Global Health Care Update

Transcription

1 Global Health Care Update March/April 2014 This bimonthly Update summarizes recent legislative developments and trends related to health care and highlights recently passed and pending legislation that may require employers to take action to comply with new rules or review existing plans. Action May Be Required United States The Internal Revenue Service (IRS) issued guidance on reporting Patient Protection and Affordable Care Act health insurance providers fees for expatriate health plans. Notice provides a temporary safe harbor for covered entities that report direct premiums for expatriate plans on a Supplemental Health Care Exhibit (SHCE). A covered entity may apply this temporary safe harbor for purposes of reporting direct premiums written on Form 8963, Report of Health Insurance Provider Information, which is used to calculate the fee imposed by Section 9010 of the Act. For the 2014 and 2015 fee years, it allows such an entity to exclude 50% of its direct premiums written for expatriate plans in reporting total direct premiums to the IRS for purposes of determining its health insurance provider s fee. Canada The New Brunswick Prescription and Catastrophic Drug Insurance Act received Royal Assent. This Act establishes a new catastrophic drug plan to help New Brunswickers avoid catastrophic drug costs and ensure prescription drug insurance is available to everyone. Phase one begins on May 1, 2014 and allows enrollment for those who do not have drug coverage from another source. Premiums will be income based. Phase two begins April 1, 2015, when all provincial residents are required to have prescription drug insurance. All private group drug plans will be required to include every drug covered under the New Brunswick Prescription Drug Formulary, effective April 1, Private group plans will not be permitted to have annual or lifetime caps on coverage. Pharmacy costs must be managed in one of two prescribed methods, depending on plan design. Recent Developments U.S. Health Care Reform The U.S. Departments of Labor, Health and Human Services (HHS), and the Treasury (the Departments) released final regulations implementing the 90-day waiting period limitation under the Public Health Service Act, as added by the Patient Protection and Affordable Care Act (Affordable Care Act). The final regulations require that no group health plan or group health insurance issuer impose a waiting period that exceeds 90 days Copyright 2014 Aon plc 1

2 after an employee is otherwise eligible for coverage. The rules do not require coverage be offered to any particular individual or class of individuals. The regulations also finalize amendments to existing regulations to conform to Affordable Care Act provisions. Specifically, the rules amend regulations implementing existing provisions such as some of the portability provisions added by the Health Insurance Portability and Accountability Act (HIPAA) because those provisions of the HIPAA regulations have become superseded or require amendment as a result of the market reform protections added by the Affordable Care Act. On the same day, the Departments also issued proposed regulations clarifying the maximum allowed length of any reasonable and bona fide employment-based orientation period, consistent with the 90-day waiting period limitation as part of the Affordable Care Act. Comments on the proposed regulations are due by April 25, The Treasury and Internal Revenue Service (IRS) released final regulations providing guidance to large employers subject to the information reporting requirements under Section 6056 of the Internal Revenue Code (Code), enacted by the Affordable Care Act. This guidance generally applies to employers with at least 50 full-time employees, including full-time equivalent employees. Section 6056 requires those employers to report to the IRS information about the health care coverage, if any, they offer to full-time employees, in order to administer the employer-shared responsibility provisions of Section 4980H of the Code. Section 6056 also requires those employers to furnish related statements to employees that employees may use to determine whether, for each month of the calendar year, they may claim on their individual tax returns a premium tax credit under Section 36B (premium tax credit). The regulations provide for a general reporting method and alternative reporting methods designed to simplify and reduce the cost of reporting for employers subject to the information reporting requirements under Section The Treasury and IRS also released final regulations providing guidance to providers of minimum essential health coverage that are subject to the information reporting requirements of Section 6055 of the Code, enacted by the Affordable Care Act. Health insurance issuers, certain employers, and others that provide minimum essential coverage to individuals must report to the IRS information about the type and period of coverage and furnish the information in statements to covered individuals. These final regulations affect health insurance issuers and carriers, employers, governments, and other persons that provide minimum essential coverage to individuals. The regulations are effective as of March 10, The HHS Centers for Medicare and Medicaid Services (CMS) issued a Frequently Asked Question (FAQ) on the coverage of same-sex spouses as related to the Affordable Care Act. In the FAQ, CMS states that a health insurance issuer in the group or individual market may not refuse to offer coverage to a same-sex spouse if the health insurance issuer offers coverage to an opposite-sex spouse. The FAQ follows up on final regulations released in February 2013, which require health insurance issuers offering non-grandfathered health insurance coverage in the group or individual markets (including qualified health plans offered through Exchanges) to guarantee the availability of coverage unless one or more exceptions apply. The preamble to the final regulations indicates that discriminatory marketing practices or benefit designs represent a failure by health insurance issuers to comply with the guaranteed availability requirements, and the final regulations establish certain marketing and nondiscrimination standards in the regulation text. The FAQ is provided to clarify the meaning of the terms used in the regulations for the purposes of describing the Copyright 2014 Aon plc 2

