It's a brand new year for Health Care Reform and the changes keep on coming. While many parts of the law scheduled to become effective in 2012 center around health care providers and Medicare, a handful of new requirements will keep employer groups busy as well.
Here are 5 things to keep on your Health Care Reform radar for 2012:
1. Arguments in the U.S. Supreme Court
The Supreme Court has scheduled more than five hours from March 26th–28th to hear oral arguments on the constitutionality of select parts of the law, most notably the "individual mandate" which requires non-exempted individuals to maintain a minimum level of health insurance or pay a tax penalty beginning in 2014. If the minimum coverage provision is declared unconstitutional, the Court would then need to determine whether some or all of the remaining law must also be invalidated.
There's also the possibility the Court will decide it's prohibited by federal law from hearing challenges to the individual mandate before the requirement becomes effective in 2014 (and a taxpayer actually incurs a penalty tax for noncompliance).
With a ruling expected in June, it's safe to say that all eyes will be on the Court in the first half of 2012.
2. Reporting of Employer-Sponsored Health Coverage on Forms W-2
Beginning with calendar year 2012 Forms W-2 (required to be furnished to employees in January 2013), employers that provide a group health plan to their employees are generally required to report the cost of the coverage provided to each employee annually. Please note that this requirement does not apply to employers that were required to file fewer than 250 Forms W-2 for the preceding calendar year, unless and until the IRS publishes further guidance giving at least 6 months advance notice of any changes.
Notice 2012-9 includes information on how to report, what coverage to include and how to determine the cost of the coverage for employers that are subject to the reporting requirement for the 2012 Forms W-2 and those that choose to voluntarily comply.
3. Summary of Benefits and Coverage (SBC) and Uniform Glossary Requirements
The law requires group health plans to provide participants and beneficiaries, without charge, a summary of benefits and coverage (SBC) containing specific information about the plan, as well as a uniform glossary of terms commonly used in health insurance coverage. Both documents must comply with certain appearance and format requirements and must utilize terminology understandable by the average plan enrollee. Proposed templates are available for both the SBC and the uniform glossary.
Under proposed rules issued last August, these new requirements would be applicable beginning March 23, 2012. However, the U.S. Department of Labor (DOL) recently released a set of FAQs which advise that group health plans are not required to comply with the requirement to provide the SBC and uniform glossary until final regulations are issued. It is anticipated that the final regulations, once issued, will include an applicability date that gives plans sufficient time to comply.
4. Expanded Coverage of Preventive Services for Women for Non-Grandfathered Plans
New Guidelines for Women's Preventive Services adopted last August require non-grandfathered health insurance plans to cover additional women's preventive services such as well-woman visits, breastfeeding support, domestic violence screening, and contraception without charging a co-payment, co-insurance or deductible, effective for plan years beginning on or after August 1, 2012.
5. Medical Loss Ratio (MLR) Rebates
Beginning in 2012, insurance issuers that do not meet specific standards relating to premium expenditures are required to provide rebates to enrollees by August 1 each year. In some cases, the rebate may go to the employer-policyholder that paid the premium on the enrollee's behalf. Regardless of whether the rebate is provided to enrollees directly or indirectly through their employer, each enrollee must receive a rebate that is proportional to the premium amount paid by that enrollee.
The DOL's Employee Benefits Security Administration (EBSA) has released technical guidance on how to handle rebates paid pursuant to the medical loss ratio requirements. Note that these rules do not apply to employers who operate self-insured plans.
If there's one thing we've come to expect with Health Care Reform, it's that compliance requirements can change at any time. Stay up-to-date on the latest information by visiting http://www.healthcare.gov/. You can also check out our section on Health Care Reform.