Posts Tagged: Essential Health Benefits

Essential Health Benefits for Self-Insured Plans

in Affordable Care Act

The meaning of “essential health benefits” is an issue for self-insured plans in several contexts, including the annual and lifetime limit restrictions and the determination of whether the plan provides minimum value. For purposes of determining minimum value, employers will have to select a benchmark plan against which to measure their plan. Although, they aren’t required to offer the same benefits that are provided in the benchmark plan. In 2010, the agencies issued interim guidance regarding the annual and lifetime limit restrictions in which they defined essential health benefits by reference to Section 1302(b) of the Affordable Care Act and… Continue Reading

HHS Proposed Regulations – Wellness Plans

in Affordable Care Act, Wellness Programs

This morning HHS released three separate proposed regulations for public inspection. The official copies of the proposed regulations are scheduled to be included in the Federal Register for November 26th. This first group is just the tip of the iceberg. Much more guidance is expected over the next 3-4 months. However, an air of mystery surrounds the most important piece of guidance that was released this morning – the nondiscrimination rules for wellness plans. 1. Guaranteed Availability and Renewability of Coverage. [Link] This proposed rule would implement the Affordable Care Act’s policies related to fair health insurance premiums, guaranteed availability,… Continue Reading

Minimum Essential Value Guidance

in Affordable Care Act

Yesterday, the Service issued a flurry of IRS Notices under the Affordable Care Act. IRS Notice 2012-31 describes possible approaches to determining minimum value under an eligible employer-sponsored plan. A large employer may be assessed a penalty under the Affordable Care Act if any full-time employee cannot enroll in coverage that provides minimum value. Comments are requested by June 11. http://www.irs.gov/pub/irs-drop/n-12-31.pdf IRS Notices 2012-32 and 2012-33 request comments on Section 6055 and 6056. Both sections require insurers and self-insured plans to file annual returns reporting specific information for certain applicable individuals who are enrolled in coverage. Comments are due by… Continue Reading

Essential Health Benefits – Working Toward a Possible Solution

in Affordable Care Act

Last month our firm submitted comments on behalf of two clients concerning the proposal for essential health benefits (EHB).  (These comments are included in a prior post.)  The proposal set forth by HHS to rely on each state’s insurance laws is really unworkable for self-insured plans and large group insured plans, and it is also contrary to ERISA.  As released, the EHB proposal would require each multi-state employer to annually test its plan benefits for compliance with the annual and lifetime limits and the employer penalty based on each state’s EHB list. This test would have to be performed for… Continue Reading