1. DID YOU KNOW
While insured small group plans and
individual health insurance policies will
be subject to new deductible and out-of-
Benefits and HR tips brought to you by pocket limit caps in 2014, proposed
The Gardner Group legislation indicates that the government
does not intend to impose these
regulations on self-insured group health
plans or insured large group health
plans. In addition, remaining
grandfathered group health plans will
also be exempt from these new
requirements.
Health Care Reform: Proposed Rules Proposed Reinsurance
on Workplace Wellness Programs Fees Will Cost Group
Health Plans
The Affordable Care Act (ACA) includes standards:
provisions to encourage appropriately On Dec. 7, the Department of Health and
designed, consumer-protective wellness  Frequency of opportunity to Human Services (HHS) issued proposed
programs in group health coverage. qualify regulations on some of the fees that will
affect insurers and health plans. The
On Nov. 26, proposed regulations were  Size of reward regulations on transitioned reinsurance
released regarding the ACA’s fees provide:
nondiscrimination requirements for  Uniform availability and
wellness programs. reasonable alternative  For self-insured group health
plans, the plan sponsor is liable
The proposed regulations would increase  Reasonable design for paying the reinsurance fees,
the maximum reward under a health- although a TPA or ASO
contingent wellness program from 20  Notice of other means of contractor may be used to make
percent to 30 percent of the cost of qualifying for the reward the payment
coverage, and would further increase the These regulations would apply to both
maximum reward to 50 percent for  The amount of the fee is
grandfathered and non-grandfathered proposed to be $63 per covered
wellness programs designed to prevent group health plans and group health
or reduce tobacco use. life per year
insurance coverage for plan years
Health-contingent wellness programs beginning on or after Jan. 1, 2014.  The rate will be announced
require individuals to satisfy a standard each year by HHS
Definitive guidance will not be available
related to a health factor in order to until the regulations are in final form.
obtain a reward. This includes wellness Comments on the proposed regulations
programs that require an individual to are due by Jan. 25, 2013.
attain or maintain a certain health
outcome in order to obtain a reward
(such as not smoking, attaining certain
results on biometric screenings or
meeting exercise targets). This type of
wellness program must meet the
following five nondiscrimination
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