Federal Health Care Reform Where have we been? Where are we going? 1 Helana A. Darrow 513.651.6110 October 23, 2012 TOPICS U.S. Supreme Court Decision Upholds Law Health Care Reform s Impact on Employers Changes effective in 2012 through 2014 Pay or Play in 2014 2018 Excise Tax Action Items Changes effective before 2012 Health Care Reform Websites 2 U.S. Supreme Court Decision (June 28, 2012) Congress called shared responsibility payment a penalty (not a tax ) so Anti-Injunction Act does not bar suit (i.e., do not have to wait until someone pays it to challenge it) Individual mandate to maintain minimum essential health insurance coverage not a valid exercise of Congress s power under the Commerce Clause and the Necessary and Proper Clause 3
U.S. Supreme Court Decision (cont.) Individual mandate upheld as within Congress s power to lay and collect taxes Bottom Line: Employer and individual mandates survive Employers with 50 or more full time equivalent (FTE) employees face potential penalties Individuals face penalties if they don't have health coverage 4 U.S. Supreme Court Decision (cont.) Medicaid expansion violates Constitution by threatening States with loss of existing Medicaid funding if they decline to comply with expansion States can choose whether to expand Medicaid and don't lose funding for existing Medicaid program if choose not to expand Possibility of repeal? Some commentators note it would be hard to do, even if a Republican wins the presidential election Employers and industry are preparing for compliance and not counting on repeal 5 Scope of Health Care Reform Plan design changes are required for self-insured and fully-insured plans (including governmental and church plans) as long as the plans cover at least one active employee New employer reporting, fee, and potential for penalty if employees enroll in state exchange and get subsidized coverage Changes are not required for: Retiree-only plans Stand-alone vision, dental, cancer, etc. policies 6
Scope of Health Care Reform HRAs and Medical Reimbursement Accounts are no longer permitted unless combined with major medical benefits that meet the plan design requirements (no lifetime limits, etc.) Health FSAs are not subject to reform rules if a group health plan is available and the maximum benefit payable for the EE under the FSA does not exceed 2x the EE's salary reduction election for the year (or, if greater, the amount of the EE's salary reduction election for the year, plus $500) 7 Employer Responsibilities Administrative and Other Employer Responsibilities and Costs Before Reform: Enrollment and payroll processing payment for coverage COBRA Notices to employees: SPDs, cancer rights, special enrollment rights, newborns and mothers, HIPAA privacy Reporting Form 5500s and SARs CMS Reporting quarterly by carrier or TPA 8 Employer Responsibilities Administrative and Other Employer Responsibilities and Costs After Reform: W-2 reporting of health coverage (2012) Comparative effectiveness fee $1, $2 (2012) SBC 2012 enrollment, for 2013 benefits Notice to employees of Exchanges March 2013 Pay or play reporting, possible penalty payments Reinsurance fee (2014) Administering MLR rebates (2012) Auto enrollment if over 200 employees (2015?) Cadillac excise tax (2018) 9
Employer Responsibilities MLR Rebates Carriers limited to 15% profit, 20% for small plans Amounts not used to pay for health benefits are measured by carriers Refunds sent to policy holder employer Funds belong partially to employees, if they pay some premiums, unless plan or policy documents say differently Give employees premium holiday or payment in refund of premiums Use within 3 months or must be held in trust 10 2012 Changes Summary of Benefits and Coverage (SBC) 4 pages front and back, plus there s a glossary that must be made available May be a stand-alone document or in combination with other materials, such as an SPD, as long as it is displayed prominently and in the same format Proposed template and instructions available at www.dol.gov/ebsa/healthreform/ Must be provided by an insurer to a group health plan, by an insurer and group health plan to participants and beneficiaries, and by an insurer to individuals and dependents in the individual market Interim Regs issued 08/22/2011; Final Regs issued 02/14/2012 11 2012 Changes SBC Requirements Effective Date Distribute to all eligible employees on the 1 st day of the 1 st enrollment period that begins on or after 09/23/2012 Insurer must provide SBC to plan (employer) no later than 7 days following an application for group coverage or a request for information by the employer, and no later than 30 days prior to the 1 st day of each new policy year For self-funded plans, employer as plan administrator is responsible for preparation of SBC, but third party administrator who processes claims should help, depending on how customized a plan s design is 12
