New laws have been
implemented that will
have a significant
impact on plans whether
they are calendar year
or plan year. Some
things to keep in your
headlights are:
COBRA subsidy
-
Although this will
most likely be
extended the ARRA of
2009 provides a 65%
COBRA premium
subsidy for
individuals who are
involuntarily
terminated and lose
health coverage
between September 1,
2008 and December
31, 2009. Continue
using your updated
election notices for
qualifying events on
or before December
31, 2009. If
Congress doesn’t
extend the COBRA
subsidy program
beyond December 31,
2009, resume using
prior pre-ARRA COBRA
notices for 2010.
GINA (Genetic
Information
Nondiscrimination
Act of 2008)
- For
plan years beginning
after May 21, 2009
(January 1, 2010,
for a calendar year
plan). This
prohibits adjusting
group premiums or
contributions based
on genetic
information,
requesting or
requiring anyone to
undergo genetic
testing or obtaining
information for
underwriting
purposes or before
enrollment. This
may also affect
health risk
assessments that
could be part of a
wellness program.
We are waiting for
further guidance.
HIPAA Breach
Notification and
Revised Business
Associate Agreements
(BAA)
-
Recent amendments
require notification
to individuals if
there has been a
data breach. This
piece of the
regulation went into
affect on September
23, 2009. In
addition the
amendments require
revisions to BAAs
affecting changes to
the “minimum
necessary” rule,
additional
restrictions on
marketing, expansion
of certain
individual rights
and imposing
significantly higher
penalties for HIPAA
violations. We sent
our revised BAA to
you earlier today
for signature.
Mental Health and
Addiction Benefits
Parity
-
GHPs that offer
mental health or
substance abuse
benefits must begin
offering them on the
same basis as for
other medical and
surgical benefits.
This is effective
for plan years on or
after October 3,
2009, (January 1,
2010 for a calendar
year plan). (This
does not apply to
plans with 50 or
fewer employees
during the preceding
calendar year.)
Michelle’s Law
-
Beginning on or
after October 9,
2009 (January 1,
2010 for a calendar
year plan), a GHP
must continue
coverage of a
dependent child who
is a full-time
student for up to
one year when the
dependent takes a
“medically necessary
leave of absence”
that starts while
the dependent is
suffering from a
serious illness or
injury, is medically
necessary, and
causes the dependent
to lose student
status for purposes
under the GHP. We
are waiting on
further guidance as
to how this will
coordinate with
COBRA.
Medicaid and SCHIP
-
Effective April 1,
2009, federal
legislation expanded
the State Children’s
Health Insurance
Program (SCHIP) to
allow 60 days vs 30
(or 31) days special
enrollment rights
when employees or
their dependents
become eligible for
coverage under an
employer’s GHP
because they lose
Medicaid or SCHIP
coverage.
CMS Medicare
Secondary Payer
-
As your TPA we have
begun the process of
reporting to CMS for
the GHP to comply
with this new
regulation. The
purpose of this
legislation is to
enable CMS to
determine whether or
not the GHP is
primary and Medicare
should be paying
secondary to the
GHP.
