets, both inside and outside an exchange. The proposed regulations also address standards for determining the actuarial value of coverage and provide a timeline and application process for insurers to become accredited to offer coverage through federally-facilitated and state-partnership exchanges. (See Federal Register and fact sheet.) A separate notice was also issued recognizing two entities as accredited for purposes of QHP certification. (See advanced copy.) 
• Health Insurance Market Rules. HHS has released proposed rules that would implement a variety of key insurance reforms, including guaranteed availability and renewability of coverage, permissible rating factors for health insurance premiums, risk pool restrictions, and catastrophic-coverage plans. The proposed regulations also address data collection for insurers and states, and revised timelines for state monitoring of health premium increases. (See Federal Register and fact sheet.)

For more information, visit the DOL Health Care Reform webpage and CCIIO Health Care Reform webpage.

Large Group and Self-Funded Plans

Attorneys Jon W. Breyfogle and Tamara S.Kilion of Groom Law Group point out that while the Essential Heath Benefits Bulletin explicitly addresses EHB for purposes of the individual and small-group market, the definition of the essential health benefits is critical to self-funded and large plans. Under the Affordable Care Act, group health plans and health insurance issuers are prohibited from placing annual or lifetime limits on benefits that are "essential." Because of the potential inclusion (for 2014 and 2015) of state-mandated benefits in the benchmark EHB plan for each state, the proposed outline by CCIIO may become difficult for self-funded plans operating in multiple states to administer, as every state may have different essential health benefits. 

Click here to read the full article. 

The Impact of PPACA Rules 

According to an analysis, the proposed regulations governing essential benefits that must be included in health care plans sold through exchanges provides states and insurers "a high level of flexibility."

State or federal government will operate the exchanges, with some states deciding not to participate as a political issue.  

The 131 pages of proposed rules are designed to carry out the mandates under PPACA and govern the individual and small-group markets. Click here to read more.  

American Benefits Council officials said the premium restrictions ---- in which premiums are prohibited from ---- would apply to the large-group market if a state permits large employers to purchase coverage through an exchange (which they are eligible to do beginning in 2017).

KHN ---- After the Election: A Consumer's Guide to the Health Law

According to Kaiser Health News (KHN), the law contains a number of provisions that are changing the rules of health care for consumers. Just a few of the questions raised by the law include:

• I don't have health insurance. Under the law, will I have to buy it and what happens if I don't?
• I get my health coverage at work and want to keep my current plan. Will I be able to do that? How will my plan be affected by the health law?
• I want health insurance but I can't afford it. What will I do?
• What if I make too much money for Medicaid but still can't afford to buy insurance?
• Will it be easier for me to get coverage even if I have health problems?
• I own a small business. Will I have to buy health insurance for my workers?
• I'm over 65. How does the legislation affect seniors?
• Will I have to pay more for my health care because of the law?
• Has the law hit some bumps in the road?
• Are there more changes ahead for the law?

Click here for responses and the full article.

Society of Human Resource Professionals (SHRP) Health Promotion and Wellness Workshop

December 13, 2012 ---- Italian Community Center ---- Milwaukee, WI 

SHRP offers a unique learning experience exclusive to MRA members.

BSG's Health and Wellness Consultant, Michelle Spehr, will present:

• Beyond Health Fairs: Developing a Wellness Business Plan that Will Improve Employee Health and Change Your Culture

This event is open to MRA members only. To learn more about the SHRP event, MRA membership and how to register, click here.   

BizTimes Annual Economic Trends Event

January 18, 2013 ---- Italian Conference Center ---- Milwaukee, WI

Jerry Frye will participate in a vibrant discussion between prominent Wisconsin business leaders, state representatives, and industry experts on the state of the economy. 

To learn more about the event and how to register, click here.

 HR360