Employee Relations 07/16/2010
Employee Benefits Security Administration Issues Model Notices
For New Rules under The Patient Protection and Affordable Care
The Employee Benefits Security Administration (EBSA) has issued interim final regulations for group health plans (plan) and health insurance issuers, implementing new rules under the recently enacted Patient Protection and Affordable Care Act (Act). Additionally, EBSA has provided model notices (required in the regulations) regarding patient protection, the elimination of lifetime and annual limits on benefits and mandatory dependent coverage until the age of 26.
Elimination of Annual and Lifetime Benefits. The Act prohibits plans and health insurance issuers from imposing lifetime or annual limits on the dollar value of health benefits. These regulations require participants in a plan to be notified via written notice that such limits no longer apply. Additionally, the plan must give eligible employees the opportunity to enroll in the plan that lasts at least 30 days. The model notice can be found here.
Patient Protection. The Act allows participants in plans to choose any participating provider or pediatrician when the plan requires the participant to designate one. The participant also now has the right to obtain obstetrical and gynecological care without prior authorization. The EBSA regulations require a plan to notify participants about these rights and a model notice can be found here.
Extension of Dependent Coverage to Age 26. The regulations require a plan or health insurance issuer to provide a dependent under the age of 26 with the opportunity to enroll in the plan that lasts for 30 days. Plans must also provide written notice of the enrollment opportunity no later than the first day of the first plan year beginning on or after September 23, 2010. A model notice can be found here.
Please click here for the full text of the final regulations.