2012 Changes SBC When employees must receive From Insurer and Group Health Plans to Eligible Employees and Dependents: For new hires and dependents: with the enrollment materials, or if no enrollment materials provided, no later than 1 st date the individual is eligible to enroll With open enrollment materials, or if no open enrollment, no later than 30 days before plan year No later than 90 days after enrollment by HIPAA special enrollees No later than 7 days after request 13 Upcoming Changes SBC Requirements Content Uniform definitions of standard insurance terms and medical terms Description of the coverage, including cost sharing, for each category of benefits Exceptions, reductions, and limitations on coverage Cost-sharing provisions of the coverage Renewability and continuation of coverage provisions Coverage examples for 2 common benefits scenarios Statement that the SBC "is only a summary" and that the plan document, policy, or certificate of insurance should be consulted 14 Upcoming Changes SBC Requirements Content (con t) Contact number to call with questions and an Internet web address where a copy of the actual policy or group certificate of coverage can be reviewed and obtained Contact information for obtaining a list of the network providers If applicable, an Internet address to find more information about the prescription drug coverage under the plan or coverage Internet address for the uniform glossary of health coverage terms, a phone number to obtain a paper copy of the uniform glossary and disclosure that paper copies are available If applicable, statement in non-english language that assistance is available 15
2012 Changes SBC Requirements - 60 Days Advance Notice of Plan Changes that Impact SBC Disclosure If any mid-year plan change would change the SBC, a separate notice or a new SBC must be issued 60 days before the change is effective Applies to both increases and decreases in coverage For changes effective for a new plan year, 60 day advance notice rule does not apply; changes are included in open enrollment materials which do not have to go out 60 days before the year begins $1,000/enrollee penalty for willfully failing to provide the advance notice 16 2012 Changes SBC Requirements Delivery In paper form Electronically If to participants and beneficiaries who are already covered, then the DOL's electronic disclosure safe harbor must be met If to participants and beneficiaries who are eligible but not yet enrolled in coverage, then the format must be readily accessible and a paper copy is to be provided free of charge upon request. If the electronic form is an Internet posting, the individual must be advised in paper form or via email of the documents available on the Internet, of the Internet address, and that a paper form is available, upon request. 17 2012 Changes New Annual Fee $1, then $2 assessed per participant until 2019 (to fund federal program on comparative effectiveness research) Effective for policy and plan years ending after September 30, 2012; first fee due July 31, 2013 For fully-insured plans, the fee is paid by the issuer of the policy For self-insured plans, the fee is paid by the plan sponsor Governmental entities that are issuers or plan sponsors are generally subject to the fees. 18
2012 Changes New Annual Fee (cont'd) Does not apply to excepted benefits Fee calculated based on all individuals covered Number can be determined based on actual count of individuals covered, or by using an average of the actual count or the count on a quarterly snapshot date, counting single coverage as 1 and non-single as 2.35 By using average of participants reported on 5500 at beginning and end of plan year, times two 19 2012 Changes Form W-2 Reporting Begins in January 2013 for 2012 calendar year (must report on calendar year basis, even if policy or plan year is not calendar year) Until future rule guidance is issued, reporting is optional for ERs who file fewer than 250 Forms W-2 for prior year (if file fewer than 250 W-2s for 2011, reporting of 2012 coverage is not required in January 2013) Value of health coverage reported in W-2 box 12 using code DD Includes the entire cost of the coverage under a group health plan, regardless of whether the plan is insured or self insured the portion paid by the employee any imputed income to the employee the scope of the coverage Coverage value to report is what carrier charges; for self-insured plans, use COBRA rate (without 2% administrative charge) 20 2012 Changes Form W-2 Reporting (cont'd) Excludes cost of dental or vision insurance under a separate policy Excludes coverage under an HSA or HRA Excludes coverage under an FSA if the amount of salary reduction (for all qualified benefits) elected by the EE equals or exceeds the amount of the health FSA for the plan year Excludes cost of coverage under EAP, wellness program, or on-site medical clinic if the ER does not charge a premium for such coverage under COBRA to a qualifying beneficiary Excludes cost of coverage under a multiemployer plan ERs not required to issue a Form W-2 to retirees or other former EEs to whom the EE would not otherwise issue a Form W-2 21
