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New ACA FAQs – Special Enrollment, Women’s Preventive Care and a Cure for the HRA that Ails You (If You’re Small Enough)

December 28, 2016

Authors

Katharine Finley and Chris Rylands

New ACA FAQs – Special Enrollment, Women’s Preventive Care and a Cure for the HRA that Ails You (If You’re Small Enough)

December 28, 2016

by: Katharine Finley and Chris Rylands

In the latest round of FAQs on ACA implementation (now up to 35 if you’re keeping track), the DOL, HHS and Treasury Department addressed questions regarding HIPAA special enrollment rights, ACA coverage for preventive services, and HRA-like arrangements under the 21st Century Cures Act.

Special Enrollment for Group Health Plans. Under HIPAA, group health plans generally must allow current employees and dependents to enroll in the group health plan if the employee or dependents lose eligibility for coverage in which they were previously enrolled.  This FAQ clarifies that an individual is entitled to a special enrollment period if they lose individual market coverage.  This could happen, for example, if an insurer covering the employee or dependent stops offering that individual market coverage.  However, a loss of coverage due to a failure to timely pay premiums or for cause will not give the employee

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The Latest and Greatest ACA FAQs

January 14, 2014

Authors

benefitsbclp

The Latest and Greatest ACA FAQs

January 14, 2014

by: benefitsbclp

Last week, the Departments of Labor, HHS and Treasury issued their 18th set of FAQs intended to answer a smattering of questions regarding the implementation of ACA.  Issues addressed in those FAQs include, among other things:

  • Risk-Reducing Breast Cancer Drugs Must Be Provided Without Copay.  On September 24, 2013, the United States Preventive Services Task Force (USPSTF) revised its “B” recommendation with respect to medications for risk reduction of primary breast cancer in women.  The recommendation now provides that, for women who are at increased risk for breast cancer and at low risk for adverse medication effects, clinicians should offer to prescribe risk-reducing medications, such as tamoxifen or raloxifene.  Given that evidenced-based items or services that have in effect a rating of “A” or “B” must be provided by non-grandfathered group health plans and health insurance coverage without cost-sharing, this means that risk-reducing medications prescribed by clinicians
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ACA FAQs Part XII – Preventive Care Rules

February 28, 2013

Authors

Chris Rylands and Serena Yee

ACA FAQs Part XII – Preventive Care Rules

February 28, 2013

by: Chris Rylands and Serena Yee

As discussed in our prior post, the Department of Treasury/IRS, Department of Labor, and the Department of Health and Human Services (the “Departments”) recently issued its twelfth set of Frequently Asked Questions addressing cost-sharing limitations and a slew of preventive services issues.  The cost-sharing rules are covered in our prior post; here, we’ll discuss the preventive care rules.  By way of reminder, non-grandfathered group health plans are required to cover specified preventive services.  The FAQs address some open questions that were not addressed in the regulations.

Out-of-Network Services.  A plan with a network is generally not required to cover preventive services out-of-network without cost-sharing.  However, if a preventive service is not available from any in-network provider, then the FAQs say a plan cannot impose cost-sharing when it is obtained from an out-of-network provider.

Over-the-Counter Medications. The FAQs make clear that plans do have to cover

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Proposed Contraceptive Compromise Rule Released

February 5, 2013

Authors

Chris Rylands

Proposed Contraceptive Compromise Rule Released

February 5, 2013

by: Chris Rylands

Continuing what has become a habit of Friday afternoon rule issuances, the Departments of the Treasury, Labor, and Health and Human Services issued a proposed rule last Friday to attempt to accommodate the objections of religious employers to the contraceptive mandate.  The rule makes a few accommodations to the prior guidance.

  • First, the definition of “religious employer” (i.e., an employer entirely exempt from the mandate) has been expanded by eliminating the 3 prior requirements, which resulted in widespread objections:  that the organization (1)  have as its purpose the inculcation of religious values, (2) primarily employ persons who share its religious beliefs, and (3) primarily serve persons who share its religious beliefs.  Under the new proposal, a “religious employer” must be described in Code section 6033(a)(3)(A) (i) and (iii), which refer to churches, their integrated auxiliaries, conventions and associations of churches, and the exclusively
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