Tuesday, January 18, 2011

Keeping Up with the Health Care Reform Changes

For all plan years beginning on or after September 23, 2010, employers are required to dole out an array of reform notices to all plan participants. Here are six notices that should be provided to employees:
  • Dependent coverage notice. All health plans are required to offer a one-time enrollment opportunity to participants’ children who are under age 26. In addition, participants must have 30 days to enroll their dependents. Participants must be notified of the changes no later than the first day of the plan year beginning on or after September 23, 2010.
  • Lifetime limits notice. Under the new law, plans are prohibited from putting lifetime limits on the dollar amount of coverage plan participants receive. Participants who had previously reached the limits of their healthcare coverage must be given a special enrollment notice that lets them know they are once again eligible for coverage.
  • Primary care designation and OB/GYN notice. Employers must communicate to employees that they have the right to designate a primary care physician within the plan’s network to coordinate their medical care. Additionally, female employees need to be informed they can obtain OB/GYN care without prior authorization.
  • Grandfathered status notice. All participants must be notified as to whether or not their health plan will retain its grandfathered status. If the plan does keep its grandfathered status, participants must be told that the plan is exempt from certain reform law provisions.
  • Cancellation of coverage notice. Participants’ healthcare coverage cannot be cancelled or terminated retroactively except in cases of deliberate fraud or similar situations. However, if a plan does cancel a participant’s coverage, the individual must still be given at least 30 days advance notice of the cancellation.
  • Claims appeals notice. A notice must be given to all participants who have a claim denied, explaining their right to appeal the denial. It must also outline the plan’s procedures for internal appeals and external reviews of those decisions.
For model language to satisfy these six notice requirements, see http://bit.ly/model384. Health plan providers may also furnish you with the proper notices.