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.
Specific Questions relating to this article should be addressed directly to the author.
The Departments of Labor, Treasury, and Health & Human Services have issued new guidance on the content requirements for health plan summaries of benefits and coverage ("SBCs").
E-mail can be powerful evidence in a dispute, and whether employers and criminal investigators may use employee e-mail in litigation proceedings is a hot topic. A recent New York federal court decision outlined the current law in this area.
I wrote two years ago about the challenges employers face when an employee attributes his or her misconduct to a disability.
I wrote two years ago about the challenges employers face when an employee attributes his or her misconduct to a disability.
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