PPACA SBC: New Federal “Insurance Verification” Law Goes Into Effect 09/23/2012

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On March 19, 2012, DOL, HHS & IRS published a new enforcement guidance on how to comply with the new federal “Insurance Verification” law, PPACA SBC FAQ VIII, a new chapter of US healthcare with “One Nation, One Verification”. ERISAclaim.com offers webinars on this new federal insurance law.

“Every healthcare provider and hospital must learn and master the new federal PPACA SBC laws (insurance verification law) for every new and established patient, unless without expectations to get paid”, said Dr. Zhou.

On March 19, 2012, DOL, HHS and IRS published a new enforcement guidance on how to comply with the new federal “Insurance Verification” Law, PPACA SBC FAQ VIII. The new PPACA SBC law goes into effect 09/23/2012, opening a new chapter of US healthcare history with “One Nation, One Verification.” On February 14, 2012, the Departments published the final rules regarding the summary of benefits and coverage (SBC) provisions of the Affordable Care Act. ERISAclaim.com offers webinars to educate health providers on this new federal insurance verification and disclosure law to say Goodbye to the old history of insurance verification with no national standard and no legal protections.

DOL, HHS and IRS FAQs About Affordable Care Act Implementation Part VIII is available at http://www.dol.gov/ebsa/faqs/faq-aca8.html

The Departments' sample completed SBC is available at: http://www.dol.gov/ebsa/pdf/SBCSampleCompleted.pdf

“First of all, now we have 'One Nation & One Standard Format' for all insurance verifications on a four-page Form in the federal standard terms. This alone will save billions of dollars and administrative headaches for all healthcare providers,” said Dr. Jin Zhou, President of ERISAclaim.com, a national expert on PPACA and ERISA appeals and compliance.

“Now, all out-of network providers and patients will not be misinformed of their out-of-network coverage and benefits when about 77% of insured Americans in private sector paid for out-of-network coverage”, said Dr. Zhou. (Page 11 of 167 at http://stats.bls.gov/ncs/ebs/detailedprovisions/2010/ebbl0047.pdf)

New PPACA SBC Penalties: $1,000 Per Willful Failure Per Participant And $100 a Day Per Participant in Excise Taxes

According to DOL SBC FAQ Part VIII, “Consistent with this guidance, during this first year of applicability, the Departments will not impose penalties on plans and issuers that are working diligently and in good faith to provide the required SBC content in an appearance that is consistent with the final regulations.” However, any willful and intentional failure to comply with the PPACA SBC requirements may result in a daily penalty of up to $1,000 per willful failure per participant and $100 a day per participant in excise taxes. If the plan SBC is inaccurate, participants may sue for new surcharge or make-whole damages under ERISA and allege that the plan administrator (usually the employer / plan sponsor) breached its fiduciary duties by providing a SBC (mini-SPD) disclosure that was materially deceptive, misleading or inaccurate, explained Dr. Zhou.

“Every healthcare provider and hospital must learn and master the new federal PPACA SBC laws (insurance verification law) for every new and established patient, unless without expectations to get paid,” said Dr. Zhou.

The PPACA & ERISA Claim Specialist SBC Webinar will cover the following topics:

New federal PPACA SBC (Summary of Benefits and Coverage) Laws and Uniform Glossary

1.    DOL, HHS, IRS FAQs About Affordable Care Act Implementation Part VIII, The Departments' sample completed SBC
2.    Final Regulations, http://www.dol.gov/ebsa/pdf/SBCfinalreg.pdf
3.    DOL Compliance Guide, http://www.dol.gov/ebsa/pdf/SBCguidance.pdf
4.    Summary of Benefits and Coverage Template
5.    DOL Instructions for Completing the SBC - Group Health Plan Coverage,
6.    DOL Instructions for Completing the SBC - Individual Health Insurance Coverage,
7.    HHS Information for Simulating Coverage Examples,
8.    Uniform Glossary of Coverage and Medical Terms, http://www.dol.gov/ebsa/pdf/SBCUniformGlossary.pdf

To find out more about PPACA Claims and Appeals Compliance Services from ERISAclaim.com:
http://www.erisaclaim.com/products.htm

Located in a Chicago suburb in Illinois, for over 12 years, ERISAclaim.com is the only ERISA & PPACA consulting, publishing and website resource for healthcare providers in the country. ERISAclaim.com offers free webinars, basic and advanced educational seminars and on-site claims specialist certification programs for doctors, hospitals and commercial companies, as well as numerous pending national ERISA class action litigation support. Dr. Jin Zhou is regarded as the industry “Godfather of PPACA claims” for healthcare providers.

Dr. Jin Zhou & ERISAclaim.com were nominated for White House Champions of Change PPACA Program in 2012 for educating others about the new health care law to raise awareness about the benefits of the Patient Protection & Affordable Care Act (PPACA). (http://www.sfgate.com/cgi-bin/article.cgi?f=/g/a/2012/02/11/prweb9189619.DTL)

For any questions, please contact Dr. Jin Zhou, president of ERISAclaim.com, at 630-808-7237.

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