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Benefits buzz january 2013
1.
DID YOU KNOW While insured small group plans and individual health insurance policies will be subject to new deductible and out-of- Benefits and HR tips brought to you by pocket limit caps in 2014, proposed The Gardner Group legislation indicates that the government does not intend to impose these regulations on self-insured group health plans or insured large group health plans. In addition, remaining grandfathered group health plans will also be exempt from these new requirements. Health Care Reform: Proposed Rules Proposed Reinsurance on Workplace Wellness Programs Fees Will Cost Group Health Plans The Affordable Care Act (ACA) includes standards: provisions to encourage appropriately On Dec. 7, the Department of Health and designed, consumer-protective wellness Frequency of opportunity to Human Services (HHS) issued proposed programs in group health coverage. qualify regulations on some of the fees that will affect insurers and health plans. The On Nov. 26, proposed regulations were Size of reward regulations on transitioned reinsurance released regarding the ACA’s fees provide: nondiscrimination requirements for Uniform availability and wellness programs. reasonable alternative For self-insured group health plans, the plan sponsor is liable The proposed regulations would increase Reasonable design for paying the reinsurance fees, the maximum reward under a health- although a TPA or ASO contingent wellness program from 20 Notice of other means of contractor may be used to make percent to 30 percent of the cost of qualifying for the reward the payment coverage, and would further increase the These regulations would apply to both maximum reward to 50 percent for The amount of the fee is grandfathered and non-grandfathered proposed to be $63 per covered wellness programs designed to prevent group health plans and group health or reduce tobacco use. life per year insurance coverage for plan years Health-contingent wellness programs beginning on or after Jan. 1, 2014. The rate will be announced require individuals to satisfy a standard each year by HHS Definitive guidance will not be available related to a health factor in order to until the regulations are in final form. obtain a reward. This includes wellness Comments on the proposed regulations programs that require an individual to are due by Jan. 25, 2013. attain or maintain a certain health outcome in order to obtain a reward (such as not smoking, attaining certain results on biometric screenings or meeting exercise targets). This type of wellness program must meet the following five nondiscrimination © 2012 Zywave, Inc. All rights reserved
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