The Department of Health and Human Services (HHS) has released three new proposed regulations regarding the Patient Protection and Affordable Care Act’s (PPACA) essential health benefit requirements, the new rating rules for individual and small group market policies and new requirements for employer-based wellness programs.

In accordance with the Patient Protection and Affordable Care Act (PPACA), group health plans and health insurance issuers will begin issuing Summary of Benefits and Coverage (SBCs), starting September 23, 2012. According to Human and Health Services (HHS), this document explains “simple and consistent information about health plan benefits and coverage. People will receive the summary and glossary when shopping for coverage, enrolling in coverage, at each new plan year and within seven business days of requesting a copy from their health insurance issuer or group health plan.”

Starting August 1, 2012, women are getting greater control over their health care and adding eight new prevention-related health care services without paying more out of their pocket. Many insurance companies did not cover these preventative services for women at all under their health plans, as some women had to pay deductibles or copays for the care they needed to stay healthy. The new rules in the health care law requiring coverage of these services take effect at the next renewal date –on or after Aug. 1, 2012- for most health insurance plans.

On June 28, 2012, the US Supreme Court ruled that the Affordable Care Act’s (ACA) individual mandate is a constitutional exercise of Congress’s power to impose taxes. Due to the Court’s decision, compliance efforts likely will continue with major provisions of the ACA becoming effective in 2013 and 2014. According to Chief Justice Roberts, “The Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax. Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.”

An estimated 10.7 million American women use oral contraceptives, the leading method of contraceptive in the United States. The Patient Protection and Affordable Care Act now requires coverage of FDA-approved contraceptive methods for women at 100 percent, without charging a copayment, coinsurance or deductible, when filled at a network pharmacy. HHS commissioned an Institute of Medicine study to review what preventive services are necessary for women’s health and well being and should be considered in the development of comprehensive guidelines for preventive services for women.

The Kaiser Family Foundation released a report estimating the impact the Patient Protection and Affordable Care Act’s (PPACA) medical loss ratio (MLR) provisions will have on health insurance consumers this year in the form of premium rebate checks that are supposed to be mailed to health insurance consumers this August. Although $1.3 billion, the total amount of the projected rebates seems large, when you read the fine print, it becomes apparent that these rebates aren’t quite the bonus some have been predicting. Furthermore, the coverage disruptions, loss of agent services, and higher overall premiums caused by both the MLR requirements specifically and PPACA generally, negate any consumer benefit the rebates may provide.

As discussed in our previous blog article, earlier this year, Mary Landrieu (D-LA) had submitted legislation (S. 2068) to try to help protect health insurance agent and broker jobs by attempting to exclude independent health insurance producer compensation from the medical loss ratio (MLR) requirements in the Patient Protection and Affordable Care Act (PPACA). On April 17th, Landrieu, along with cosponsors Johnny Isakson (R-GA), Lisa Murkowski (R-AK) and Ben Nelson (D-NE) re-filed the bill, now titled S. 2288.

The Department of Human Health Services released its rules for states regarding the implementation of health insurance exchanges. According to the HHS, the rules provide “a framework to assist states in building Affordable Insurance Exchanges.” They also “set minimum standards for Exchanges, give states the flexibility they need to design Exchanges that best fit their unique insurance markets, and are consistent with steps states have already taken to move forwards with Exchanges.”

Mary Landrieu (D-LA) has submitted legislation (S 2068) to try to help protect health insurance agent and broker jobs by attempting to exclude independent health insurance producer compensation from the medical loss ratio (MLR) requirements in the Patient Protection and Affordable Care Act (PPACA). The bill’s co-sponsors are Ben Nelson (D-Neb.), Johnny Isakson (R-GA) and [...]

The essential benefits report, created by the Institute of Medicine (IOM), has been released. The Affordable Care Act requires the package to reflect benefits covered by a typical employer plan and include 10 categories. According to the report, HHS officials will compare potential services and products against a set of critera, created by the IOM, including medial effectiveness, safety and relative value compared with alternative options, and evaluate whether the package as a whole protects the most vulnerable individuals, promotes services that have proved effective and addresses the medical concerns of greatest important to the public. In keeping with their assigned task, the IOM did not address and specific types of benefits in their recommendations. It instead tells the Secretary of HHS how to define the minimum benefits. Click here to view additional recourses by the IOM including the IOM’s press release, criteria, report brief and report release presentation.