Health Care Reform Update – Summary of Benefits and Coverage

Effective for plan/policy years and open enrollments (OEs) beginning on or after September 23, 2012, health insurers and self-insured group health plans will be required to provide a standard Summary of Benefits & Coverage (SBC) to enrolled members.

The group administrator is responsible for distributing SBCs to plan participants at least 30 days prior to renewal date (during the first day of OE), at initial enrollment, during special enrollments, 60 days prior to a material modification, and upon request.

Under the SBC requirements, willful failure to comply could result in up to a $1,000 fine per plan participant or beneficiary for each failure. HHS or the DOL can also issue an additional fine of $100 per day per affected person until the SBCs are properly issued.


For a more comprehensive overview on SBCs, please review the Reform Update 10/1/2012 - SBC Explanation and the SBC Sample. Current clients can log in to MyBasicGuru to access the Employer Notifications Checklist & Guide as well as Carrier specific information and instructions on obtaining SBCs.

Expanded Women’s Preventive Care Services

Under the Affordable Care Act, women’s preventive health care – such as mammograms, screenings for cervical cancer, prenatal care, and other services – is covered with no cost sharing for new health plans.

Additional women’s preventive services that will be covered in plan years starting on or after August 1, 2012 without cost sharing requirements include: Well-woman visits; Gestational diabetes screening; HPV DNA testing; STI counseling, and HIV screening and counseling; Contraception and contraceptive counseling; Breastfeeding support, supplies, and counseling; and Domestic violence screening.

The full list of covered preventive services can be found online at www.healthcare.gov. 

 

Supreme Court Ruling & Health Care Reform Update for 2012

Attached please find the update for Health Care Reform in 2012 that includes the following topics:

• Supreme Court Ruling;
• Politics & Ongoing Issues;
• ACA Already in Effect;
• ACA Next Steps;
• 2012 - Medical Loss Ratio Rebate, Women's Preventive Services, and Summary of Benefits and Coverage (SBC) Forms.
• 2013 – FSA Contribution Limit, Additional Medicare Tax, Medical Expenses Itemized Deduction, Exchange Notices, and Comparative Effectiveness Research Plan Fees.

 

Medical Loss Ratio Rebates

The Affordable Care Act requires health insurers in the individual and small group markets (2 to 50 employees) to spend at least 80 percent of the premiums they receive on health care services and activities to improve health care quality (in the large group market (51+ employees), this amount is 85 percent). This is referred to as the Medical Loss Ratio (MLR) rule or the 80/20 rule. If a health insurer does not spend at least 80 percent of the premiums it receives on health care services and activities to improve health care quality, the insurer must rebate the difference.

Health Care Reform News for 2012

Attached is an overview of some of the key provisions for Health Care Reform in 2012: 

• W-2 reporting,
• Small Business Health Care Tax Credit—available through 2013,
• Uniform Summary of Benefits and Coverage (SBC) Forms and Notice of Material Modifications—DELAYED,
• Medical Loss Ratio Rebate,
• Quality of Care Reporting,
• Comparative Effectiveness Research Plan Fees, and
• Women's Preventive Services.

Other topics addressed:

• Reform Lawsuits & Decisions
• Virginia Health Reform Initiative
• Pre-existing Condition Insurance Plan
• PPACA Grandfathered Plan Notice

Navigating the next phase of health care reform

Benefit changes. Coverage requirements. Tax credits. Exchanges. When it comes to health care reform, there’s a lot to know – and a lot to do. Here are some key provisions that will affect you through 2018.

Anthem Article: Navigating the next phase of health care reform; Your guide to making strategic decisions

Health Care Reform News for 2011

Attached is an overview of some of the key provisions for Health Care Reform in 2011: 

• Small Business Tax Credit
• Health Coverage and Older Children
• Changes to Over-the-Counter Drugs
• HSA Tax Penalty
• Nondiscrimination Testing Delayed
• W2 Reporting - Optional in 2011
• Pre-existing Condition Insurance Plan
• Virginia Health Reform Initiative
• Reform Lawsuits & Decisions
• PPACA Notices
• New Reform Website