E to E...by Employers for Employers E to E provides information from a business perspective that will educate regional employers about significant healthcare issues to help them make decisions benefiting their organizations and employees.

 Sponsored by Northern Illinois Health Plan

July 2010 Issue

Contents

Grandfather Status Under the New Health Plan

New Patient’s Bill of Rights

Health Coverage for Adult Children

Quick Poll – Review

July Quick Poll – Vote

Contact Information

NIHP Home

New Government Web Site on Health Insurance Plans
HealthCare.gov was launched by the Department of Health and Human services to provide a central database of health coverage options that includes information from more than 1,000 private insurance plans. Comparisons can be made between private and public plans, along with those for Medicare. The site also includes hospital comparison data on quality and patient safety information.

The Affordable Care Act introduces a number of health related provisions to take effect over the next four years. As you work through the various sections that impact your business, we encourage you to contact us with questions.

Grandfather Status Under the New Health Plan

Many businesses have been asking the obvious question when it comes to the Health Care Reform Act – what must we do to make sure that we’re following the guidelines in order for my health plans to be considered "grandfathered?" The regulations that were formally introduced on June 14, 2010 by the Departments of Health and Human Services, Treasury and Labor, answer the question.

Highlights of what you cannot do if you want to keep your Grandfathered Status:

  • Eliminate benefits
  • Increase cost-sharing
  • Increase fixed-amount cost-sharing other than co-pays
  • Increase co-pays
  • Decrease employer contributions

In order to maintain Grandfather Status:

  • Document your plan or policy terms as to what was in place on March 23, 2010 to show that you are not breaking any rules.
  • Always reveal that your plan is grandfathered in your plan materials.


FURTHER READING

Legal alert: Analyzing the Grandfather Regs under PPACA
Employee Benefit News, June 25, 2010

Once you go grandfathered, don’t go back
Employee Benefit News, June 15, 2010

Rules defining grandfathered plans issued
Employee Benefit Advisor, June 15, 2010


New Patient’s Bill of Rights

A new Patient’s Bill of Rights was implemented under the Patient Protection and Affordable Care Act (PPACA) that ensures a basic set of consumer protections when it comes to healthcare. Many of the rules will take effect on or after September 23, 2010. Because some of these apply to Grandfathered Plans and some do not, contact NIHP for specific questions on your company’s plan.

Key provisions include:

  • Preexisting conditions – Prohibits exclusions for both benefit limitations and coverage.
  • Lifetime limits – Prohibits liftetime health insurance coverage limits.
  • Coverage limits – Removes restrictions on annual coverage limits.
  • Direct care access – Allows for direct access to certain types of providers and out-of-network emergency care.
  • Rescission limits – Limits the ability of insurance companies to cancel coverage except in cases of fraud.


FURTHER READING

Fact Sheet: The Affordable Care Act's New Patient’s Bill of Rights
HealthReform.gov, June 22, 2010

Government unveils new Patient's Bill of Rights under PPACA
Employee Benefit News, June 24, 2010

Implementing health reform: A Patient Bill Of Rights
Health Affairs, June 23, 2010


Health Coverage for Adult Children

The Affordable Care Act requires plans and insurers to make coverage available for children up until the age of 26 if they are eligible to be covered on their parents' plan. This extension of coverage is mandatory for group health plans as of the first plan year beginning on or after September 23, 2010. For employers with calendar year plans, which are the most common, the requirement begins January 1, 2011. Grandfathered group health plans are not required to follow the regulations until January 1, 2014.

In a sign of good will, many insurers extended their coverage prior to the deadlines mentioned. Their decision was based on the desire to reduce the likelihood of gaps in coverage for young adult children. A Fact Sheet and Frequently Asked Questions regarding health coverage for adult children has been prepared by Health and Human Services.


FURTHER READING

Health insurance for the under-26 crowd
CNNMoney.com, May 12, 2010

Navigating tax rules on health coverage for adult children
Employee Benefit News, May 21, 2010

Young adults and the Affordable Care Act
Department of Health and Human Services


A Quick Review of Last Issue's "Quick Poll"

In the April 2010 issue of E to E we asked readers, "How well do you understand the impacts the new healthcare reform law will have on your benefit programs?" Specific survey results are noted in the chart, below.

April Quick-Poll Summary


JULY Quick Poll – Vote

Have any of your employees asked you how the Affordable Care Act may change their benefits?
(Click a response to vote. Answers are strictly anonymous.)

Then, visit the NIHP website to view this issue's quick poll results.



For more information contact us at:
(800) 723-0202 or NIHPCustomerService@nihp.com

Northern Illinois Health Plan

1006 W. Stephenson St., Freeport, IL 61032

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