Indianapolis, IN (PRWEB) December 21, 2012
To help employers quickly understand their obligations under the Patient Protection and Affordable Care Act (PPACA), United Benefit Advisors (UBA) has issued a summary of the most crucial components of the proposed rules recently released by the Department of Health and Human Services. PPACA is confusing as it is and staying up with "proposed" and "final" rule clarifications is even harder. In addition to the summary, UBA has broken each of the guidelines down further making them easier to understand.
On Nov. 20, 2012, the Department of Health and Human Services issued three sets of proposed rules that provide some of the details on how PPACA will probably unfold. In early December , 2012, they issued two more sets. All rules are still in the “proposed” stage, which means that there may – and likely will – be changes when the final rules are issued.
The proposed rules address:
Essential Health Benefits (EHBs) and Actuarial Value: The proposed rule confirms that non-grandfathered plans in the exchanges and the small group market will be required to cover the 10 essential health benefits and provide a benefit expected to pay 60, 70, 80 or 90 percent of expected allowed claims. The proposed rule also says that self-funded plans and those in the large employer market would not need to provide the 10 EHBs; instead, they would need to provide a benefit of at least 60 percent of expected allowed claims and provide coverage for certain core benefits. The proposed rule would consider current year employer contributions to a health savings account (HSA) or a health reimbursement arrangement (HRA) as part of the benefit value calculation.
Market Reforms: The proposed rule confirms that non-grandfathered health insurers (whether operating through or outside of an exchange) would be prohibited from denying coverage to someone because of a pre-existing condition or other health factor. The proposed rule also provides that premiums for policies in the exchanges and individual and small group markets could only vary based upon age, tobacco use, geographic location, and family size and sets out details on how premiums could be calculated.
The “Benefit and Payment Parameters”: proposed rule addresses a number of topics. Of particular interest to employers are proposed rules regarding:
The “Multi-State Plan Program”: proposed rule begins to address the complex topic of multi-state health exchanges. PPACA directs the federal Office of Personnel Management (OPM) to enter into contracts with private health insurance issuers to offer at least two Multi-State Plans (MSPs) through the exchanges. Health insurance issuers who wished to provide an MSP would apply to OPM. OPM would determine which issuers are qualified to become MSP issuers, enter into contracts with the issuers and approve the plans to be offered on exchanges.
Important: These rules are still in the “proposed” stage, which means that there may be changes when the final rule is issued. Employers should view the proposed rules as an indication of how plans will be regulated beginning in 2014, but need to understand that changes are entirely possible.
To read the complete summary of all rules, click here. Follow the instructions for access to the individual summaries of each proposed rule.
About United Benefit Advisors: One of the nation's top five employee benefits advisory organizations, United Benefit Advisors is a Member-owned alliance of more than 140 premier independent benefit advisory firms with more than 200 offices throughout the U.S., Canada and the U.K. As trusted and knowledgeable advisors, UBA Members collaborate with more than 2,200 professionals to deliver expertise, thought leadership and best-in-class solutions that positively impact employers and make a real difference in the lives of their employees and families. Employers, advisors and industry-related organizations interested in obtaining powerful results from the shared wisdom of our Members should visit UBA online at http://www.UBAbenefits.com.
csammartino (at) fishervista (dot) com