Employers Guide to Health Care Reform, 2012-2013 Edition

Employer's Guide to Health Care Reform is the premier step-by-step practical guide for employers struggling to keep up with the rapid pace of changes affecting their health benefit plans. Specifically, it will help you:

• Grasp every implication of health care reform from the employer's perspective
• Fully understand even the most complex rules
• Achieve significant cost savings
• Meet deadlines and take advantage of opportunities to delay implementation
• And much more!

Written by experts from Ballard Spahr LLP, the 2012-2013 Edition of Employer's Guide to Health Care Reform has been updated to include coverage of the latest health care reform developments, including:

• A review of the landmark U.S. Supreme Court decision in National Federation of Independent Business v. Sebelius, which upholds the constitutionality of the Affordable Care Act
• When is a plan a "grandfathered" health plan - and how to keep it that way
• Whether an employer-sponsored health plan covering solely retirees is subject to the Affordable Care Act design changes, such as the requirement to cover children through age 26
• What types of subsidies and tax credits are available right now to employers that provide health coverage to employees
• Which health plans and benefits are currently subject to new prohibitions on annual and lifetime limits, and what exemptions are available
• How and when the Affordable Care Act restricts preexisting-condition exclusions
• When must an employer-sponsored health plan provide full coverage for preventive health services without cost-sharing
• What are the consequences of offering health plan coverage to children up to age 26
• What are the new claims and appeals processes mandated by the Affordable Care Act for health plans
• What additional changes to health plan design are going to be required beginning in 2014 How will employer-sponsored health plans need to change their employee communications to address the Affordable Care Act requirements
• What new types of reporting will be required for health plans
• What is the "individual mandate" to enroll in health coverage
• Which employers will have to pay a penalty if they do not provide adequate and affordable health plan coverage
• How employers can determine whether their coverage is adequate and affordable
• What is a health care Exchange, and how will it affect the U.S. health care system
• What states will need to do to set up a health care Exchange
• How the Affordable Care Act affects retiree prescription drug coverage under Medicare Part D and how the changes create new opportunities for employers
• How and when the new nondiscrimination rules apply to insured health benefits, and what are the consequences of discriminatory coverage
• Which employer-sponsored health plans are subject to auto-enrollment and when do the rules go into effect
• What are the new FormW-2 reporting requirements for employer-sponsored health plans and when do they go into effect
• When health care flexible spending accounts (Health FSAs) and health savings accounts (HSAs) may and may not pay reimbursements for over-the-counter medicines and drugs
• And much more

