1. Under PPACA, non-grandfathered plans must provide in-network preventive care benefitswithout cost-sharing. In 2016, the IRS, DOL and HHS (the "Agencies") published FAQs clarifying preventive care requirements for colonoscopies and contraceptives. Also, the U.S. Preventive Services Task Force [...]
1. In November 2015, the IRS, HHS, and DOL (the "Agencies") published final regulations on many PPACA benefit mandates , including the rules regarding grandfathered health plans, preexisting condition exclusions, lifetime and annual dollar limits, rescissions, coverage of [...]
For plan years beginning in 2014 or later, PPACA requires that non-grandfathered group health plans impose annual out-of-pocket maximums with respect to "self-only" coverage and family coverage, and the maximums cannot exceed certain dollar amounts. Generally, [...]
1. Non-grandfathered plans must provide certain preventive care benefits without cost-sharing.All of the USPSTF's recommendation statements are available at http://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations/. Plans must comply with new and revised recommendations starting with the first plan year that begins one or [...]
UPDATED GUIDANCE ON PREVENTIVE CARE REQUIREMENTS The United States Preventive Services Task Force ("USPSTF") has revised several of its recommendations concerning preventive care services that must be covered by non-grandfathered group health plans subject to PPACA's [...]
HPIDs Generally Required by November 5, 2014 A health plan identifier ("HPID") is a numeric code that will be used to identify a health planFor purposes of the HIPAA electronic transaction rules, "health plan" is broadly [...]
In February 2014, the Treasury Department issued final regulations under Internal Revenue Code ("Code") Section 4980H, more commonly known as PPACA's "Play or Pay" or "Employer Shared Responsibility" rules. This bulletin provides a summary of the [...]
In February 2014, the DOL, IRS and HHS issued final regulationsFor the 2014-15 plan year, plans can rely on either the final waiting period regulations or the proposed regulations that were issued in 2013. This Bulletin [...]
In 2012 the USPTF updated its recommendation describing the preventive health services plans must provide for obesity under the "preventive care" requirements of PPACA. Non-grandfathered plans must provide preventive care without cost-sharing. Significantly, preventive care for obesity [...]
In December 2013, the IRS, DOL and HHS issued proposed regulations on “excepted benefits,” which are generally exempt from HIPAA’s portability rules and Health Care Reform’s benefit mandates. The proposed regulations would make it easier for [...]