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Benefits buzz january 2013


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Benefits buzz january 2013

  1. 1.   DID YOU KNOW While insured small group plans and individual health insurance policies will   be subject to new deductible and out-of-Benefits and HR tips brought to you by pocket limit caps in 2014, proposedThe Gardner Group legislation indicates that the government does not intend to impose these regulations on self-insured group health plans or insured large group health plans. In addition, remaining grandfathered group health plans will also be exempt from these new requirements.Health Care Reform: Proposed Rules Proposed Reinsuranceon Workplace Wellness Programs Fees Will Cost Group Health Plans The Affordable Care Act (ACA) includes standards:provisions to encourage appropriately On Dec. 7, the Department of Health anddesigned, consumer-protective wellness  Frequency of opportunity to Human Services (HHS) issued proposedprograms in group health coverage. qualify regulations on some of the fees that will affect insurers and health plans. TheOn Nov. 26, proposed regulations were  Size of reward regulations on transitioned reinsurancereleased regarding the ACA’s fees provide:nondiscrimination requirements for  Uniform availability andwellness programs. reasonable alternative  For self-insured group health plans, the plan sponsor is liableThe proposed regulations would increase  Reasonable design for paying the reinsurance fees,the maximum reward under a health- although a TPA or ASOcontingent wellness program from 20  Notice of other means of contractor may be used to makepercent to 30 percent of the cost of qualifying for the reward the paymentcoverage, and would further increase the These regulations would apply to bothmaximum reward to 50 percent for  The amount of the fee is grandfathered and non-grandfathered proposed to be $63 per coveredwellness programs designed to prevent group health plans and group healthor reduce tobacco use. life per year insurance coverage for plan yearsHealth-contingent wellness programs beginning on or after Jan. 1, 2014.  The rate will be announcedrequire individuals to satisfy a standard each year by HHS Definitive guidance will not be availablerelated to a health factor in order to until the regulations are in final form.obtain a reward. This includes wellness Comments on the proposed regulationsprograms that require an individual to are due by Jan. 25, 2013.attain or maintain a certain healthoutcome in order to obtain a reward(such as not smoking, attaining certainresults on biometric screenings ormeeting exercise targets). This type ofwellness program must meet thefollowing five nondiscrimination © 2012 Zywave, Inc. All rights reserved