DOL Provides Guidance on Participant-Level Disclosure Regulation
The Department of Labor (DOL) has published a Bulletin providing guidance on some of the most frequently asked questions relating to the participant-level disclosure regulation published in 2010. This regulation requires plan administrators to disclose certain plan and investment related information, including fee and expense information, to participants and beneficiaries in participant-directed individual account plans, such as 401(k) plans.[1] See Field Assistance Bulletin No. 2012-02, available at: http://www.dol.gov/ebsa/regs/fab2012-2.html.
Agencies Issue New Guidance on Summary of Benefits and Coverage Requirement
The Department of Labor’s Employee Benefits Security Administration (EBSA) along with the Departments of Health and Human Services (HHS) and the Treasury have released a ninth set of Frequently Asked Questions (FAQs) on the Affordable Care Act’s implementation. This most recently issued guidance addresses questions regarding the health care reform law’s summary of benefits and coverage (SBC) requirement. The Affordable Care Act requires group health plans and health insurance issuers to provide consumers with a SBC that “accurately describes the benefits and coverage under the applicable plan or coverage” to enable enrollees and participants to better compare plan terms and benefits.
HHS Adds New Medical Loss Ratio Reporting Requirement
The Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS) has issued a final rule (pdf) that imposes a new reporting requirement on health insurance issuers in the group and individual markets that meet or exceed the applicable medical loss ratio (MLR) standard for the 2011 reporting year.
Health Plans Have an Added Mandatory Disclosure under ERISA
Health care reform expands ERISA's disclosure requirements by requiring that group health plans provide a summary of benefits and coverage (“SBC”) to plan participants and beneficiaries before enrollment or re-enrollment. The primary purpose of the SBC is to enable participants to compare coverage options easily and to help them better understand their health benefits. The SBC must accurately describe the benefits and coverage available to the participant or beneficiary under the applicable plan. This SBC requirement applies in addition to the SPD and SMM requirements already in place.
DOL Issues Guidance on Mental Health Parity and Addiction Equity Act
The Department of Labor’s Employee Benefits Security Administration (EBSA) has issued a new set of Frequently Asked Questions (FAQs) on the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). This law generally requires private group health benefit plans that provide mental health and/or substance use disorder benefits through a group health benefit plan that also offers medical and surgical benefits to do so on an equivalent basis.
HHS Begins HIPAA Privacy and Security Audits
s you may recall, the HITECH Act required Health and Human Services (HHS), the federal agency in charge of administering HIPAA, to affirmatively conduct periodic audits to ensure that covered entities and business associates are complying with HIPAA's privacy and security rules. Before HITECH, HHS was mostly responding to complaints and not conducting random audits of HIPAA compliance.
New Limits for Health Savings Accounts and Flexible Spending Arrangements in 2013
The Internal Revenue Service has announced the 2013 inflation-adjusted deduction limits for Health Savings Accounts (“HSAs”). Internal Revenue Service Revenue Procedure 2012-26. HSAs are consumer-driven pre-tax accounts that can be contributed to by, or on behalf of, individuals who are covered under a high-deductible health plans (“HDHPs”) to pay for certain medical expenses of the employee and dependents, including premiums and deductibles.
FAQs Regarding Summary Of Benefits And Coverage
In response to the February 14, 2012 final rules and regulations issued by the Labor Department regarding the summary of benefits and coverage (SBC) provisions of Health Care Reform, the DOL, in conjunction with Health and Human Services and the Treasury Department issued a new set of 24 Frequently Asked Questions to address some of the pertinent questions raised to date and to help consumers, employers and individuals understand the new law.
Guidance On MLR Rebates For Insured Plans
One of the provisions in the recent healthcare reform law is the medical loss ratio (MLR) that requires insurance companies to spend a certain proportion of their income on healthcare benefits for their customers. If an insurance company does not meet its MLR standard, it is required to issue a rebate to its policyholders. (The MLR standards do not apply to self-insured medical plans.) In 2011, the Labor Department issued a Technical Release, which provided guidance on how sponsors of group health plans covered by ERISA should handle such rebates.
Information Sought on Stop Loss Insurance Coverage
The Departments of Treasury, Health and Human Services, and Labor are soliciting input from group health plans and their sponsors regarding the use of stop loss insurance. Stop loss insurance protects against catastrophic or unpredictable health insurance claims and provides coverage to self-insured group health plans once a certain level of risk has been assumed by the plan. According to the request for information, the agencies lack sufficient data on the incidence or terms of stop loss insurance among self-insured employers’ group health plans.
