Health care reform: Recent events from the administration

Health and Human Services, the Department of Labor and our new National Prevention Council have been busy! As you develop your enrollment campaign (for plans effective Jan 1), you’ll want to consider this news in your key messages and possibly the media elements themselves.

Details on reforms to annual and lifetime limits

You’re busy working through 2010 plan design. Thankfully, you’ve got more information to work with now. Read the fact sheet on the regulations about the most pressing reforms for grandfathered plans. Additionally, sample language has been issued (that we think requires translation or a rewrite, take your pick!)

Adult child eligibility can’t be tied to student, financial or marital status

Much has already been said about adding adult kids up through age 26 to employer-sponsored plans. Like our clients, you may already be fielding employee questions about early compliance. If not, be sure to see our sample talking points and additional background as well as our sample FAQs. The Department of Labor has been issued sample enrollment language that is super legal and will invite questions if not translated or rewritten.

Sample legal disclosure language

The department of labor has also issued sample language for other aspects of reform that take effect (for most employers) January 1, 2010.

• Annual and lifetime limit changes
• Revised dependent eligibility for older kids
• Primary care physician designation and OB/GYN self referral change

This will have to be factored into your enrollment communication planning!

healthcare.gov is live

If the new federal health care portal is any indication of what the state exchanges could look like, we’re in luck. The site targets segments of the American population, asking them to define key aspects of their health care insurance search, then providing them with options. Of course, the options are not all actual insurance products but information on where to obtain free community based coverage or sign up for federal programs. For instance, this will serve as the gateway for the Pre-Existing Condition Insurance Plan (PCIP)—or the high risk pool that is mandated to be live July 1.

National Prevention Council submits first report

The Affordable Care Act already elevated prevention to the national stage, with a pool of funds to invest in public health programs, mandated insurance reforms and a new National Prevention Council. On July 1, the first report by the advisory team was issued. The effects on employers are TBD.

Grandfathered status defined

Grandfathered plans are exempt from some insurance reforms, such as first-dollar coverage for preventive care, so employers have been eager for more details. The detailed regulations have been issued as well as the more digestible fact sheet. Health and Human Services (HHS) notes that the choices employers make in the next three years will significantly alter the landscape of employer-sponsored health coverage. Although final regulations say “routine” changes are okay, benefit reductions are not.