2013 Changes Effective March 1, 2013, employers must provide employees written notice: (i) of the existence of the health insurance exchange; (ii) of potential eligibility for federal assistance if the employer's health plan is "unaffordable"; and (iii) that they may lose the employer's contribution to health coverage if they purchase health insurance through the health insurance exchange New level of Medicare tax on higher earners = 0.9% on all wages over $200,000 (single) or $250,000 (joint return), to be collected by employers Employers do not match this tax payment as they do other Medicare taxes These same individuals will be taxed 3.8% (total then- Medicare rate) on other types of non-wage income like interest, dividends, pass-through business income, etc. $2,500 Health FSA contribution cap 22 Upcoming Changes In 2014 or later, once rules issued Non-grandfathered fully-insured health plans must not disproportionately favor highly compensated employees (HCEs) (self-insured are already subject to these rules) 2014 Requirements All pre-existing condition exclusions will be banned Annual dollar limits on essential health benefits will be banned Waiting periods before coverage is effective can be a max. of 90 days for full-time employees (Full time = average of 30 hours per week) Health plans must provide coverage for clinical trials (N/A to grandfathered plans) Unknown Effective Date: Large employers (200+ full time employees) will be required to automatically enroll new full-time EEs into health coverage if they do not affirmatively opt out. Not required until the regulations are issued. The DOL has concluded that guidance will not be ready to take effect by 2014. 23 2014 - Individual Mandate Individuals must have health coverage through an individual policy or through their employer for themselves and all dependents under age 18 or will pay a penalty of 1% of individual s income (increases to 2% in 2015 and 2.5% in 2016), with a minimum dollar level of $95 in 2014, $395 in 2015 and $695 in 2016) and capped at the then-average cost of a "bronze" level Exchange Plan No criminal penalties or tax liens allowed to enforce this Exceptions for incarcerated, religious objectors, those without coverage for short periods 24
2014 Essential Health Benefits Insured non-grandfathered plans in the individual and small group market (and plans offered through a state insurance exchange) will be required to offer "essential health benefits" During the 3 rd quarter of 2012, each state will select a benchmark plan from 4 benchmark plan types: The largest plan by enrollment in any of the 3 largest small group insurance products in the state Any of the largest 3 state employee benefit plans Any of the largest 3 national Federal Employee Health Benefits Programs plans The largest commercial HMO in the state Will impact self-insured group and large group plans, which are prohibited from placing annual or lifetime limits on essential health benefits in 2014 25 Essential Health Benefits Essential health benefits will include items and services covered within the following categories: ambulatory patient services emergency services hospitalization maternity and newborn care mental health and substance use disorder services, including behavioral health treatment prescription drugs rehabilitative services and devices laboratory services preventive and wellness services and chronic disease management pediatric services, including oral and vision care 26 2014 Pay or Play Insurance exchanges open in 2014 for individuals and employees working for a company with 50 or < full-time employees (expands to 100 in 2016) An employer with 50+ full-time equivalent employees ((based on a 120 hour/month time equivalency count) could be subject to a penalty if any full-time employee is certified to receive a premium tax credit or cost-sharing reduction payment (a/k/a subsidized coverage) for coverage under the state exchange. Subsidized coverage is available for individuals with a household income of less than 400% of the FPL ($92,200 for a family of 4) but more than 133% of the FPL ($30,657 for a family of 4) and Whose employer does not offer coverage, or Whose employer offers non-qualifying coverage. Non-qualifying coverage means the coverage is either not affordable or does not provide minimum value. 27
