2013 - Recent Federal Regulations Affecting Employee Benefits

Overview : This presentation will provide attendees with an introduction to some of the many new regulations relating to employee benefits, with a focus on regulations that have been issued in the last year. Most of the new regulations relate to the Patient Protection and Affordable Care Act (PPACA, also known as health care reform). Other regulations that will be summarized include the FMLA (Family and Medical Leave Act) and Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security.
PPACA Regulations to be addressed include:
Employer shared responsibility (pay-or-play). These rules define the circumstances under which large employers will be required to pay a penalty. Penalties will apply if a large employer fails to offer minimum value, affordable coverage to all full-time employees.
Individual shared responsibility (individual mandate). These rules define when individuals will be required to pay a penalty for failing to have health insurance.
Premium tax credits (subsidies). These rules define when individuals who purchase coverage through the new Exchanges will be eligible to receive a subsidy to help pay for the insurance.
Definition of full-time employee. Penalties are based on full-time employees. These rules define who is a full-time employee. The major impact of these rules is related to employees who work variable schedules.
Health insurance market rules. These rules generally apply to individual health insurance policies and small group health plans, although certain rules also apply to large group health plans. These rules relate to guaranteed availability, guaranteed renewability, rating areas, age rating bands and limits and tobacco use rating adjustments.
Essential health benefits. Individual health insurance policies and small group health plans must cover essential health benefits and large group health plans are prohibited from having lifetime or annual limits on essential health benefits. The federal government has delegated to the states the responsibility for determining what constitutes essential health benefits. These rules define the parameters that apply to states in determining what is or is not an essential health benefit. These new rules also define the minimum value that large group health plans must provide in order to avoid penalties. These rules also relate to cost-sharing limits, some of which apply to all health plans and small of which only apply to individual policies and small group health plans.
National per Capita Reinsurance Contribution Rate (Reinsurance fee). Health insurers offering coverage in the new Exchanges will be protected initially by a new reinsurance program. In order to pay for this program, all sponsors of group health plans will pay a significant new fee.
Why should you attend: The employee benefits field is constantly changing. Employee benefits professionals need to keep up with the latest developments, including regulatory changes. Compliance is not optional and what you don't know can hurt you!
Some of the new regulations apply to or will affect all or virtually all employers. Do you know the latest rules relating to penalties for employers who do not offer minimum value, affordable coverage to all full-time employees? What about the individual mandate? Do you know what a premium tax credit is? The new rules defining full-time employees will impose significant new requirements for establishing procedures and keeping records-do you know what these rules are? Similarly, health insurance market rules will impact all small plans, even those outside the new Exchanges, and will affect some large plans, too.
In addition to regulations under the Patient Protection and Affordable Care Act (PPACA, also known as health care reform) there are new regulations under the Health Insurance Portability and Accountability Act (HIPAA) related to privacy and security that will have broad applicability and the Family and Medical Leave Act (FMLA) regulations have been updated to reflect changes to military family leave and make other changes as well.
Some of the regulations issued in the past year are very specialized and only apply to certain types of plans, like small health plans. Others, like the health insurance market rules only to insurers, but not self-funded plans. Some regulations, like those regarding employer shared responsibility only apply to large employers, not small employers. Of course, if you fall into one of these categories, you need to know about the rules.
Areas Covered in the Session:
Health Care Reform
Employer Shared Responsibility
Individual Shared Responsibility
Premium Tax Credits
Definition of Full-time Employee
Health Insurance Market Rules
Essential Health Benefits
Fees, Wellness Plans
HIPAA Privacy Security
FMLA
Who Will Benefit:
Vice President of Human Resources
Director of Compensation and Benefits
Benefit Manager
Benefit Specialist
Insurance Agent
Insurance Broker
Employee Benefits Consultant
Group Insurance Representative
John Garner is the founding Principal of Garner Consulting, an employee benefit consulting firm in Pasadena. Under Garner’s leadership, this nationally recognized consultancy has built a broad base of services including benefits consulting, claim audits and compliance for insurance companies, employers, health care organizations and providers, and managed care companies. Garner Consulting recently merged its insurance brokerage division with two other brokerage firms to create Valence Benefits, where Garner also serves as a Principal.