3 requirements health insurance issuers must meet to ensure guaranteed availability of coverage and reinforce the current regulations prohibition against discrimination based on sexual orientation. However, the prohibition is not intended to interfere with a plan sponsor s ability to define a dependent spouse for purposes of coverage eligibility, according to the FAQ. On the same day, HHS restated this nondiscriminatory guidance in a blog posting: Beginning next year, if an insurance company offers coverage to opposite-sex spouses, it cannot choose to deny that coverage to same-sex spouses. In other words, insurance companies will not be permitted to discriminate against married same-sex couples when offering coverage. Americas British Columbia s (Canada) 2014 budget includes a provision that would increase Medical Services Plan premiums. Effective January 1, 2015, Medical Services Plan premiums would increase to help fund health care for British Columbians. Maximum monthly premium rates would increase by about 4% or CAD 2.75 per month for a total of CAD for single persons; by CAD 5.00 per month for a total of CAD for two-person families; and by CAD 5.50 per month for a total of CAD for families of three or more persons. Also effective January 1, 2015, premium assistance would be enhanced to ensure those receiving assistance would not be affected by the increase. Europe Employers in France are reminded that the portability of supplementary health care plans will be extended to all professions, effective June 1, The maximum portability period will be extended from 9 months to 12 months. In Germany, the federal cabinet approved draft legislation that would reduce employees health care contributions. Under the draft bill, employees would no longer be required to pay a 0.9% surcharge. Hence, the total health care contribution would be reduced from 15.5% to 14.6%, equally divided between employers and employees. Health care funds, however, would be permitted to assess an additional fee if necessary. Fees would vary according to an employee s pay. Poland s Ministry of Health has published draft provisions for the rollout of private health insurance. Under the draft provisions, insurers would have to provide a basic basket of services in a plan, and they would be prohibited from engaging in risk selection practices. National health fund (NFZ) hospitals would be permitted to contract with private insurers, and the number of private patients using NFZ facilities would be contingent upon the contract. NFZ hospitals and clinics could not provide separate facilities for private and public patients. The Ministry of Health asserts that a public-private partnership would alleviate overcapacity in state facilities and help address a funding shortage. Middle East The Saudi government may require health insurance for all foreign visitors. Insurance would be required to cover medical assistance and evacuation in the event of an emergency. Only visitors with health insurance policies would be permitted to apply for a visitor s visa. It is not yet known when action will be taken. Copyright 2014 Aon plc 3

4 * * * * For more information on the topic and countries in this newsletter, please refer to the Aon Hewitt Country Profiles eguide. You can learn more about the Country Profiles eguide here. Copyright 2014 Aon plc 4

5 About Aon Hewitt Aon Hewitt empowers organizations and individuals to secure a better future through innovative talent, retirement and health solutions. We advise, design and execute a wide range of solutions that enable clients to cultivate talent to drive organizational and personal performance and growth, navigate retirement risk while providing new levels of financial security, and redefine health solutions for greater choice, affordability and wellness. Aon Hewitt is the global leader in human resource solutions, with over 30,000 professionals in 90 countries serving more than 20,000 clients worldwide. For more information on Aon Hewitt, please visit Copyright 2014 Aon plc This document is intended for general information purposes only and should not be construed as advice or opinions on any specific facts or circumstances. The comments in this summary are based upon Aon Hewitt's preliminary analysis of publicly available information. The content of this document is made available on an as is basis, without warranty of any kind. Aon Hewitt disclaims any legal liability to any person or organization for loss or damage caused by or resulting from any reliance placed on that content. Aon Hewitt reserves all rights to the content of this document. Copyright 2014 Aon plc 5