Amidst the celebrating that they can’t be penalized for violating Obamacare’s “employer play or pay mandate” until 2015, companies need to be careful not to overlook the other reform law requirements that start to kick in as early as next week.
Despite the fact that the Obama administration is wavering on several Affordable Care Act requirements — at least for one more year — there’s plenty companies still have to contend with in the very near future or face stiff penalties.
What hasn’t left the table
Here are several of the reform law’s requirements that health plan sponsors and insurers still have to worry about complying with and will begin to kick in next week:
- Payment of the comparative effectiveness fee. For plan years ending on and after Oct. 1, 2012 through Sept. 30, 2019, all employer health plans must pay an annual fee to support “patient-centered outcomes research.” For calendar-year plans, this means the fee applies to your 2012 plan year. The fee is $1 per covered life the first year, and it doubles to $2 in the second plan year. It’s then adjusted for inflation during the final five years. Fees for the previous year are due July 31 every year. So for calendar-year plans, the fee for 2012 is due next week!
- Distributing health exchange notices. Employers must provide a notice to all current employees informing them of their ability to purchase insurance via a health exchange. The notices are due to employees by Oct. 1, 2013. And new employees hired after that date must receive the notice at the time of their hire.
- Waiting period restrictions. Beginning in 2014, employees can’t be forced to wait longer than 90 days to be eligible for health plan coverage.
- Preexisting condition elimination. Also starting in 2014, plans will no longer be allowed to deny coverage to employees because they have a preexisting medical condition.
- Dollar limit elimination. From 2014 on, group health plans may not establish any annual or lifetime dollar limits on essential health benefits.
- Payment of reinsurance program fee. Under Obamacare, in 2014 insurers will have to pay a fee of $5.25 per health plan participant per month ($63 dollars per year). Self-insured companies will also have to pay the fee, which will fund the Transitional Reinsurance Program. In 2015, the fee is expected to drop to about $42 per participant per year. In 2016, it’s expected to fall to nearly $26. The money from the fee will be pooled in an account managed by the HHS. It will be used to reimburse insurance companies who end up covering a large share of individuals with pre-existing conditions. Those insurers will be eligible for reimbursement of a percentage of those individuals’ claims that exceed a specified amount.
- Establishment of a reasonable alternative standard in wellness programs. The agencies charged with implementation of the Affordable Care Act (the HHS, DOL and IRS) just issued final rules covering wellness programs that will kick in Jan. 1, 2014. They say that activity-only programs (those only requiring workers to complete a wellness activity, like a smoking-cessation class, to earn an incentive) must offer participants a reasonable alternative to the program to earn the incentive. But they can require a doctor’s verification that the employee can’t complete the original program for a medical reason. Outcome-based programs (those requiring workers to accomplish a goal, like quitting smoking, to earn an incentive), on the other hand, will be treated differently. They must offer a reasonable alternative to all employees, even those with medical conditions.
- Distributing summaries of coverage with revisions. New rules governing the summary of benefits and coverage (SBC) documents group health plans must provide to current and perspective plan participants will apply to plans with coverage that begins on or after Jan. 1, 2014. The new rules state that SBCs must answer these two questions: 1) Does this coverage provide minimum essential coverage? and 2) Does this coverage meet the minimum value standard?
A previous version of this article was published on our sister website, HRBenefitsAlert.com.