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Employer's Guide to Health Care Reform, 2021 Edition by Lisa Campbell , Brian M. Pinheiro Ballard Spahr LLP , Dilroop Sidhu , Lisa Lowenstein , Groom Law Group, Chartered , Christopher W. Welsch , Matthew Muma , Joel Wood , Jean C. Hemphill , Tamara Killion , Emily Lucco , Kurt R. Anderson Employer's Guide to Health Care Reform, 2021 Edition by Lisa Campbell , Brian M. Pinheiro Ballard Spahr LLP , Dilroop Sidhu , Lisa Lowenstein , Groom Law Group, Chartered , Christopher W. Welsch , Matthew Muma , Joel Wood , Jean C. Hemphill , Tamara Killion , Emily Lucco , Kurt R. Anderson

Employer's Guide to Health Care Reform, 2021 Edition

By Lisa Campbell, Tamara Killion, Emily Lucco, Matthew Muma, Joel Wood, Groom Law Group, Chartered
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Overview

Employer's Guide to Health Care Reform, 2021 Edition is the premier step-by-step practical guide for employers struggling to keep up with the rapid pace of changes affecting their health benefit plans. This practical guide helps you strategize about how to design your employee health plans to satisfy ACA requirements; design your workforce to minimize penalty exposure; achieve significant cost-savings; understand new notice requirements; meet deadlines and take advantage of opportunities to delay implementation; and more!

Specifically Employer's Guide to Health Care Reform will help you:

  • Design your employee health plans to satisfy ACA requirements
  • Design your workforce to minimize penalty exposure
  • Understand new notice requirements that apply in 2015
  • Achieve significant cost savings
  • Meet deadlines and take advantage of opportunities to delay implementation
  • Plan ahead to avoid or minimize Cadillac tax exposure

Employer's Guide to Health Care Reform, 2021 Edition provides in-depth discussion and detailed explanations on critical topics, including:

  • The repeal of the ACA’s individual mandate penalty, the Fifth Circuit’s decision determining the ACA’s individual mandate provision unconstitutional, and the impending oral argument before the U.S. Supreme Court on the constitutionality of the individual mandate and the ACA.
  • Update on the maximum out-of-pocket requirements relating to drug manufacturer coupons for group health plans
  • A summary of group health plan requirements under the Families First Coronavirus Response Act, the Coronavirus Aid, Relief, and Economic Security Act, and the Tri-Agency COVID-19 sub-regulatory guidance implementing these laws.
  • Update on Tri-Agency Proposed Rule providing more flexibility for grandfathered health plans.
  • Tri-Agency Proposed Rule on Transparency in Coverage requiring group health plans to provide costsharing information to participants and beneficiaries upon request, and to publish pricing information on a public website.
  • Update on challenge to Final Rule on transparency of hospital charges.
  • An update on the litigation relating to the constitutionality of the ACA, due to the repeal of the individual mandate penalty.
  • An update on the ACA’s requirement to cover contraception under the Trump Administration.
  • An update on the challenges to ACA Section 1557 Nondiscrimination Final Rule provision requiring transgender services.
  • An update on the challenges to the ACA’s risk corridors program.
  • And much more

Note: Online subscriptions are for three-month periods.

Previous Edition: Employer's Guide to Health Care Reform, 2020 Edition, ISBN 9781543810332

Last Updated 11/20/2020
Update Frequency Semi-annually
Product Line Wolters Kluwer Legal & Regulatory U.S.
SKU 10083578-7777
Publish Frequency Semi-annually
Product Line Wolters Kluwer Legal & Regulatory U.S.
SKU 000000000010048421
Table of Contents

CHAPTER 1 INTRODUCTION

CHAPTER 2 INDIVIDUAL MANDATE

  • Individual Mandate
  • Returns and Information Reporting

CHAPTER 3 THE ACA’S IMPACT ON EMPLOYERS

  • Introduction
  • Calculating the Number of Employees for Applicability of the Shared Responsibility Requirements
  • Shared Responsibility and Applicable Large Employers
  • Features Available to Small Employers

CHAPTER 4 EMPLOYER “PAY-OR-PLAY” RULES

  • Introduction
  • Applicable Large Employers
  • Counting Full-Time Employees for Pay-or-Play Penalties
  • Penalties

