As you all know the Supreme Court has ruled that the Patient Protection and Affordable Care Act ("PPACA" or "health care reform") is constitutional.

Legal scholars can debate the reasoning of the decision and pundits can debate its political impact, but employers have a lot to do in order to comply with the many mandates contained in the law.

Over the summer, we will be providing guidance on the health care reform mandates applicable to employers and steps that should be taken to ensure compliance. The first in the series will discuss how to comply with the September, 2012 deadline for providing summaries of benefits and coverage ("SBC") to participants and beneficiaries. The SBC is a four page summary of the plan that needs to be provided to participants and beneficiaries. For fully insured plans, both the insurer and plan administrator are responsible to provide the SBC, but only one party needs to provide it. Thus, employers should decide now which party will be providing the SBC, and when and how it will be distributed. For self-funded plans, employers will likely need to contract with a third party administrator ("TPA") for preparation of the SBC. Again, this is something that employers should consider now given that the SBC requirement will soon become effective.

In addition to the SBC requirements, we will provide guidance on other mandate requirements, such as the following:

  • Non-discrimination rules applicable to fully insured plans
  • W-2 reporting
  • Internal and external claims procedures
  • Annual limits and pre-existing conditions
  • Preventive care
  • Individual coverage mandate

Stay tuned!

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.