As HR pros wait on the fate of the Affordable Care Act (ACA), the feds continue to clarify how businesses are supposed to comply with the law’s many provisions.
Special Enrollment & HIPAA
The FAQs addressed special enrollment for group health plans under HIPAA. Because HIPAA generally allows current employees and dependents to enroll in a company’s group health plan if the employees/dependents lose their previous coverage, they must be offered the same special enrollment option if they lose individual market coverage (i.e., health coverage they obtained through the individual Obamacare marketplace).
This could happen to individual market participants if an insurer that was covering an employee/dependent decides to stop offering that individual market coverage. As we’ve seen last year, several major insurers have taken that step.
One exception to this special enrollment: If the loss of coverage is due to a failure to pay premiums in a timely manner or “for cause.”
Qualified small employer HRA
As we’ve reported on previously, the 21st Century Cures Act, among other things, allows certain small employers — known as “qualified small employer health reimbursement arrangement (QSEHRA) — to offer general purpose stand-alone health reimbursement arrangements (HRAs) without violating the ACA.
The FAQs touched on how this new law gibes with the ACA and clarified that in order to be a qualified small employer or a QSEHRA, the structure of the plan must:
- be funded entirely by an eligible employer — one with fewer than 50 full-time equivalent employees in the prior year and that doesn’t offer a group health plan to any of its employees
- provide for payment to, or reimbursement of, an eligible employee for medical care under Code section 213(d)
- not reimburse more than $4,950 for eligible expenses for individuals or $10,000 for families, and
- be provided to all eligible employees of the employer offering the HRA.
One thing the 21st Century Cares Act (and the feds guidance) doesn’t address: Whether ERISA applies to these QSEHRAs that are now OK under Obamacare.
Updated women’s preventive services
All non-grandfathered health plans are required to provide recommended preventives services for women without any cost-sharing.
Those services are listed in the Health Resources and Services Administration’s (HRSA) guidelines, and the HRSA was just updated on December 20, 2016. The updated guidelines bolster many of the existing preventive care guidelines for women and include (among others) screenings for:
- breast cancer
- cervical cancer
- gestational diabetes
- HIV, and
- domestic violence.
The services in the updated guidelines must be covered — without cost-sharing — for plan years beginning on or after December 20, 2017 (Jan. 1, 2018 for calendar year plans). Until then, plans can keep using the previous HRSA guidelines.