CHAPTER 5 HEALTH CARE EXCHANGES

  • In General
  • Eligibility
  • Special Eligibility Rules
  • Qualified Health Plans
  • Catastrophic Plan
  • Exchange Subsidies
  • Special Rules
  • State Innovation Waivers
  • Guidance for States
  • Whistleblower Provisions

CHAPTER 6 STRATEGIC DECISIONS FOR EMPLOYERS

  • Decision Points for Large Employers
  • Incentives for Small Employers

CHAPTER 7 COVERAGE IMPROVEMENTS

  • Introduction
  • Prohibitions on Annual and Lifetime Dollar Limits
  • Coverage of Preventive Health Services
  • Extension of Coverage for Children Up to Age 26
  • Mandated Claim and Appeal Process
  • Prohibitions on Rescissions
  • Patient Protections
  • Prohibitions on Preexisting-Condition Exclusions
  • Prohibitions on Discrimination Based on Health Status
  • Fair Health Insurance Premiums
  • Guaranteed Availability and Renewability of Coverage
  • Prohibiting Discrimination Against Health Care Providers
  • Quality Coverage Provisions
  • Limits on Waiting Periods
  • Coverage for Individuals Participating in Approved Clinical Trials
  • Section 1557 Nondiscrimination in Certain Health Programs and Activities

CHAPTER 8 HEALTH CARE REFORM EXEMPTIONS

  • Grandfathered Health Plans: “If You Like Your Current Insurance, You Will Keep Your Current Insurance”
  • Collectively Bargained Insured Plans
  • Exemption for Retiree-Only Plans
  • Exemption for Excepted Benefits

CHAPTER 9 REPORTING, TRANSPARENCY, AND ACCOUNTABILITY

  • Introduction
  • Summary of Benefits and Coverage
  • Reporting Health Insurance Coverage and Form 1095
  • Transparency: Reporting Cost of Coverage on Form W-2
  • Transparency: Financial and Quality Reporting
  • Containing the Cost of Health Insurance Coverage
  • Ensuring That Consumers Get Value for Their Dollars
  • Empowering Consumers with Information
  • State Health Insurance Consumer Information

CHAPTER 10 OPERATIONAL CHANGES FOR EMPLOYERS AND HEALTH PLANS

  • Nondiscrimination Rules Applicable to Insured Health Benefits
  • Auto-Enrollment
  • Additional Electronic Transaction Standards
  • Nursing Mothers
  • Simple Cafeteria Plans for Small Businesses
  • Medicare Part D

CHAPTER 11 TAXES AND OTHER REVENUE RAISERS

  • The “Cadillac” Tax
  • Health Flexible Spending Accounts
  • Health Savings Accounts
  • Administrative Fees for Self-Funded and Insured Plans
  • Additional Taxes on High Earners
  • Other Taxes

CHAPTER 12 HISTORICAL PROGRAMS

  • Temporary Reinsurance Program for Early Retirees
  • Preexisting Condition Insurance Plans

CHAPTER 13 HEALTH CARE REFORM LITIGATION

  • Introduction
  • Constitutionality of the Individual Mandate
  • Challenges to Premium Tax Credits Assistance for Federal Exchange Plan Subscribers
  • Religious Challenges to Contraceptive Coverage
  • U.S. House of Representatives and Cost Sharing Reductions
  • Section 1557 Nondiscrimination Rules Litigation
  • Risk Corridors Litigation
  • Risk Adjustment Litigation

GLOSSARY

APPENDICES

Appendix A Affordable Care Act Provisions Applicable to Grandfathered Health Plans

Appendix B Tri-Agency Regulations on Grandfathered Health Plans and Amendments

Appendix C IRS Form 8941 and Instructions (Small Employer Tax Credit)

Appendix D Tri-Agency Regulations on Preventive Care Without Cost-Sharing

Appendix E Tri-Agency Regulations on Religious Employer Exemption from Contraceptive Services Coverage

Appendix F Tri-Agency Regulations on Extended Coverage for Adult Children

Appendix G Tri-Agency Regulations for Internal Claims and Appeals and External Review Processes

Appendix H Model Notices for Claims and Appeals

Appendix I Tri-Agency Final Regulations on 90-Day Waiting Period

Appendix J Summary of Benefits and Coverage Model and Completed Notices

Appendix K Final Regulations on Employer Pay-or-Play

INDEX

Volumes