Last week, the Internal Revenue Service, the Department of Labor, and the Department of Health and Human Services jointly issued proposed rules on pre-existing conditions, essential health benefits, and wellness programs. Employers now have the opportunity to comment on these rules. A description of the proposed rules and the deadlines for comments on each follows.
Pre-existing Conditions: This proposed rule would implement the Affordable Care Act’s policies related to fair health insurance premiums, guaranteed availability, guaranteed renewability, risk pools, and catastrophic plans. It would clarify the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers and group health plans that are non-federal governmental plans. It would also amend the standards for health insurance issuers and states regarding reporting, utilization, and collection of data under section 2794 of the Public Health Service Act (PHS Act). And, it revises the timeline for states to propose state-specific thresholds for review and approval by CMS. The comment period for this rule ends December 26, 2012. Click here for the full text.
Essential Health Benefits: This proposed rule outlines exchange and issuer standards related to coverage of essential health benefits and actuarial value. It also proposes a timeline for qualified health plans to be accredited in federally-facilitated exchanges and an amendment which provides an application process for the recognition of additional accrediting entities for purposes of certification of qualified health plans. The comment period for this rule ends December 26, 2012. Click here for the full text.
Wellness Programs: This document proposes amendments to regulations, consistent with the Affordable Care Act, regarding nondiscriminatory wellness programs in group health coverage. Specifically, the proposed rule would increase the maximum permissible reward under a health-contingent wellness program offered in connection with a group health plan (and any related health insurance coverage) from 20 to 30 percent of the cost of coverage. It would further increase the maximum permissible reward to 50 percent for wellness programs designed to prevent or reduce tobacco use. It also includes other proposed clarifications about the reasonable design of health-contingent wellness programs and the reasonable alternatives they must offer in order to avoid prohibited discrimination. The comment period for the rule ends January 25, 2013. Click here for the full text.
Each rule describes the steps to follow when making comments.