November 18, 2015
Rules Finalize Prior 2010 Guidance and Incorporate Regulatory Clarifications
The U.S. Departments of Labor, Treasury, and Health and Human Services have published final rules for grandfathered plans, preexisting condition exclusions, lifetime and annual limits, rescissions, dependent coverage, appeals, and patient protections under the Affordable Care Act (ACA). The rules finalize a series of 2010 interim final regulations (and amendments) without substantial change and incorporate the clarifications issued thus far in sub-regulatory guidance.
Special Integration Rule for Certain Medicare Premium Reimbursement Arrangements
In addition to numerous clarifications, the rules provide a special rule for certain employers with fewer than 20 employees regarding the application of the annual dollar limit prohibition and preventive services requirements to Medicare premium reimbursement arrangements. Specifically, the special rule applies to employers with fewer than 20 employees that:
- Are not required to offer their group health plan coverage to employees who are eligible for Medicare coverage; and
- Offer group health plan coverage to their employees who are not eligible for Medicare, but not to their employees who are eligible for Medicare coverage.
For these employers, a premium reimbursement arrangement for Medicare Part B or D premiums may be integrated with Medicare (and deemed to satisfy the annual dollar limit prohibition and the preventive services requirements) if the employees who are not offered the other group health plan coverage would be eligible for that group health plan but for their eligibility for Medicare. These employers may use either of the non-Medicare specific integration tests, as applicable, for account-based plans for employees who are not eligible for Medicare.
The final rules generally apply to group health plans and health insurance issuers on the first day of the first plan year beginning on or after January 1, 2017. Until the final rules become applicable, plans and issuers are required to continue to comply with the corresponding interim final regulations that are currently in effect.
Click here to view the final rules in their entirety.
© 2012 - 2013 HR 360, Inc.