Certified Healthcare Reform Specialist & Certified Healthcare Reform Professional Workbook

Transcription

1 Certified Healthcare Reform Specialist & Certified Healthcare Reform Professional Workbook Employer Healthcare & Benefits Congress Washington D.C. September th, 2016

2 CHRS 2016 WORKBOOK TABLE OF CONTENTS I. ACA Mandates: A Roadmap for Employer Compliance Grandfathered Health Plans Adult Child Coverage Lifetime Limits, Annual Limits, and Essential Health Benefits Recissions and Preexisting Condition Exclusions Patient Protections Claims and Appeals Requirements Preventive Services Preventive Care Nondiscrimination Requirements Reimbursement for Over-the-Counter Drugs Medical Loss Ratio Rebates Cap on Health FSA Deferrals Changes Day Waiting Period Pre-Existing Conditions Clinical Trials Cost-Sharing Limitations Wellness Programs Later Changes Automatic Enrollment Penalties for Noncompliance II. Just the Essentials: Examining the Important Distinctions Between Minimum Essential Coverage v. Essential Health Benefits Why Essential Health Benefits Are Important Why Minimum Essential Coverage Is Important What Is the Role of Minimum Value? American Health Benefit Exchanges Supreme Court Fallout Defining Minimum Essential Coverage Defining Essential Health Benefits EHB Benchmark Plans Distinguishing EHBs from MEC MEC, EHB, and MV in Employer Plans MEC and Eligible Employer-Sponsored Plans Determining MV Employer Compliance Strategies III. Strategically Communicating with Employees about Healthcare Reform: What They Don t Know Can Hurt You Where Are You Now? Notice and Disclosure Requirements i

3 Lifetime Limits Grandfathered Notice W-2 Reporting Health Coverage Notices Advance Notice of Material Modifications Summary of Benefits and Coverage (SBC) ACA Section Reporting Requirements Report ACA Reporting Combined Reporting Penalty for Failure to Report Communication and Notices to Employee Fundamentals IV. Look Before You Leap: Understanding the Opportunities and Pitfalls in Public and Private Insurance Exchanges Health Insurance Marketplaces Under the Affordable Care Act Premium Assistance Tax Credit What Is a Private Exchange? Private Exchange Models Post-ACA Group Market Private Exchanges Individual Market Private Exchanges Web-Broker Entities What s in It for Employers and Employees? What Are the Risks Under the Private Exchange Model? How Can These Risks Be Minimized? V. The Who, What, Where and When s of the Employer Mandate under ACA (Part I) Employer Mandate What Is an Applicable Large Employer Special Rules for Seasonal Workers A Penalty What Is Minimum Essential Coverage B Penalty Affordability Minimum Value (MV) Employer Disaggregation Delayed Effective Date What Was Not Delayed The Sub-MV Plan Strategy Insurance Product Availability VI. The Who, What, Where and When s of the Employer Mandate under ACA (Part II) Who Is a Full-Time Employee Counting Hours of Service ii

4 Bona Fide Volunteers Determining Full-Time Status Look-Back Method Current EEs Determining FT Status New EEs Look-Back Method New EEs Seasonal Employees Changes in Status Staffing Agency Workers Unpaid Leaves of Absence Integrated and Non-Integrated HRAs Health FSAs Employee Assistance Plans (EAPs) Key ACA Taxes and Fees VII. Fiduciary Fundamentals & Risks: Understanding Your Responsibilities (and Liabilities) What Is a Welfare Benefit Plan Listed Benefits What Is a Group Health Plan Two Key Exceptions Other Common Exemptions The Big Four Summary Plan Description ( SPD ) Timing of Disclosure Obligations Claims & Appeals Procedures Penalties for Noncompliance VIII. ACA Practical Considerations & Litigation Avoidance Workforce Realignment Claims to Mandated Benefits Retiree Medical Exit Strategy Race, Color, National Origin, Sex, Age, or Disability Discrimination in the Provision of Health Coverage and Related Activities Preparing for the Audit Developing a Settlement Strategy iii

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