Essentials of Healthcare Reform HS: 345

Assignment 2

Updates

Assignment 2: Overview of Healthcare Reform

Assignment 1 Learning Objectives

• Overview of Healthcare Reform

• Sources of Law Governing Reform

• Timeline of Reform

• PHSA Mandates

• Insurance Definitions and Applicability

• Excepted Benefits

Healthcare Reform: Sources of Law• Patient Protection and Affordable Care Act

• Health Care and Education Reconciliation Act

• Affordable Care Act

• Amends Several Major Laws:– IRC, ERISA, SSA, PHSA, FLSA

• HHS, DOL, IRS

2010 Changes• Dependent Coverage

Age Extension

• ERRP

• High Risk Pools

• Healthcare.gov

• Patient Protections

• PCE Prohibition

• Lifetime Limits

• Annual Restrictions

• Rescission Prohibition

• Automatic Enrollment

• Preventive Care

2011 Changes

• HSA Tax Increase

• OTC Reimbursement

Rules

• MLR Regulations

• Small Business Grants

(pending)

• Four-Page Summary of

Benefits

• W-2 Reporting

(exceptions created)

2012 Changes

2013 Changes• Health FSA Cap for

Cafeteria Plans

• Notice of Exchange

• HIPAA Regulations

• Increase in Medical

Deduction

• Fair Premiums

• Reporting Requirements

• Exchanges

• Individual Mandate

2014 Changes

2014 Continued• Play or Pay Tax

• PCE Total Prohibition

• Annual Limits Prohibition

• Waiting Period Limits

• Availability and Renewability Requirements

• Clinical Trial Coverage

• Comprehensive Coverage

Provisions of Healthcare Reform

• What coverage do mandates and other provisions of healthcare reform apply to?

• Answer: Group Health Plans, Individual Policies, Self-Insured Plans, Insurers, Church Group Plans, Wellness Programs that are attached to a group health plan, Governmental Health Plans

ERISA Definition of Group Health Plan

• ERISA & PHSA Definition

– Employee Welfare Benefit Plan?

• Plan, Fund, Program

• Maintained by Employer

• Benefits Provided to Participants or

Beneficiaries

Codes Definition of Group Health Plan

• A Plan (including a self-insured plan) of, or contributed

by, an employer (including a self-employed person) or

employee organization to provide health care (directly or

otherwise) to the employees, former employees, the

employer, others associated or formerly associated with

the employer in a business relationship, or their families.

Excepted Benefit Types

• Accident-Only

• Disability Income

• Liability Insurance

• Worker’s Comp

• Automobile Medical

• Credit-Only

• On-Site Medical Clinics

• Limited-Scope Benefits

• Noncoordinated Benefits

• Certain Supplemental

Benefits

– Medicare and Tricare

Supplements

– Safe Harbor Rules

Immediate Changes to Social Programs

• Changes to Medicare

– Improving of Quality of Care

– Reform of Healthcare Delivery System

– Pricing Services and Modernizing Financing Systems

– Fighting Waste, Fraud, and Abuse

• Changes to Medicaid and CHIP

– Expansion of both programs