Frequency of Updates:Quarterly
Written and edited by experienced employee benefits attorneys, EBIA Health Care Reform is your essential partner for employer plan compliance, and provides up-to-date expert analysis of the key requirements that affect employers, advisors, and insurers. It features in-depth coverage of legal requirements and information critical to effective decision-making - with examples, tables, implementation timelines, sample documents, and practical tips that will help you comply with the myriad of complex rules. You’ll get guidance on:
- Which employer plans are subject to health care reform and related mandates, and which benefits are excepted. Special rules for grandfathered health plans, plus noncompliance consequences.
- Various plan design and administration reforms, plus fees and other tax rules for both employer plans and insurers.
- Which employers are subject to the employer shared responsibility penalty (also referred to as the “play or pay” penalty). Understanding “eligible employer-sponsored plans” and the “minimum value” and “affordability” conditions for avoiding the penalty.
- Penalty for individuals who do not have health insurance (also referred to as the “individual mandate”). How Exchanges and the individual mandate impact employers (including required notices, reporting, and the relationship to employer shared responsibility penalty).
List of Content (Click any title to expand the list)
- Overview of Health Care Reform for Employers and Advisors
- Health Care Reform: Effective Dates, Timeline, and Reference Tools
- Which Plans and Insurers Must Comply With the PHSA Mandates?
- Grandfathered Health Plans
- PHSA Mandates: Consequences of Noncompliance
- Lifetime, Annual, and Cost-Sharing Limits
- Preexisting Condition Exclusions, Waiting Periods, and Rescissions
- Dependent Coverage for Adult Children
- Patient Protections, Preventive Health Services, and Clinical Trials
- Nondiscrimination in Plan Design
- Insurance Mandates
- Appeals Process and External Review Requirements
- Summary of Benefits and Coverage (SBC)
- Mechanisms to Allocate Risk
- Exchanges, Qualified Health Plans (QHPs), and CO-Ops
- Temporary High Risk Pool: PCIP Program
- Small Business Health Care Tax Credit
- Early Retiree Reinsurance Program (ERRP)
- Shared Responsibility for Employers (Play or Pay Penalty Tax)
- Shared Responsibility for Individuals (Individual Mandate)
- Tax on High-Cost Health Coverage
- Automatic Enrollment
- HIPAA Electronic Transactions and Operating Rules
- Employee Protections
- Special Issues for FSAs, HRAs, HSAs, and Cafeteria Plans (Including Simple Cafeteria Plans)
- Reporting, Fees, and Required Payments
- Participant Notices and Disclosures
- EBIA's Health Care Reform for Employers and Advisors: What's New View