Boardman Law Firm

Employee Benefits Update: Health Care Reform Regulations on Preexisting Condition and Other Mandated Coverage

By Cindy Van Bogaert
July 3, 2010

Here is your latest Employee Benefits Update from Cindy Van Bogaert, Partner and Chair of the Employee Benefits Practice Group at Boardman Law Firm LLP. This Employee Benefits Update provides information about Health Care Reform guidance that affects employer plans.

Regulations continue to be issued providing rules for employer group health plans to comply with Health Care Reform (the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act). The new regulations provide details on Health Care Reform limits on preexisting condition restrictions, annual and lifetime limits, rescissions, and patient protections such as emergency care and primary care provider access limitations. Employers may have notice and special enrollment obligations.

These regulations provide critical details for employer group health plan design. The Department of Labor website has a link to regulations, a fact sheet, and notices: http://www.dol.gov/federalregister/HtmlDisplay.aspx?DocId=23983&AgencyId=8&DocumentType=2 and http://www.dol.gov/ebsa/healthreform/.

What should employers do?

• Employers need to identify which plans need to be modified, keeping in mind the grandfathered plan rule protection.
• Employers need to understand what options and obligations they have under these new regulations and make changes as mandated.
• Employers should take steps to put in place notice and special enrollment, if needed, for their plans.

Please contact me if I can be of assistance. We'll be covering the lastest regarding both the preexisting condition exclusion, annual and lifetime limits, rescissions, and patient protection regulations as well as the grandfathered plan rules, including new notice and recordkeeping requirements, limits on benefit changes, contribution rates, copays, and annual limits, treatment of retiree-only, one-person and "excepted benefits" at our July 28 seminar. Find out about: how the preexisting condition limitation applies - including different application for those under age 19; lifetime and annual limits, including how to handle health flexible spending accounts; new restricted annual caps allowed for essential benefits and a potential waiver of those limits; new notice and special enrollment obligations with respect to those who reached prior benefit caps; rescission - what it means and when coverage can be retroactively eliminated; and restrictions on primary care provider required authorizations or referrals, coverage of out-of-network emergency care treatment, special rights of participants relating to OB/GYN care and pediatricians, and new notices.

Upcoming seminars:

• "Health Care Reform" Seminar in Madison, WI on July 28, 2010. For information, click here.
• "Health Care Reform: Finding Your Way Through the Maze," telephone seminar through HRWebAdvisor on August 12, 2010. For information: http://www.hrwebadvisor.com/schedule.
• "401(k) Plans" Seminar in Madison, WI on September 14, 2010. For information: click here.
• "Tougher HIPAA Privacy and Security Rules: Learn the New Compliance Requirements," telephone seminar through HRWebAdvisor on September 21, 2010. For information: http://www.hrwebadvisor.com/schedule/detail/tougher-hipaa-privacy-and-security-rules.
• "HIPAA Privacy Training" two seminars, one for the basics and one for new developments, both on October 26, 2010. If you work with employer health benefits, you should consider these training seminars to meet your legal obligations. For information: click here.
• "Fundamentals of Employee Benefit Plans," for the American Law Institute-American Bar Association, in Philadelphia, PA on April 6-8, 2011.

This update is not legal advice. Individuals should seek advice based on their particular circumstances from their own counsel.

If you have any questions or need assistance, please contact Cindy Van Bogaert at (608) 283-7543 or Email.

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