HHS Proposes Revisions to ACA Section 1557
HSA Limits Updated For 2020
DOL Updates Model Summary Annual Report for Welfare Plans
What is the appropriate correction when, due to an administrative error by the employer or COBRA vendor, a COBRA participant has been charged incorrect premium rates?
On May 6, 2019, the Insurance Department published Bulletin HC-126. The bulletin relates to stop-loss insurance policies in Connecticut. According to the bulletin, the department will not approve stop-loss policies that have an annual attachment point for claims incurred per individual that is lower than $20,000. For groups of 50 or fewer, the department will not approve polices that have an annual aggregate attachment point that is lower than the greater of $4,000 times the number of group members, 120% of expected claims, or $20,000; for groups of 51 or more, that aggregate attachment point must be higher than 110% of expected claims. Lastly, the department will not approve polices that provide direct coverage of health care expenses of an individual.
The bulletin also outlines several provisions in stop-loss policies that will not be allowed, including claims denials that the employer is legally obligated to pay under the health plan, medical necessity and usual or customary determinations, experimental or investigational determinations, case management requirements and mandated provider networks, or benefits incentives for enrollees. The bulletin includes a full list of such prohibited provisions. The bulletin also states that lasering (the practice of assigning different attachment points or deductibles, or denying coverage for, individual employees or dependents with pre-existing, high cost medical conditions) is allowed during the stop-loss process, but that no attachment point for an enrollee can exceed three times the attachment point for the policy. Finally, the bulletin states that retiree-only stop-loss policies are not subject to the above restrictions, but that the department will review each such policy on a case-by-case basis.
While directed to stop-loss carriers, employers with self-insured plans that use a stop-loss policy issued in CT should be aware of the bulletin. Such employers can work with their adviser or carrier on any questions regarding the bulletin.
Extended Relief for Non-ACA-compliant Small Group and Individual Policies and Plans
On May 28, 2019, Gov. Mills signed into law LD 369, which is a new paid sick leave law. Effective January 1, 2021, the new law requires employers with 10 or more employees to provide an hour of paid sick leave for every 40 hours worked, up to a maximum of 40 hours of paid leave per year. Accrual of leave begins at the start of employment, although the employer is not required to permit use of the leave until the employee has worked 120 days. During the leave, employees must be paid at least the same base rate of pay that the employee received immediately prior to taking the paid leave, and must receive the same benefits as those provided to employees under other types of paid leave. Employees can use paid sick leave to take care of their own illness or serious condition or that of a family member. Employees are expected to provide advanced notice to employers, where possible.
We anticipate the Maine government and regulatory agencies providing additional detail on this new law prior to the 2021 effective date; we’ll continue to monitor any developments and report them here in Compliance Corner.
On April 3, 2019, Commissioner Afable released a bulletin that extended the ability of health insurance carriers in the individual and small group market to continue transitional health insurance plans that renew for a policy year starting on or before October 1, 2020, as long as the transitional policy ends by December 31, 2020.
As background, on March 25, 2019, CMS provided guidance for a transition policy extension that allows insurers the option to renew non-grandfathered non-ACA-compliant plans, as long as the state allows for such an extension. Such transition policies are not required to be in compliance with certain ACA mandates including community rating, coverage of essential health benefits, prohibition on pre-existing condition exclusions and the annual out-of-pocket maximum limit. This bulletin applies this most recent federal extension to Wisconsin and allows the issuer to renew these non-ACA compliant plans.
Small employers that are interested in renewing their non-ACA-compliant plan should work with their advisors and insurers.
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