In this ALERT we continue summarizing recent government guidance/announcements.
Automatic Enrollment in Large Employer Health Plans
Recall that Health Care Reform contained a provision requiring automatic enrollment for large employers with more than 200 full-time employees. There were varying interpretations of when this provision would take effect.
EBSA recently announced that it is hosting a public forum on April 8, 2011 to exchange information and views on issues relating to the automatic enrollment provision. Three panels will be formed addressing the definition of full-time employee, the selection of the plan in which employees would be automatically enrolled and the notice and opportunity to opt out.
You must register by March 25, 2011 if you want to participate either in person or by phone. Final regulations are expected by 2014.
HHS issues CLASS Act FAQs (CLASS repealed later in 2011)
Health Care Reform established CLASS (Community Living Assistance Services and Supports) a voluntary, federally administered insurance program aimed at providing long term care services to eligible individuals. We will provide an overview of the recently issued FAQs provide some guidance.
CLASS is not an entitlement program but rather a voluntary insurance program available to most working adults. Pre-existing conditions will not disqualify someone from enrolling. Enrollees pay the premiums and benefits will be paid from the premiums and earnings on the premiums. Taxpayer funds will not be used to pay benefits.
CLASS enrollees will have to meet specific requirements regarding functional limitations, earnings and premium payment in order to receive benefits.
Working adults age 18 or over will be able to enroll; retirees will not be able to enroll in CLASS. In addition, those planning to retire within the next few years may not be able to qualify for benefits under CLASS.
Employers will be able to decide whether to participate in the CLASS automatic enrollment process for their employees. Employees will be able to opt out if the employer participates in the automatic enrollment process. Employees can enroll individually if their employer does not auto enroll.Self-employed individuals will be able to enroll if they meet the eligibility requirements.
The premium amount and benefits payable have not yet been determined. However, the CLASS act requires a cash benefit averaging at least $50 per day.
More information is expected by October 1, 2012.
Extension of Non-enforcement period relating to Internal Claims and Appeals
Section 2719 of the PHS Act sets forth standards for plans and issuers that are not grandfathered health plans regarding internal claims and appeals and external review. The government published interim final regulations implementing PHS Act section 2719 on July 23, 2010, at 75 FR 43330 (the 2010 interim final regulations).
On September 20, 2010, the Department of Labor issued Technical Release 2010-02 (T.R. 2010-02), which set forth an enforcement grace period for compliance with certain new provisions with respect to internal claims and appeals until July 1, 2011. Based on a review of the comments received on the 2010 interim final regulations and other feedback from interested stakeholders, the government has issued Technical Release 2011-01, which modifies and extends the enforcement grace period set forth in T.R. 2010-02.
Note: all links are active as of the date of issuance of this ErisaALERT.
Disclaimer: This material is for the sole purpose of providing general information and does not under any circumstances constitute legal advice and should not be used as a substitute for legal advice. You should seek the advice of counsel when applying the requirements to your plan. For more information on this ErisaALERT contact us by phone at 610-524-5351 and ask for Mary Andersen or 973-994-7539 and ask for Theresa Borzelli.
