President Barack Obama has promised to make health care reform a priority for his administration. We do not yet know the shape of his proposals nor whether any proposed changes will pass Congress and become law. However, even without wholesale reform, employers will be busy addressing new laws that affect group health plans, among them the following:
- GINA. The Genetic Information Nondiscrimination Act of 2008 (GINA) generally prohibits employee benefit plans from discriminating in premiums or denying coverage on the basis of genetic information. Unless an exemption applies, employer plans are forbidden to ask employees for genetic information. Many employer wellness programs ask for information about the health history of family members, information that is considered “genetic information” under the statute. Regulations are supposed to be issued by May 21, 2009, and GINA is generally effective for plan years beginning after May 21, 2009 (January 1, 2010, for calendar year plans). Employers may need to make changes to wellness and other programs to meet these new requirements.
- Michelle’s Law. Michelle’s Law, enacted in October 2008, requires employer health plans to continue regular health plan coverage for up to one year for dependent children who are college students and who take a medically necessary leave of absence. The law is effective for plan years beginning on or after October 9, 2009, or January 1, 2010, for calendar year plans. The extent to which this additional coverage runs concurrently with COBRA or is in addition to COBRA is unknown. Employers can hope for more guidance before the effective date.
- Medicare Secondary Reporting. Employer health plans must now provide information to Medicare sufficient to allow the Centers for Medicare & Medicaid Services (CMS) to determine whether Medicare claims are being properly paid secondary to employer group health plans. The reporting requirement generally falls on the third-party administrators and insurers so that employers who do not administer their own plan are not directly affected. However, third-party administrators may be asking employers for help in obtaining certain information, such as social security numbers for covered dependents, that CMS requires be included in the filings.
- Mental Health Parity. Minnesota has required parity between mental health and physical health requirements in fully insured medical plans for some years. The federal legislation included in the Emergency Economic Stabilization Act (the bailout bill) now creates a similar requirement in federal law. The law is generally effective for plan years beginning after October 4, 2009, or January 1, 2010, for a calendar year plan. Generally speaking, under the law coinsurance, deductibles, and out-of-pocket maximums and general treatment limitations must be the same for mental health and physical health conditions, including chemical dependency. There is an exception for plans of small employers (no more than 50 employees) and for plans for which an employer can show increased costs of more than 1% or 2% attributable to the change. To take advantage of the exception, the employer must give notice to the Department of Labor and to the participants that the plan will not provide mental health parity and can take this action only after the plan has complied with the provisions for at least the first six months of a plan year. The Mental Health Parity bill is named for the late Senator Paul Wellstone, who championed its passage before his death in October 2002.