Employer's Guide to Health Care Reform, 2014 Edition

Employers Guide to Health Care Reform, 2014 Edition by Brian M. Pinheiro, Jean C. Hemphill, Jonathan M. Calpas, Kurt R. Anderson
  • Author(s): Brian M. Pinheiro Jean C. Hemphill Jonathan M. Calpas Kurt R. Anderson
  • Media: Paperback
  • Pages: 460
  • Supplement Date: 09/06/2013
  • Publication Frequency: Updated annually
  • Offer Number/PIN: 1454825499
  • ETA: Available: Item ships in 3-5 Business Days
  • Product Line: Aspen Publishers

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Price: $309.00

ISBN: 9781454825494
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Employer's Guide to Health Care Reform, 2014 Edition is the premier step-by-step practical guide for employers struggling to keep up with the rapid pace of changes affecting their health benefit plans. Specifically, it will help you:

  • Grasp every implication of health care reform from the employer's perspective
  • Fully understand even the most complex rules
  • Achieve significant cost savings
  • Meet deadlines and take advantage of opportunities to delay implementation
  • And much more!

The 2014 Edition of Employer's Guide to Health Care Reform has been updated to include discussions of the latest health care reform developments and detailed explanations of these important topics:

  • The U.S. Supreme Court's landmark decision in National Federation of Independent Business v. Sebelius, which upholds the constitutionality of the Affordable Care Act
  • Other legal challenges, including claims brought by religious organizations seeking exemptions from the requirement to cover contraceptive services in employer-sponsored group health plans
  • When is a plan a "grandfathered" health plan—and how to keep it that way
  • Whether an employer-sponsored health plan covering solely retirees is subject to the Affordable Care Act design changes, such as the requirement to cover children through age 26
  • What types of subsidies and tax credits are available to employers that provide health coverage to employees
  • Which health plans and benefits are subject to new prohibitions on annual and lifetime limits, and what exemptions are available
  • The extent to which health reimbursement accounts (HRAs) qualify for an exemption from the prohibition on annual limits
  • How and when the Affordable Care Act restricts preexisting-condition exclusions
  • When must an employer-sponsored health plan provide full coverage for preventive health services without cost sharing
  • What are the consequences of offering health plan coverage to children up to age 26
  • What are the new claims and appeals processes mandated by the Affordable Care Act for health plans
  • What additional changes to health plan design will be required beginning in 2014
  • How the Affordable Care Act is encouraging the use of wellness programs to control health benefit costs
  • What are the restrictions on eligibility waiting periods that may be imposed in an employer-sponsored group health plan
  • How will employer-sponsored health plans need to change their employee communications to address the Affordable Care Act requirements
  • What new types of reporting are required for health plans
  • How employers can use premium rebates received from insurance companies under the medical loss ratio (MLR) rebate rules
  • What is the "individual mandate" to enroll in health coverage
  • Which employers must pay a penalty if they do not provide adequate and affordable health plan coverage
  • The impact of the delay in implementation of the employer pay-or-play rules until 2015
  • How employers determine which employees are full-time employees for purposes of applying the pay-or-play penalties
  • How much flexibility employers have in structuring their workforces to avoid the pay-or-play penalties
  • How employers can determine whether their coverage is adequate and affordable
  • What is a health care Exchange, and how will it affect the U.S. health care system
  • What types of "essential health benefits" will be included in health insurance policies offered through an Exchange
  • What states will need to do to set up a health care Exchange
  • How the Affordable Care Act affects retiree prescription drug coverage under Medicare Part D and how the changes create new opportunities for employers
  • How and when do the new nondiscrimination rules apply to insured health benefits, and what are the consequences of discriminatory coverage
  • Which employer-sponsored health plans are subject to auto-enrollment, and when do the rules go into effect
  • What are the Form W-2 reporting requirements for employer-sponsored health plans
  • When health care flexible spending accounts (health FSAs) and health savings accounts (HSAs) may and may not pay reimbursements for over-the-counter medicines and drugs
  • What new limits apply to certain contributions to health FSAs
  • How are the transitional reinsurance fee and the PCORI fee calculated, and are they applicable to both insured and self-funded health plans
  • What additional taxes and fees apply to help defray the cost of health care reform

