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Every employer should be aware of recent guidelines for healthcare reform under the Affordable Care Act. The new guidelines released by the departments of Health and Human Services, Treasure and Labor include immediate restrictions on pre-existing conditions for plan participants under the age of 19. This measure is effective for plans beginning on September 23, 2010 or later.

Under the Patient Protection and Affordable Care Act, employees covered by group health insurance will be able to choose their own primary care physician or pediatrician, and must be able to see an obstetrician or gynecologist without a referral. Plans cannot require prior approval for emergency care at a hospital, even if the hospital is out of the network.

The final rule published in the June 28, 2010 Federal Register goes into effect on August 27, 2010.  

Effective with the next plan year, health insurance companies cannot: 

• Impose limits on coverage based on pre-existing conditions for those 18 and under
• Take away coverage based on an unintentional mistake on the health insurance application
• Set limits on lifetime coverage 

The healthcare reform law also eliminates dollar limits on annual coverage, except in specific circumstances. In general, the insurer cannot limit annual coverage.

The restrictions on annual limits will be phased in. Plans that begin before September 23, 2011, (more…)

The new Health Reform Law allows employers to offer increased incentives for workers to participate in wellness programs beginning in 2014.

Under the Patient Protection and Affordable Care Act, employers can also offer incentives to employees for meeting certain health targets, like smoking cessation, weight loss, lower blood pressure or lower cholesterol. These incentives may include the employer picking up an additional 30% of the cost of health insurance coverage. Nationwide, companies on average pay 45% of health insurance premiums, so this could mean that the employer pays 75% or more of the health insurance tab, while the employee pays 20% or less.

Current HIPAA regulations permit the employer to pay an additional 20% of health insurance coverage as an incentive for a wellness program. This law applies until 2014.

In addition, federal agencies have the option of increasing the 30% maximum after conducting a study on wellness programs.

Many small employers have complained that wellness programs are too expensive to implement for fewer than 100 employees. In response, the Healthcare Reform Bill also provides $200 billion to provide grants to small employers to fund new wellness programs.

Many HR experts wonder if this measure will be effective. They note that few companies are even offering the 20% incentive now. The main reason, of course, is expense. While it is great to have healthier employees, paying 20% to 30% more in addition to the employer’s already high costs for healthcare coverage (more…)

According to industry experts, the healthcare reform signed into law on March 23, 2010 and amended earlier today will have wide-reaching effects on employers nationwide.

The greatest change for HR pros and employers under the Patient Protection and Affordable Care Act will come from penalties to employers who fail to provide group health insurance. The law technically stops short of a mandate, because it does not require that employers provide healthcare benefits to workers. However, companies that fail to offer health care coverage will have to pay a penalty of $2,000 per employee beginning January 1, 2014. The law makes an exception for small employers, as the first 30 workers do not count towards the penalty.

If the employer offers health care benefits, if even one employee applies for a federal subsidy to purchase individual health insurance, the employer may be fined $750 per person, under the law signed by President Barack Obama.

One important change involves how employees are enrolled in healthcare plans. Under the new system, employers with 200 or more employees will automatically enroll new employees in the group health insurance. Employees will have to intentionally opt out of the plan, in order to not receive healthcare.

The law also includes provisions to make healthcare coverage more affordable for low-income workers, according to the Society for Human Resource Management or SHRM. An employee who earns less than four times the federal poverty level will have the option of buying health insurance through a health care exchange.

Small business owners and employees will have the option of purchasing health insurance through an exchange, which will offer lower rates for insurance than currently available. So-called SHOP exchanges, or Small Business (more…)