2014 Pay or Play Coverage is not affordable if the employee s premium for the least expensive self-only coverage is more than 9.5% of the household income. Proposed safe harbor: Employers may use Form W-2 wages instead of household income for determining whether coverage is affordable for an employee Example: The premium for Employer X's least expensive selfonly coverage is $410. If EE pays the entire premium, coverage would be unaffordable for any EE making < $52K If ER pays half of the premium, coverage would be unaffordable for any EE making < $26K 28 2014 Pay or Play Coverage does not provide minimum value if the plan s share of the total allowed costs of benefits provided under the plan is less than 60% of such costs. Generally thought to mean and refer to an actuarial standard that is based on the anticipated costs of a hypothetical or standard population Example: If a health plan is expected to reimburse, on average, 80% of the eligible expenses covered under the plan, the actuarial value of that plan is 80%. The individuals covered under the plan would pay the remaining 20% through plan features such as deductibles, copayments, coinsurance, etc. 29 > 400% FPL 133-400% FPL <133% FPL 2014 Pay or Play Potential Penalties Eligible for exchange coverage only if no employer plan offered. Not eligible for premium subsidies through the exchange Eligible for subsidized exchange coverage if no employer plan offered or coverage is non-qualifying Eligible for Medicaid regardless of employer coverage or contributions, IF state expands Medicaid If health plan offered but is deemed non-qualifying (i.e., unaffordable or does not provide minimum value) for some full time EEs so they select subsidized exchange coverage: $3,000 per year (prorated by month) per full time EEs claiming a tax credit But in no event more than $2,000/yr. for ALL full time EEs in excess of the first 30 If no health plan offered and full time EEs participate in the exchange: Same result as above, except penalty is $2000/yr. x No. of full time EEs, minus 30 All penalties will adjust after 2014 based on health premium adjustments; penalties are not tax deductible 30
2014 Pay or Play Example 1: 40 full time employees, and 20 employees who work 100 hours per month, on average. ER does not offer coverage, and but no full-time employees receive credits for exchange coverage. This is a large employer, because 40 full timers and 20 PT s x 100 hours = 2000/120 = 16.7 FTEs = 56.7 FTEs No penalty. But, because of the individual mandate and the fact that employees with income between 133-400% would be eligible for subsidized coverage under the exchanges, it seems likely that at least some employees will sign up for the subsidized exchange coverage 31 2014 Pay or Play Example 2: 40 full time employees, and 20 employees who work 100 hours per month, on average. ER does not offer coverage and at least one full-time employee receives credits for exchange coverage. Penalty is $20,000 (# of full-time employees 30 x $2,000) 32 2014 Pay or Play Example 3: 40 full time employees, and 20 employees who work 100 hours per month, on average. ER offers coverage, and no full-time employees receive credits for exchange coverage No penalty. Example 4: Same facts as Example 3 except that 1 or more full-time employees get credit for exchange coverage Penalty could be as low as $3,000 (if only one employee gets credit for exchange coverage = 1 x $3,000) or as high as $20,000 (number of full-time employees 30 x $2,000) 33
2014 Pay or Play Full time employee defined for purposes of pay or play penalty and 90 day eligibility rule Penalties are applied by month and only on full time employees who are not offered affordable coverage providing minimum value Full time employees are defined as those working 30 hours or more Full time employees, if eligible for employer coverage, must be enrolled within 90 days of hire Determining full time status for penalties and 90 day enrollment is a very different rule than full time equivalent rule to see if you are a large (50+ employee) employer subject to potential penalties 34 2014 Pay or Play Several methods are currently permitted under temporary rules: If a new hire is reasonably expected to work full-time on an annual basis and does work full-time during 1 st 3 months of employment, EE must be offered coverage within 90 days of employment If it cannot reasonably be determined that a new hire is expected to work full-time and: If the EE works full-time during the 1 st 3 months of employment, and the EE's hours during that period are reasonably viewed at the end of 3 months as representative of the average hours the EE is expected to work on an annual basis, the EE will be considered to be a full-time EE If EE works full-time during 1 st 3 months of employment, but the EE's hours during that period are reasonably viewed at the end of 3 months as NOT representative, the plan will have a 2 nd 3 month period to determine the EE's status 35 2014 Pay or Play Example 1: New hire EE expected to work full-time Facts: ER with at least 50 full-equivalent EEs, hires Employee X on December 1. Employee X is expected to work full-time on an annual basis and does work full-time during December, January, and February Conclusion: Employee X must be able to enroll in coverage beginning in March or the ER potentially would be subject to the pay or play penalty 36