  • 1. INTRODUCTION
  • 2. EVOLUTION OF HEALTH CARE REFORM
    • Reasons for Health Care Reform
    • The Employer-Based Health Care Coverage Landscape Prior to Health Care Reform
    • The Legislative Process: Making Sausage
    • Enforcement Responsibility
  • 3. LEGAL CHALLENGES TO HEALTH CARE REFORM
    • Constitutionality of the Individual Mandate
    • Federal Government's Taxing Power
    • Federal Government's Commerce Clause Power
    • Religious Challenges to Contraceptive Coverage
  • 4. HEALTH CARE COVERAGE KEY TERMS
  • 5. HEALTH CARE REFORM EXEMPTIONS
    • Grandfathered Health Plans: "If You Like Your Current Insurance, You Will Keep Your Current Insurance"
    • Collectively Bargained Insured Plans
    • Exemption for Retiree-Only Plans
    • Exemption for Excepted Benefits
  • 6. QUALITY, AFFORDABILITY, AND ACCESSIBILITY
    • Immediate Steps to Expand and Preserve Coverage
    • Transition Period Coverage Improvements Applicable to Group Health Plans
    • Coverage Improvements Applicable to Employment-Based Coverage Effective January 1, 2014
    • New Reporting Obligations
    • Additional Electronic Transaction Standards
  • 7. PRESERVING AND EXPANDING IMMEDIATE ACCESS TO COVERAGE
    • Temporary Reinsurance Program for Early Retirees
    • Pre-Existing Condition Insurance Plans
    • Small-Employer Incentives
  • 8. COVERAGE IMPROVEMENTS DURING THE TRANSITION PERIOD
    • Prohibitions on Lifetime and Annual Dollar Limits on Benefits
    • Prohibition on Preexisting-Condition Exclusion Provisions for Children Under Age 19
    • Coverage of Preventive Health Services
    • Extension of Coverage for Children Up to Age 26
    • Mandated Claim and Appeal Process
    • Prohibitions on Rescissions
    • Patient Protections
  • 9. IMPROVEMENTS EFFECTIVE JANUARY 1, 2014
    • Prohibitions on Preexisting-Coverage Exclusions or Other Discrimination Based on Health Status
    • Fair Health Insurance Premiums
    • Guaranteed Availability of Coverage
    • Prohibiting Discrimination Against Health Care Providers
    • Quality Coverage Provisions
    • Limits on Waiting Periods
    • Coverage for Individuals Participating in Approved Clinical Trials
  • 10. TRANSPARENCY AND ACCOUNTABILITY
    • Summary of Benefits and Coverage
    • Reporting on Claims Practices and Plan Financing
    • Quality-of-Care Reporting
    • Containing the Cost of Health Insurance Coverage
    • Ensuring That Consumers Get Value for Their Dollars
    • Empowering Consumers With Information
    • State Health Insurance Consumer Information
  • 11. MANDATES AND EXCHANGES
    • Individual Mandate (Enroll-or-Pay)
    • Employer Mandate (Pay-or-Play)
    • Health Care Exchanges
    • Whistleblower Provisions
  • 12. OPERATIONAL CHANGES FOR HEALTH PLANS
    • Medicare Part D
    • Nondiscrimination Rules Applicable to Insured Health Benefits
    • Auto-Enrollment
    • Employer Notice of Coverage Options
    • Nursing Mothers
    • Reporting Cost of Coverage on Form W-2
    • Simple Cafeteria Plans for Small Businesses
  • 13. NEW TAXES AND OTHER REVENUE RAISERS
    • "Cadillac" Tax
    • Health FSAs
    • HSAs
    • Administrative Fees for Self-Funded and Insured Plans
    • Additional Taxes on High Earners
    • Other Taxes
  • 14. ANALYZING THE IMPACT OF HEALTH CARE REFORM
    • Differences Based on Employer Size
    • Differences Based on Full-Time vs. Part-Time Employees
    • Differences Based on Union vs. Non-Union Workforces
    • Employers Providing Retiree Health Coverage
    • Looking Ahead
  • APPENDICES
    • Affordable Care Act Provisions Applicable to Grandfathered Health Plans
    • Tri-Agency Regulations on Grandfathered Health Plans and Amendments
    • IRS Form 8941 and Instructions (Small Employer Tax Credit)
    • Tri-Agency Regulations on Preventive Care Without Cost Sharing
    • Tri-Agency Regulations on Religious Employer Exemption from Contraceptive Services
    • Coverage
    • Tri-Agency Regulations on Extended Coverage for Adult Children
    • Tri-Agency Regulations for Internal Claims and Appeals and External Review Processes.
    • Model Notices for Claims and Appeals
    • Tri-Agency Proposed Regulation on 90-Day Waiting Period
    • Summary of Benefits and Coverage Model and Completed Notices
    • DOL Guidance on Rebates for Group Health Plans Paid Pursuant to the Medical Loss Ratio Requirements of the Public Health Service Act
    • Proposed Regulations on Employer Pay-or-Play Rules and IRS Notice 2013-45 (Transitional Relief for 2014 from Pay-or-Play Rules)
    • HHS Bulletin on Essential Health Benefits from December 2011
    • Model Notices of Exchange (including revised COBRA Model Election Notice) (as per IRS Technical Release 2013-02)

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Brian M. Pinheiro

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Jean C. Hemphill

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Jonathan M. Calpas

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Kurt R. Anderson
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