OTC Guidance Released

in Affordable Care Act, Cafeteria Plans

The Affordable Care Act provides that the cost of an over-the-counter medicine or drug cannot be reimbursed from a health FSA or HRA unless a prescription is obtained. This new rule applies only to purchases made on or after January 1, 2011. Moments ago, the IRS released Notice 2010-59, which provides guidance regarding how this new rule will operate. A link to the guidance is appended below, and we will have additional details regarding the guidance next week.

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ERRP Approvals Released Today

in Affordable Care Act

Today, the HHS Office of Consumer Information and Insurance Oversight stated that it has approved nearly 2,000 plans representing a broad range of employers from all 50 States and the District of Columbia into the Early Retiree Reinsurance Program in this first round of approvals with more applications being reviewed every day.  Starting in September, approved applicants can begin submitting claims dating back to June 1, 2010 and, starting in October, approved applicants will begin to...Continue Reading

Mini-Med Update

in Affordable Care Act

Our August 23rd post discussed the status of the mini-med waiver program.  This program will allow mini-med sponsors to apply for a waiver from the annual and lifetime limit requirements prior to January 1, 2014.  We understand that the issuance of the waiver program requirements is imminent and the guidance may come as early as this week.  We will let you know as soon as it is released.

The Next Generation of Appeal Procedures

in Affordable Care Act

On Monday, the DOL released additional rules with respect to the Federal external appeal procedures.  These procedures apply to non-grandfathered self-insured health plans.  The procedures include a number of issues for plans and plan sponsors, and unfortunately there is little time to manage them. Calendar year plans will have until January 1, 2011 to accomplish the following –

  • The rules require the plan to process external appeals, send notices to participants and send the appeal to...Continue Reading

Significant Changes for Appeal Rules and EOBs

in Affordable Care Act

Previously, on July 23, 2010, DOL, HHS and Treasury issued interim final rules regarding the claim and appeal requirements under the Affordable Care Act.  These new requirements will apply to all non-grandfathered plans beginning January 1, 2011 (for calendar year plans).  Yesterday, DOL updated the rules by releasing two additional pieces of guidance - new Federal external appeal rules for self-insured plans and model notices for all plans. The Federal external appeal rules are...Continue Reading