2014 Pay or Play Example 2: New hire EE who seasonally works fulltime Facts: ER with at least 50 full-equivalent EEs, hires Employee Y, and expects Employee Y to work full-time during the holiday season and part-time the rest of the year. Employee Y works an average of 35 hours per week in December, January, and February and 20 hours per week in March, April, and May Conclusion: If the 1 st 3 month period is reasonably viewed as not representative of average hours Employee Y is reasonably expected to work on an annual basis, the ER may use a 2 nd 3- month period (March-Mary) as a look-back period. ER does not have to offer Employee Y coverage in June because Employee Y was determined to be part-time during the March-May lookback period 37 2014 Pay or Play Other full time employee and 90 day enrollment rules Employers can use a measurement period of a month or up to one year to see if an ongoing employee remains a full-time employee for continued coverage Then coverage must be provided for a stability period that is up to a year and at least as long as the measurement period An administrative period between the measurement period and stability period is also permitted An employer might measure full time status based on hours worked over the 12 months ending October 31, and use that to provide coverage for the next calendar plan year New hire 90 day enrollment period has special rules for those not known at hire to be full-time, but otherwise must be in within 90 days of hire; 1 st of the month after 90 days will not comply 38 2018 Excise Tax If total cost of health coverage of active or retired employee exceeds certain thresholds, ER will have to pay 40% excise tax on the value over the thresholds: 2018 Thresholds: ER coverage subject to excise tax Type of Enrollee Self-only Coverage Tier Any other tier General $10,200 $27,500 High-risk Professions Retirees b/t 55 and 64 $11,850 $30,950 Multiemployer plan $27,500 $27,500 39
Action Items Ensure self-insured and fully insured plans have made coverage changes and appeal process changes and notified participants Effective first plan year beginning on or after 9/23/10 (see 5500 filing cycle) Consider plan language on eligibility and rescission of coverage; strengthen language on retroactive coverage termination and processing of eligibility claims Track data to report health coverage on W-2 for 2012 Prepare 4-page SBC for distribution by open enrollment beginning on or after September 23, 2012 Consider 2014 costs with current plan structure and begin planning for 2014 (coverage changes, eligibility changes, waiting period changes, nondiscrimination, excise tax alternative) 40 Changes Currently Effective For all Plans Children retain coverage to age 26 Preexisting condition exclusions for children under the age of 19 eliminated No lifetime limits on the dollar value of health benefits Only "reasonable annual limits" may be placed on "essential health benefits" until 2014 (and then no annual limits on essential benefits are permitted) Plans cannot rescind coverage once it has begun, except for fraud or intentional misrepresentation of a material fact Tax change over-the-counter medicines For only non-grandfathered Plans New complex internal and external appeals requirements Coverage for certain preventive services, immunizations, and screenings, must be provided without any cost sharing If emergency services are covered, then they must be covered out-of-network on the same basis as in-network 41 Changes Currently Effective Changes for Virtually All Health Plans for 2011 Plan Year (Even Grandfathered and Union Plans) Children retain coverage to age 26 Exception for grandfathered plans where child has coverage available at child s own job (ceases in 2014) One-time notice of availability of coverage required Regs issued June, 2010 42
Changes Currently Effective Changes for Virtually All Health Plans for 2011 Plan Year (Even Grandfathered and Union Plans) (cont'd) Preexisting condition exclusions for children under the age of 19 eliminated Employers can still exclude specific items or services from coverage now, if the exclusion applies regardless of when the condition arose relative to the effective date of coverage Regs issued June, 2010 43 Changes Currently Effective Changes for Virtually All Health Plans for 2011 Plan Year (Even Grandfathered and Union Plans) (cont'd) No lifetime limits on the dollar value of health benefits New notice and special enrollment right for individuals who reached a plan's lifetime limit before it had to be eliminated Only "reasonable annual limits" may be placed on "essential health benefits" until 2014 (and then no limits). $750,000 in 2011, $1.25M in 2012, $2M in 2013 Limits on number of days or number of treatments are still ok Regs issued June, 2010 44 Changes Currently Effective Changes for Virtually All Health Plans for 2011 Plan Year (Even Grandfathered and Union Plans) (cont'd) Plans cannot rescind coverage once it has begun, except for fraud or intentional misrepresentation of a material fact A "rescission" is a cancellation or discontinuance of coverage that has a retroactive effect Cancellation for failure to timely pay required premiums is excluded Plan terms must provide for rescission Plan must first provide 30 days advance written notice to the affected participant, and opportunity to challenge the rescission under a claim procedure Regs issued June, 2010 45
