You Might Feel a Slight Pinch

As to new issues, Joel Kopperud, a director of government relations at the Council of Insurance Agents and Brokers, said that the CIAB’s primary focus right now is the latest request for comments on the law’s non-discrimination requirements. “Our fear is that if the evaluation is based on actual enrollment and not eligibility, the requirement could completely stymie new plans,” he said.

The healthcare reform law extended Internal Revenue Code Section 105(h) nondiscrimination rules to insured health plans. The law prohibits fully-insured group health plans from discriminating in favor of highly compensated individuals with respect to eligibility and benefits.

These requirements apply to non-grandfathered plans and are effective for plan years beginning on or after September 23, 2010. The rules of section 105(h) continue to apply to any self-insured plan regardless of whether the plan is a grandfathered one.

The agencies also last week issued a grace period through July 1, 2011 for employers and health plans to comply with several significant changes in federal claims review and appeals standards and expanded the “safe harbor” standard for complying with the new external review requirements included in the healthcare law.

James A. Klein president of the American Benefits Council, said the actions by the Departments of Health and Human Services, Treasury and Labor, was prompted by the ABC voicing “serious concerns” over the past several weeks regarding various aspects of the claims procedure rules issued by the agencies on July 17.

“As initially issued, the regulations could not feasibly have been implemented for plan years beginning on or after September 23, 2010, as the agencies originally would have required,” he said.

“The new guidance will help ensure that employers and health plans have much-needed additional time to make complex changes in the procedures they use to make accurate and efficient determinations on hundreds of millions of health care claims each year,” Klein said.