Dependent Coverage for Children Under Age 26. Group health plans and insurers that offer dependent coverage must make coverage available for adult children until age 26. Children who become (or are required to become) eligible to enroll because of this coverage requirement must be provided written notice of their enrollment rights and 30 days to enroll, by the first day of the first plan year beginning on or after September 23, 2010. This notice may be included with a plan's enrollment materials.  The disclosure must be prominent. (The model language states that enrollment will be effective retroactively to the first day of the first plan year beginning on or after September 23, 2010. So, plans and insurers must provide the required notice at least 30 days in advance of the first day of the first plan year before this requirement takes effect to avoid having to administer retroactive
enrollment.)



http://www.dol.gov/ebsa/dependentsmodelnotice.doc



Lifetime Limits. Group health plans and insurers may not impose a lifetime limit on the dollar value of "essential health benefits," as defined by the statute (these have not yet issued).  Individuals who previously reached a lifetime limit under the group health plan or insurance coverage and who are otherwise still eligible under the plan must be given a written notice that the lifetime limit no longer applies. Individuals who are no longer enrolled must be provided a written notice (no later than the first day of the first plan year beginning on or after September 23, 2010) informing them of an enrollment window that must continue for at least 30 days. The notice, which may be provided to an employee on behalf of the employee's dependent, may be included with a plan's enrollment materials, provided the statement is prominent.

http://www.dol.gov/ebsa/lifetimelimitsmodelnotice.doc

For each of the above, those eligible for these enrollment opportunities must be treated as special enrollees, i.e., they must be given the right to enroll in all of the benefit packages available to similarly situated individuals upon initial enrollment.



Patient Protection. When applicable, group health plans and insurers are required to notify participants of their rights to (1) choose a primary care provider, a pediatrician or an ob-gyn from within the plan's network without prior authorization.  This notice must be provided whenever the plan or issuer provides a participant with an SPD or other similar description of benefits under the plan or coverage--starting no later than the first day of the first plan year beginning on or after September 23, 2010.

http://www.dol.gov/ebsa/patientprotectionmodelnotice.doc



Web Portal



On July 1st, DHHS unveiled it's consumer Web portal www.healthcare.gov <http://www.healthcare.gov> .  This portal is geared toward individuals and small groups, allowing them to compare private insurance options and obtain information (and some applications) for public programs.  While, it was unveiled on Thursday, all of the information is not yet available.  The portal should be finalized by October 1st.



Early Retirement Reinsurace Program



HHS announced that on June 29, 2010, it began accepting applications for the early retiree reinsurance program.  Under that program, plan sponsors who provide health coverage to early retirees may receive reimbursement for 80% of a plan's annual claims that exceed $15,000 but do not exceed $90,000 for each early retiree.


Applications must be submitted using the form available on the HHS website. The application must be completed electronically and then printed, signed, and sent  by U.S.mail. Additional typewritten pages may be attached if necessary. Originals must be submitted (no photocopies).  


Payment will be made based on when claims--not applications--are submitted, so timely submission of claim reimbursement requests is the "critical step."

Definition of Early Retiree. While HHS will generally defer to a plan's rules to determine whether a given individual is an active employee and not an early retiree, that deference will be limited to  specific rules included in a written plan document in effect as of the day the claim was incurred. If there is no such document, or the  document's rules are "vague and unclear," the determination as to whether someone is an active employee will be made using the Medicare Secondary Payer rules and related CMS guidance.   



Additional information may be found at:

http://www.hhs.gov/ociio/regulations/eerp_update_0629.html
http://www.hhs.gov/ociio/regulations/index.html
http://www.hhs.gov/news/press/2010pres/06/20100629a.html



Interim Final Rule on Pre-Existing Condition Exclusions and Annual & Lifetime Limits



Pre-Existing Condition Exclusions



The legislation requires that group health plans and insurers offering health coverage to individuals and groups not impose a pre-existing condition exclusion on enrollees under age 19 for plan years beginning on or after September 23, 2010.  The regulation applies to both grandfathered and non-grandfathered plans, as well as, insured and self-funded plans (individual and group coverage).



The Regulation amended the definition of Pre-existing Condition Exclusion to mean a limitation or exclusion of benefits (including a denial of coverage) based on the fact that the condition existed before the effective date of coverage (or if coverage was denied, before the date of denial).  The definition also includes any exclusion based on information on a "pre-enrollment" questionnaire.  This may have an impact on health risk assessments.