Changes Currently Effective Tax Changes for Health Plans Reimbursements for over-the-counter medicines no longer permitted without a prescription, and if a health plan does so reimburse, the payment is not excluded from income Flexible spending accounts, HRAs and HSAs New rules apply to all purchases made after December 31, 2010 125 Amendments required by June 30, 2011 Individuals who use an HSA for expenses that are not qualified medical expenses will see excise tax increase from 10-20% Nondiscrimination rules for insured plans were delayed until further IRS guidance 46 Grandfathering Which Plans are Grandfathered, and What Does Being Grandfathered Mean? Generally, a benefit option under a self-insured plan or insurance contract is "grandfathered" if it was in effect on March 23, 2010, AND No changes are made, or changes don t exceed limitations (see next slide), AND Must include a statement of grandfathered status in all plan materials provided to a participant or beneficiary The Grandfather Regulations contain model language that may be used, AND Must retain records documenting the terms of the plan in effect on March 23, 2010, and for each subsequent year showing how changes comply Records must be made available for examination 47 Grandfathering Plan Changes That Revoke Grandfathered Status: Obtain an entirely new policy of insurance to fund its benefits that was effective before November 15, 2010 Eliminate coverage for a specific condition (e.g., organ transplants) or eliminate benefits necessary to diagnose or treat a condition Increase dollar co-pays for prescriptions or doctor visits by the greater of $5 or medical inflation plus 15% Increase fixed dollar cost-sharing by more than medical inflation plus 15% (except, allowed to increase the cost-sharing level for a brandname drug when the generic becomes available) Change the sharing arrangement between the employer and employees by more than 5 percentage points Impose new annual or lifetime dollar limits or lower annual limits 48
Grandfathering Very Limited Special Rules for Fully-Insured Collectively Bargained Plans: Insured union-bargained plans in effect March 23, 2010 are grandfathered until the last bargaining agreement expires After the last bargaining agreement expires, the normal rules apply: Collectively bargained plans must compare the terms of coverage at the time the CBA expires with the terms that were in effect on March 23, 2010 and determine whether any changes have been made that would revoke the plan's grandfathered status Self-insured collectively bargained plans don't have special grandfather rules their grandfathered status is based on the same rules applicable to non-bargained plans NOTE: Many health reform requirements apply anyway, even if the union-bargained plan is grandfathered 49 Grandfathering Is it worth it? If grandfathered, a plan doesn't have to (yet): Comply with the salary-based nondiscrimination rules (unless already subject because the plan is self-insured) These have been delayed until at least 2014 and quite possibly longer 50 Implement the appeals process changes Cover emergency care at non-network facilities on the same basis as in-network facilities Pay for clinical trial costs Provide no-cost preventive services Provide coverage for dependents to age 26 if they have coverage available at their own job (grandfathered plans do not have provide coverage for dependents to age 26 if they have coverage available at their own job until 2014) Changes Currently Effective Changes for Non-grandfathered Health Plans New complex internal and external appeals requirements Definition of claim denial includes coverage rescissions Claims decision makers (internal and external) cannot be paid in a way would encourage a decision to deny benefits On appeal, plans must provide a claimant with any new information considered or generated in connection with the claim and an opportunity to respond before the claim is decided Self-insured plans must provide independent external medical review of adverse claim decisions, rotating among at least 2 independent review providers (IROs) by January 1, 2012 (and with at least 3 IROs by July 1, 2012) Scope of claims eligible for federal external review narrowed to claims involving medical judgment or coverage rescission (only applies to claims initiated after September 20, 2011) Regs issued 07/23/2010 and amended on 06/24/2011 51
