It has been almost a week since last Wednesday's presidential debate between President Barack Obama and Governor Mitt Romney at the University of Denver. The political analysts have determined a winner with poll results, Saturday Night Live has done their parody, and odds are that anecdotal thoughts on the debate are no longer the focus of 'water-cooler' conversations at work.
It's easy to get distracted with the influx of commentary and analysis on the candidates that come on the back-end of any presidential debate, and lose sight of how some of the major topics will directly impact any industry, in our case, the human resource (HR) and employee benefits community.
Perhaps one of the biggest headaches for employers are the many obligations surrounding the implementation of Patient Protection and Affordable Care Act (PPACA) provisions. Despite all the rhetoric, PPACA is still the law of the land and compliance for employers is looming. Even if Governor Mitt Romney wins, repeal wouldn't happen quickly, especially if the Senate remains controlled by Democrats. It was clear from this year's debate that employers can't afford a wait-and-see attitude.
To help employers better understand PPACA compliance, we'd like to share two useful resources we came across from United Benefit Advisors, one of the nation's top five employee benefits advisory organizations and the source of some outstanding (and unbiased) resources to help companies manage their benefits packages:
(1) The PPACA Decisions Executive Summary, part of UBA's PPACA Advisor series, offers a "50,000 ft. view" of PPACA compliance, which includes an overview of PPACA, decisions employers need to make regarding PPACA and obligations employers must fulfill between now and 2014.
(2) It's also important to keep in mind that PPACA has different provisions depending on the size of your business. So, UBA offers The Expanded Decision Support Guides tailored for small
businesses (under 50 employees), mid-sized businesses (50-100 employees)
and large employers (more than 100 employees) that significantly
expand on information presented in the Executive Summary, providing the
most comprehensive PPACA compliance support.
Note: Both the executive summary and expanded reports are free but require a brief registration (worth it). If you want both, use the expanded report form and be sure to check the box to obtain a copy of the Expanded Support Guides.
As an example of the wealth of information contained in the PPACA Decisions Executive Summary, here is a list of changes that employers should already be making to comply with PPACA, which are that health plans:
- May not have a lifetime dollar maximum on any "essential health benefit".
- May not have an annual dollar limit on an "essential health benefit" that is over a certain amount.
- Must cover the health care of employee's dependent children until the dependent reaches age 26 - even if the child is married or employed.++
- May not exclude pre-existing condition limitations for children under age 19.
- May not retroactively rescind health care coverage, except for fraud or material misrepresentation or for nonpayment of premium by certain terminated employees.
- Must provide first-dollar health care coverage for specific preventive services.+
- Must cover emergency services at in-network level regardless of provider.+
- If a primary care physician (PCP) must be chosen, allow each person to choose their own PCP and allow a pediatrician to be the designated PCP.+
- Must allow women to see an OB-GYN without a referral.+
- Must have a specific and comprehensive process for handling health care claims appeals+
- May not reimburse over-the-counter drugs under a health flexible spending account, an health reimbursement account or an health savings account unless the drug is prescribed by a doctor.
Regardless of your preferred winner in the 2012 presidential election, we wish you all the best in complying with the Patient of Protection and Affordable Care Act (PPACA). We hope these resources help!
+ Does not apply to grandfathered plans
++ Limited exception for grandfathered plans
Labels: Employee Benefits, HCR, health care reform, PPACA, united benefit advisors
