January 2013
From the editors of CCH's BENE and BAN products, here are hot topics from recent Employee Benefits Management Directions newsletters as well as recent explanatory updates in Employee Benefits Management. Also included are recent explanatory updates to the Benefits Answers Now product.
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Hot Topics in Employee Benefits Management:
Departments issue proposed regulations on nondiscriminatory wellness programs under ACA, Employee Benefits Management Directions, Issue No. 529, December 4, 2012 — The Departments of Health and Human Services (HHS), Labor and the Treasury (Departments) have jointly released proposed rules on nondiscriminatory wellness programs in group health coverage pursuant to the Patient Protection and Affordable Care Act (ACA).
HHS issues proposed regulations on insurance reforms, EHBs, Employee Benefits Management Directions, Issue No. 529, December 4, 2012 — The Department of Health and Human Services (HHS) has issued proposed regulations implementing provisions of the Patient Protection and Affordable Care Act (ACA) designed to protect consumers from insurance company abuses and containing standards related to the coverage of essential health benefits (EHBs).
HHS proposes rules on premium stabilization programs, exchange user fees, SHOP, MLR under health reform, Employee Benefits Management Directions, Issue No. 530, December 18, 2012 — The Department of Health and Human Services has issued a proposed rule that provides further detail and parameters related to: the risk adjustment, reinsurance, and risk corridor programs (known as the premium stabilization programs); cost-sharing reductions; user fees for a federally-facilitated health insurance exchange; advance payments of the premium tax credit; a federally-facilitated Small Business Health Option Program (SHOP); and the medical loss ratio (MLR) program.
Common questions updated on Early Retiree Reinsurance Program website, Employee Benefits Management Directions, Issue No. 530, December 18, 2012 — New common questions about reporting and correcting data inaccuracies, use of reimbursement, and sending the Early Retiree Reinsurance Program (ERRP) form notice to plan participants have been added to the use of reimbursement and miscellaneous common question sections of www.errp.gov.
What's New in Employee Benefits Management:
MLR — Proposed regulations on ACA’s medical loss ratio provisions are discussed at ¶10,097 and ¶10,240.
Wellness programs — Proposed regulations on ACA’s nondiscrimination rules for wellness programs are addressed at ¶20,030.
ERRP — New common questions on the Early Retiree Reinsurance Program (ERRP) are discussed at ¶53,260.
Standard mileage rates — The standard mileage rates for 2013 have been updated at ¶150,535, ¶150,565 and ¶150,595.
Medicare amounts — The Part A and Part B Medicare premiums and deductibles for 2013 have been updated at ¶53,140.
PBGC maximum benefit amount — The PBGC maximum benefit amount for 2013 has been updated at ¶82,020.
Proposed regulations on ACA — The proposed regulations on the Patient Protection and Affordable Care Act’s (ACA) market reforms, wellness provisions and essential health benefits (see stories above) can be found at ¶700,075A.
What's New in Benefits Answers Now (BAN):
HHS details accepted de-identification methods for PHI. The Department of Health and Human Services (HHS) has issued guidance, primarily in a question-and-answer format, on the methods and approaches necessary to achieve de-identification of protected health information (PHI) in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA’s privacy rule protects most "individually identifiable health information" that would contain a patient’s name and/or other identifying information associated with health data content, and would include such documents as medical records, laboratory reports, or hospital bills. For more information about protecting PHI, see ¶22,070.
Departments issue proposed regulations on nondiscriminatory wellness programs under ACA. The Departments of Health and Human Services (HHS), Labor and the Treasury have jointly released proposed rules on nondiscriminatory wellness programs in group health coverage pursuant to the Patient Protection and Affordable Care Act (ACA). The proposed regulations would increase the maximum permissible reward under a health-contingent wellness program from 20 percent to 30 percent of the cost of health coverage and would further increase the maximum reward to as much as 50 percent for programs designed to prevent or reduce tobacco use. More information about wellness programs can be found at ¶23,050.
PBGC increases maximum monthly guarantee for 2013. The PBGC has increased the maximum insurance benefit for participants in underfunded pension plans terminating in 2013 to $4,789.77 per month or $57,477.24 per year for those who retire at age 65. Find out more about plan terminations and the PBGC guarantee at ¶14,400.
HHS issues proposed regs on EHBs. The Department of Health and Human Services (HHS) has issued proposed regulations containing standards related to the coverage of essential health benefits (EHBs). The proposed rule would have states select a benchmark plan from among several options, and would mandate that all plans that cover EHB offer benefits substantially equal to the benefits offered by the state’s chosen benchmark plan. To find out more about essential health benefits, see ¶20,052.
Common questions updated on Early Retiree Reimbursement Program website. New common questions about reporting and correcting data inaccuracies, use of reimbursement, and sending the early retiree reinsurance program form notice to plan participants, have been added to the use of reimbursement and miscellaneous common question sections of www.errp.gov. See the discussion at ¶22,875 for more information about the early retiree reimbursement program.
What's New in Spencer’s Benefits Reports:
Bona Fide Wellness Programs. Bona fide wellness programs are subject to rules in HIPAA and the ACA. This report summarizes the rules wellness plans must follow and includes examples of nondiscriminatory wellness programs (Report 326.-3).
Defined Contribution Limitations. IRC Sec. 415(c) limits the amount that can be contributed to a defined contribution plan. This report reviews the Sec. 415 limits, and provides the 2013 limit (Report 109.2.-1).
Essential Health Benefits. Under the ACA, qualified health plans must provide an “essential health benefits package.” This report has been updated to reflect final and proposed regulations issued in 2012 (Report 541.-1).
Highly-Compensated Employees. Identifying highly compensated employees participating in qualified retirement plans is crucial in applying various nondiscrimination tests. The regulations regarding highly-compensated employees are reviewed in this report (Report 113.05.-1).
Employer Shared Responsibility Payments. Beginning in 2014, the ACA assesses payments on certain large employers with 50 or more employees, including employers that do and do not offer health coverage. The rules are addressed in this report (Report 550.-1).
New Pension/Benefits Titles Added:
Journal of Pension Benefits (Winter 2013)