Posts Categorized: Affordable Care Act

Relief for Mini-Med Plans from Restrictive MLR Rules

in Affordable Care Act

Yesterday, many plan sponsors of mini-med plans publicly noted that the upcoming MLR regulations may force them to terminate their mini-med plans. Currently, the NAIC has published draft rules. Next month HHS is required to take that draft and turn it into proposed regulations on the medical loss ratio standards. Moments ago the Director of OCIIO released a statement saying in part that when OCIIO releases the proposed MLR regulations, it fully intends to exercise discretion under the new law to address the special circumstances of mini-med plans in the medical loss ratio calculations. According to the Affordable Care Act,… Continue Reading

Retiree Only Plans – Time is Running Out

in Affordable Care Act, Retiree Benefits

The so-called “retiree-only” plan exception has been around since HIPAA was passed back in 1996.  However, it has taken on new importance now that a retiree-only plan can also be exempt from the provisions of the Affordable Care Act.  But, what is this amorphous being?  In the past some employers have claimed that this exception applies at the benefit option level even if retiree options are wrapped together with active employee options in the same ERISA plan.  This position is certainly harder to maintain under the proposed DOL regulations defining a “plan” for Part 7 purposes.  But, clearly if an employer… Continue Reading

IROs – Relief or Confusion?

in Affordable Care Act

Late Tuesday, DOL released FAQs regarding various miscellaneous ACA issues.  DOL also released additional guidance on the claims and appeals procedures in Technical Release 2010-02.   THe FAQs can be seen here: http://www.dol.gov/ebsa/faqs/faq-aca.html The FAQs are a strange aggregation of items.  One of the FAQs states that with respect to IRO contracts that the earlier DOL guidance never required a contract between a plan and an IRO.  This is in direct contradiction with Technical Release 2010-01 which specifically states that a contract between a plan and an IRO must contain specific language as set forth in the release.  If a contract… Continue Reading

Nondiscrimination for Insured Plans – Update

in Affordable Care Act

A few weeks ago we informed you of the delay in regulations regarding the insured plan nondiscrimination rules.  Yesterday, the IRS published Notice 2010-63, requesting information regarding how the new nondiscrimination rules should apply to insured plans and the interaction with 105(h).  Comments are due by November 4, 2010.  The IRS is likely looking at how it can combine nondiscrimination testing when a single sponsor has multiple insured options and/or multiple insured and self-insured options.  Based on the timing for comments, i would not expect regulations to be issued until the early part of 2011.  Link to Notice 2010-63 is as… Continue Reading

Nondiscrimination for Insured Plans

in Affordable Care Act

New PHSA Section 2716 adopts new nondiscrimination rules on insured health plans beginning with the first plan year after September 23, 2010 (or January 1, 2011 for calendar year plans). The statute provides that rules similar to the Code Section 105(h) rules for self-insured plans shall apply for this purpose. We thought that the regulations implementing this new requirement were to be released soon. However, last week we heard, unofficially, that the regulations have been delayed, meaning that employers with insured plans have no idea whether their health plans will satisfy the new regulations when annual enrollment season begins next month…. Continue Reading