2009 will continue to be a busy year for benefits changes! Employers should review and amend plans for compliance with a variety of legislation that will be taking effect soon!
Special Enrollment for CHIP
Effective April 1, 2009, group health plans are to provide special enrollment for persons losing CHIP or Medicare coverage or obtaining premium assistance from a state under a CHIP or Medicare program. Notice requirements of certain rights will be required starting for most plans on January 1, 2011.
What to do? Determine whether your employees have been notified of this expanded right. This is usually done through a summary of material modification (SMM) to your group health plan. These new special enrollment rights may require changes to your plan documents and summary plan descriptions.
HIPAA Privacy & Security
Effective August, 2009 plan sponsors should be aware of any breach of unsecured protected health information (PHI). If a breach is discovered, an employer sponsored health plan must notify the individual within 60 days. If a breach involves more than 500 people media must be notified. Effective February 17, 2010, businesses are responsible for compliance with HIPAA’s rules and regulations.
What to do? Review documents to ensure your vendors are responsible for providing any notices needed in the event of a breach of unsecured PHI.
Mental Health Benefits
Under the Mental Health Parity and Addiction Equity Act, which takes effect Jan. 1, 2010 (for calendar year plans) there will be two changes regarding financial and treatment requirements. Group Health Plans must provide mental health and/or substance use disorder benefits on an equivalent basis to medical/surgical benefits (or eliminate these benefits).
What to do? Review your current group health plan mental health and substance abuse benefit coverage. If changes need to be made, plan for potential cost increases for the 2010 plan year.
Genetic Information
Group Health plans may not impose a pre-existing condition limitation based on genetic information. Plans may not use genetic information to discriminate regarding eligibility, premiums or coverage nor may they require genetic testing. Genetic information is considered private health information (phi).
What to do? Audit the collection or use of family medical histories or other genetic information in your wellness and health promotion programs. Know whether any information is collected for underwriting purposes or prior to enrollment. If information is used in a discriminatory manner, action will be required.
Cafeteria Plan
Currently scheduled to take effect Jan. 1, 2010, for calendar year plans, benefit options may have to be expanded and/or clarified. Plan documents may also require more detailed written plan documents.
What to do? Evaluate your current cafeteria plan documents and SPDs. Note possible changes needed when these rules become final.
Michelle’s Law
“Michelle’s Law” will prohibit an employer-sponsored health plan from cutting off benefits if a college student who is covered under a parent’s health plan due to his or her full-time student status loses that status due to a medical leave of absence.
What to do? Review current SPDs and plan documents to see what changes may be needed. Ensure continued coverage with HMO’s and Cobra administrator’s.