The Patient Protection and Affordable Care Act ("PPACA"), on its face, acknowledges a constitutional issue with employer shared responsibility:
Group health plan sponsors and health insurance issuers should take note (if they have not already taken action) that the deadline to provide the summary of benefits and coverage (SBC) as required by the Patient Protection and Affordable Care Act (PPACA) is fast approaching.
Recently, the Department of Health and Human Services, the Department of Labor and the Treasury Department (the “Agencies”) issued amendments to the interim final regulations implementing, among other things, the requirements regarding internal claims and appeals processes for group health plans and issuers under the Patient Protection and Affordable Care Act of 2010 (the “Interim Final Regulations”).
The U.S. Departments of Labor, Treasury and Health and Human Services have issued proposed rules addressing the form and content of the summary of benefits and uniform glossary requirements of Section 2715 of the Patient Protection and Affordable Care Act (PPACA).
The Patient Protection and Affordable Care Act (the Act) directs the Departments of Labor, Health and Human Services, and Treasury (collectively, the Departments) to develop, in consultation with the National Association of Insurance Commissioners (NAIC), standards for use by group health plans and health insurance issuers for providing summaries of benefits and coverage (SBC) to insureds, plan participants, and beneficiaries.
The Department of Labor (DOL) recently issued Technical Release 2011-01, extending the non-enforcement period relating to certain interim procedures for internal claims and appeals under the Patient Protection and Affordable Care Act (PPACA).
The IRS has issued Notice 2011-1, which provides relief from the requirement that non-grandfathered employer-sponsored insured group health plans not discriminate in favor of highly compensated individuals.
On September 20, 2010, the US Department of Labor ("DOL") issued Technical Release 2010-02 ("Technical Release") which provides an enforcement grace period until July 1, 2011 for some of the new internal claims and appeal provisions that were mandated by the interim final regulations.
The U.S. Departments of Treasury, Labor, and Health and Human Services have released guidance on how employer-sponsored self-funded group health plans can satisfy the new external claims review requirements arising from the federal health care reform legislation.
Effective for plan years beginning on or after September 23 (January 1, 2011, for calendar year plans and policies), non-grandfathered group health plans (including non-Employee Retirement Income Security Act plans such as governmental and church plans) and health insurance issuers will be required under the Patient Protection and Affordable Care Act (PPACA) to comply with federal rules for administering health plan claims and appeals.