• EVOLUTION OF HEALTH CARE REFORM
  • Reasons for Health Care Reform
  • The Employer-Based Health Care Coverage Landscape Prior to Health Care Reform
  • The Legislative Process: Making Sausage
  • Enforcement Responsibility
• CONSTITUTIONAL CHALLENGES TO HEALTH CARE REFORM
  • Federal Government's Taxing Power
  • Federal Government's Commerce Clause Power
• HEALTH CARE COVERAGE KEY TERMS
• HEALTH CARE REFORM EXEMPTIONS
  • Grandfathered Health Plans: "If You Like Your Current Insurance, You Will Keep Your Current Insurance"
  • Collectively Bargained Insured Plans
  • Exemption for Retiree-Only Plans
  • Exemption for Excepted Benefits
• QUALITY, AFFORDABILITY, AND ACCESSIBILITY
  • Immediate Steps to Expand and Preserve Coverage
  • Transition Period Coverage Improvements Applicable to Group Health Plans
  • Coverage Improvements Applicable to Employment-Based Coverage Effective January 1, 2014
  • New Reporting Obligations
  • Additional Electronic Transaction Standards
• PRESERVING AND EXPANDING IMMEDIATE ACCESS TO COVERAGE
  • Temporary Reinsurance Program for Early Retirees
  • Pre-Existing Condition Insurance Plans
  • Small-Employer Incentives
• COVERAGE IMPROVEMENTS DURING THE TRANSITION PERIOD
  • Prohibitions on Lifetime and Annual Dollar Limits on Benefits
  • Prohibition on Preexisting-Condition Exclusion Provisions for Children Under Age 19
  • Coverage of Preventive Health Services
  • Extension of Coverage for Children Up to Age 26
  • Mandated Claim and Appeal Process
  • Prohibitions on Rescissions
  • Patient Protections
• IMPROVEMENTS EFFECTIVE JANUARY 1, 2014
  • Prohibitions on Preexisting-Coverage Exclusions or Other Discrimination Based on Health Status
  • Fair Health Insurance Premiums
  • Guaranteed Issue and Renewability
  • Prohibiting Discrimination Against Health Care Providers
  • Quality Coverage Provisions
  • Limits on Waiting Periods
  • Coverage for Individuals Participating in Approved Clinical Trials
• TRANSPARENCY AND ACCOUNTABILITY
  • Uniform Summary of Benefits and Coverage
  • Reporting on Claims Practices and Plan Financing
  • Quality-of-Care Reporting
  • Containing the Cost of Health Insurance Coverage
  • Ensuring That Consumers Get Value for Their Dollars
  • Empowering Consumers With Information
  • State Health Insurance Consumer Information
• MANDATES AND EXCHANGES
  • Individual Enroll-or-Pay
  • Employer Pay-or-Play (Shared Responsibility)
  • Free Choice Vouchers
  • Health Care Exchanges
• OPERATIONAL CHANGES FOR HEALTH PLANS
  • Medicare Part D
  • Nondiscrimination Rules Applicable to Insured Health Benefits
  • Auto-Enrollment
  • Employer Notice of Coverage Options
  • Nursing Mothers
  • Reporting Cost of Coverage on Form W-2
  • Simple Cafeteria Plans for Small Businesses
• NEW TAXES AND OTHER REVENUE-RAISERS
  • “Cadillac” Tax
  • Health FSAs
  • HSAs
  • Administrative Feesfor Self-Funded and Insured Plans
  • Additional Taxes on High Earners
  • Other Taxes
• ANALYZING THE IMPACT OF HEALTH CARE REFORM
  • Difference Based on Employer Size
  • Differences Based on Full-Time vs. Part-Time Employees
  • Differences Based on Union vs. Non-Union Workforces
  • Employers Providing Retiree Health Care Coverage
  • Looking Ahead
• APPENDICES
  • Affordable Care Act Provisions Applicable to Grandfathered Health Plans
  • Tri-Agency Regulations on Grandfathered Health Plans
  • Amendment to Grandfathered Health Plan Regulations
  • HHS Regulations on Web Portal Requirements
  • IRS Form 8941 and Instructions (Small Employer Tax Credit)
  • Tri-Agency Regulations on Preventive Care
  • Recommended Immunization Schedules
  • Tri-Agency Regulations on Coverage of Contraceptive Services by Religious Employers
  • CMS Temporary Enforcement Safe Harbor for Coverage of Contraceptive Services by Religious Employers
  • Advance Notice of Tri-Agency Proposed Rulemaking on Coverage of Contraceptive Services by Religious Employers
  • Tri-Agency Regulations on Extended Coverage for Adult Children
  • IRS Notice 2010-38 (Exclusions from Income for Adult Children Coverage)
  • Tri-Agency Regulations on Claims and Appeals Process
  • Amendment to Tri-Agency Regulations on Claims and Appeals Process
  • Model Notices for Claims and Appeals Decisions
  • Blank and Completed Template Summaries of Benefits and Coverage
  • DOL Technical Release 2011-04 - Guidance on Rebates for Group Health Plans Paid Pursuant to the Medical Loss Ratio Requirements of the Public Health Service Act
  • HHS Center for Consumer Information and Insurance Oversight - Essential Health Benefits Bulletin and Corresponding Frequently Asked Questions