David M. Gilston Insurance Agency, Inc.

The final rule from the Department of Health and Human Services (HHS) on the Summary of Benefits and Coverage (SBC) and the Uniform Glossary requirements of the Patient Protection and Affordable Care Act (PPACA) was announced on February 9, 2012. According to the HHS, this document will explain “in plain language, simple and consistent information about health plan benefits and coverage. Starting on September 23, 2012, health insurers and group health plans will be required to provide the SBC and uniform glossary to consumers.

Because the Patient Protection and Affordable Care Act’s Summary of Benefits and Coverage (SBC) and Uniform Glossary requirements are yet to be clearly defined, the Department of Labor (DOL) submitted guidance that has delayed the effective date of these changes, therefore causing concern of a new compliance date. As described in a previous reform blog article, the SBC is intended to provide insured members with information about the plan they have or can be used when shopping for coverage and comparing plans. The Uniform Glossary is designed to help consumers have a better understanding of terminology when making a buying decision. The DOL, Internal Revenue Services (IRS) and the Department of Health and Human Services (HHS) had originally proposed March 23, 2012 as the compliance date. Due to the delay, a new compliance date is yet to be chosen. The guidance stated that, “until final rules are issued on this topic, group health plans and health insurance issuers are not required to comply.”

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.

HHS, DOL, and IRS jointly issued proposed rules requiring group health plans, including grandfathered plans, to provide their members with two new forms beginning on March 23, 2012. This ruling is currently open for public comment for a period of 60 days.

HHS issued two rules on August 1st addressing the preventive care requirements in the Patient Protection and Affordable Care Act (PPACA). The first is a proposed rule, which would require new health insurance plans to cover women’s preventive services without charging a co-payment, co-insurance or deductibles for plan years starting on or after August 1, 2012. The requirement will not apply to grandfathered plans that were in effect before the law was enacted on March 23, 2010.

The DOL, HHS, and IRS issued Part VI of the FAQs regarding implementation of the market reform provisions of the Affordable Care Act and focus on grandfathered health plan provisions of health care reform. For simplicity, only the questions are included below. You may view the government’s response here or read our previous blog articles regarding FAQs Part I, Part II, Part III, Part IV and Part V.

We are approaching another deadline for health reform, March 23, 2011. This is the date that HHS is supposed to release guidance regarding the four-page summary of benefits and coverage. Under health care reform as a part of the notification requirements, all applicants and enrollees must be provided a “summary of benefits and coverage” prior to enrollment or re-enrollment.

The DOL, HHS, and IRS jointly issued another set of FAQs (Part V) regarding implementation of the market reform provision Affordable Care Act, with topics including auto-enrollment in group health plans, summary of benefit disclosure requirements to group health plan participants, grandfathered plans, dependents to age 26 requirements, preexisting condition requirements for children in individual health policies, and value-based insurance design in connection with preventive care benefits.

The DOL, HHS, and IRS jointly issued another set of FAQs (Part IV) regarding implementation of the market reform provisions of the Affordable Care Act. For simplicity, only the questions are included below. You may view the government’s response here or access FAQs Part I, Part II and Part III.

Employers are now able to change insurers and still maintain grandfathered status, according to new rules issued November 15, 2010 by the IRS, DOL and HHS.