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SilverBlog

Wisdom from our industry experts and our SilverLink magazine.

 
 

Blog Tag: Special Bulletin

Generally
The Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) has published a final rule implementing section 1557 of the Patient Protection and Affordable Care Act (“ACA”). This section of the ACA prohibits discrimination in health programs and activities on the basis of race, color, national origin, sex, age or disability. The proposed rule (applicable to a “covered entities”) broadly prohibits discrimination on the basis of sex in health programs, and includes significant requirements related to transgender individuals and the treatments for gender dysphoria.

The rule would generally become effective July 18, 2016, however, to the extent that a group health plan or insurance carrier needs to alter its benefit design to comply with these regulations, then such plan design provisions are applicable on the first day of the plan year beginning on or after January of 2017. (But see Federal Contractor rule effective date below).

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In IRS Notice 2015-87, the agencies provided further clarification on the impact of the Affordable Care Act (ACA) group health plan market reform provisions on account-based plans and much needed guidance on the Section 4980H employer shared responsibility requirements. In many cases, common benefit design practices for employer credits and opt-outs must be revisited prior to the next annual enrollment.

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As you may have recently read, the U.S. Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) has started “Phase 2” of its audit program. Like the Phase 1 audits, OCR intends to use the audits to examine compliance mechanisms, identify best practices and discover risks and vulnerabilities to enhance compliance with HIPAA’s Privacy, Security and Breach Notification Rules. Phase 2 will be primarily desk audits, although OCR will conduct some on-site audits. If an audit reveals serious compliance issues, OCR might also launch an investigation. So now is the time to look at HIPAA compliance for your health plan and take corrective action, if needed. Business associates should do the same, as they are also subject to Phase 2 audits.

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In late 2015, the Equal Employment Opportunity Commission (EEOC) published Proposed Rules on the Genetic Information Nondiscrimination Act of 2008 (GINA). The Proposed Rules provide clarification about what incentives may be offered for spousal participation under employer-sponsored wellness programs without violating GINA. The Proposed Rules follow 2013’s Health Insurance Portability and Accountability Act (HIPAA) wellness rules and the EEOC’s proposed wellness rules under the Americans with Disabilities Act (ADA) from April 2015 and add yet another layer of complexity for employer-sponsored wellness programs.

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The Affordable Care Act (ACA) anti-retaliation provisions have been in effect for several years, but have so far largely gone unnoticed. Now that employees can receive financial assistance through the Health Insurance Marketplace, employers should revisit these provisions and carefully structure their actions to limit potential exposure.

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The Department of Health and Human Services (HHS) has proposed 2017 health plan out-of-pocket maximums of $7,150 for self-only coverage and $14,300 for family (other than self-only) coverage.

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As a holiday treat, employers subject to the Affordable Care Act’s 2015 information reporting requirements have been given the ultimate present: the gift of time!

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