Changes Currently Effective Changes for Non-grandfathered Health Plans Internal and external appeals requirements effective first plan year on or after July 1, 2011 New mandates for EOBs: Identify claim, including date of service, provider and claim amount Include denial code and meaning Include description of any standard that was used in denial If decision is on final appeal, include discussion of decision Include description of internal appeal and external review process, and how to initiate an appeal Include contact information for health insurance consumer assistance (DOL has published list) 52 Changes Currently Effective Changes for Non-grandfathered Health Plans Internal and external appeals requirements effective first plan year on or after January 1, 2012: Claims and appeals notices may need a statement in a non-english language that assistance is available in the non-english language (depends on employee population). Must also provide oral language services (e.g., telephone hotline) in the non-english language Plans must strictly adhere to all internal claims and appeals rules or risk an immediate external review or lawsuit (NOTE: an exception exists for certain minor errors) Claims and appeals notices must include statement that claimants may request the diagnosis and treatment codes (and their meanings) 53 Changes Currently Effective Changes for Non-grandfathered Health Plans Children can retain coverage to age 26, even if they have coverage available at their own employer Coverage for certain preventive services, immunizations, and screenings, must be provided without any cost sharing A list of preventive services is posted on the Department of Health and Human Services' website. The list of preventive services is subject to change, but there must be an interval of not less than one year between when recommendations or guidelines are issued, and the plan year for which coverage of the services addressed in such recommendations or guidelines must be in effect. If emergency services are covered, then they must be covered out-of-network on the same basis as in-network. 54
Legislative Amendments Repeal of expanded Form 1099 reporting requirement Originally effective January 1, 2012 Required employers to issue a Form 1099 to any vendor from whom the employer purchased $600 or more of goods or services in a calendar year Repeal of the Free Choice Voucher Originally effective January 1, 2014 Required employers to offer certain employees a free choice voucher to opt out of the employer's health plan and enroll in coverage through a state exchange 55 Health Care Reform Websites U.S. Supreme Court decisionhttp://benefitslink.com/src/misc/healthcare-sctopinion.pdf U.S. Department of Laborhttp://www.dol.gov/ebsa/healthreform/ U.S. Department of Health & Humans Services (original/archive site)-http://www.healthreform.gov/ U.S. Department of Health & Human Services (present site)-http://www.healthcare.gov/ Internal Revenue Servicehttp://www.irs.gov/newsroom/article/0,,id=222814,00.h tml 56 Questions? Helana A. Darrow hdarrow@fbtlaw.com 513.651.6110 57
Helana A. Darrow Member hdarrow@fbtlaw.com 3300 Great American Tower 301 East Fourth Street Cincinnati, Ohio 45202 T: 513.651.6110 F: 513.651.6981 Assistant Coleen Mahoney cmahoney@fbtlaw.com T 513.651.6493 PRACTICE AREAS Employee Benefits Law BAR MEMBERSHIPS American Bar Association Ohio State Bar Association Cincinnati Bar Association EDUCATION University of Cincinnati College of Law, J.D. 1998 Morehead State University, B.A. 1994 magna cum laude Helana has extensive experience in all aspects of employee benefits and executive compensation including counseling clients on the design, implementation, administration, operation and termination of employee benefit plans. Helana's practice includes advising clients on qualified retirement plans including, defined benefit plans, profit sharing plans, and 403(b) plans. She also advises on health and welfare benefit plans, fringe benefit plans, executive compensation plans, non-qualified deferred compensation plans, and equity compensation plans. Helana has significant experience with advising clients on employee benefit issues related to corporate transactions, drafting and negotiating executive compensation agreements and advising clients on ERISA litigation. Her practice also includes advising on the legal compliance of employee benefit plans under the Internal Revenue Code, ERISA, HIPAA, COBRA and PHSA. Helana represents clients before the Internal Revenue Service, the Department of Labor and the Pension Benefit Guaranty Corporation. Prior to Frost Brown Todd, Helana was a partner with Dinsmore & Shohl LLP where she had extensive experience advising clients on employee benefit matters. Helana earned her J.D. from the University of Cincinnati College of Law in 1998 and earned her B.A., magna cum laude from Morehead State University in 1994. Highlights & Recognitions YWCA Rising Star Board Leadership Program 2010 YWCA Rising Star 2009 Memberships & Affiliations The National Association of Stock Plan Professionals National Center of Employee Ownership Seminars & Speaking Engagements August 30, 2012 Practical, Workplace Solutions for Everyday Labor & Employment Issues