Health Care Reform – 2012 Update

The U.S. Supreme Court is set to hear arguments at the end of March on the constitutionality of health care reform. Several briefs on both sides of the argument have already been filed. While many commentators are hoping for a decision by summer; no one can make that promise.

In the meantime, employers should focus on adopting the changes that have gone or will shortly go into effect and training internal staff in managing and communicating in the rapidly changing world of employer-sponsored health care plans. Some of the less publicized changes in effect include:

 Ensuring that there is no employee cost sharing for specific preventive care items.
 No longer requiring prior authorization or increased cost sharing for emergency services in or out of network.
 No prohibition on authorizing or referring a participant for OB/GYN care by a specialist.
 New internal and external claims appeal procedures are in effect. The external procedures require engaging with various providers.
 Reporting the value of employer-sponsored health coverage on the 2012 W-2 forms for many employers.
Some much publicized changes that have been “postponed” until further guidance is issued are:
 Enrollment for employers with 200 or more full-time employees.
 Nondiscrimination requirements for insured plans. (Note that the full nondiscrimination requirements for self-insured and for even partially self-funded plans under IRC section 105(h) are and have been in effect.)
While there has been talk about changing the cap on flexible spending accounts, which is scheduled to be reduced to $2,500 in 2013, there has been no movement yet in that regard. Many companies are planning to convert to a limited purpose FSA and then offer employees an HSA, HRA, or both (using a limited purpose HRA) in 2013. For more information refer to our Health Care Reform Toolkit.