Frequently Asked Questions Issued on Several PPACA Topics
January 30, 2013
On January 24, 2013, the Departments of Labor (DOL), Health and Human Services (HHS) and Treasury issued new Frequently Asked Questions (FAQs) on several topics under the Patient Protection and Affordable Care Act (PPACA). No comments were requested.
Notice of Coverage Options Through Exchanges Delayed
Originally scheduled to take effect March 1, 2013, the Notice to employees of the available Exchange coverage has been delayed. The FAQ confirms that employers will not be required to provide the Exchange Notice to their employees until critical information is defined, including:
- The DOL is expected to issue regulations on the Notice
- The IRS is expected to provide guidance on minimum value
- Information on HHS’ educational efforts
The Notice has been delayed to late summer or fall of 2013 pending this information and to coordinate with open enrollment of the Exchanges, which begins October 1.
The FAQ also notes that employers will be provided with model, generic language for the Notice and an alternative template available for download on the Exchange website.
Health Reimbursement Accounts (HRAs) – Integrated vs. Stand-Alone
The FAQs reference annual and lifetime dollar limits for integrated vs. stand-alone HRAs. As stated in the Preamble of interim final regulations, an HRA is considered integrated with a group medical plan when it is only available to employees who enroll in the medical plan. Integrated HRAs are not subject to the prohibition on annual and lifetime dollar limits, if the medical plan is compliant.
While guidance is yet to be issued, the FAQs address these anticipated rules:
- An HRA cannot be integrated with an individual medical policy or employer-sponsored individual medical policy.
- An HRA that credits amounts to an individual who is not enrolled in the compliant medical plan cannot have any annual or lifetime dollar limits, as it is not an integrated HRA.
- Unused amounts credited to an HRA prior to January 1, 2014 can be used after December 31, 2013 to reimburse medical expenses without causing the HRA to violate the prohibition, whether integrated or stand-alone.
Disclosure of Information Related to Firearms
While guidance is yet to be issued on the PHS Act section 2717(c), this FAQ addresses the important role health care professionals can play in promoting gun safety. The guidance is expected to confirm that while the statute prohibits certain organizations from requiring disclosure of information concerning firearms, there are no restrictions of communication between health care professionals and their patients.
ASO Employer-Sponsored Pharmacy Coverage Supplementing Medicare Part D Through Employer Group Waiver Plans (EGWP)
While guidance is yet to be issued, this FAQ states that regulators will not take any enforcement action against an employer group plan that is an EGWP. The non-Medicare supplemental drug benefit does not comply with the health coverage provisions of PPACA.
Fixed Indemnity Insurance
Due to an increased number of policies being labeled as fixed indemnity coverage, this FAQ reiterates the existing regulatory requirements for fixed indemnity coverage.
Payment of Patient-Centered Outcomes Research Institute (PCORI) Fees, a.k.a., Comparative Effectiveness Research Fee (CERF)
This FAQ addresses a concern that Title I of ERISA prohibits a multi-employer plan’s joint board of trustees from paying the CERF from assets of the plan. Among other clarifications, this FAQ confirms that for multi-employer plans, the plan sponsor liable for the fee would generally be the independent joint board of trustees, appointed by the participating employers and employee organization, and directed by a collective bargaining agreement. Unless the plan document specifies a source other than plan assets for payment of the fee, payment from plan assets is permissible under ERISA.
Click here for further details on these FAQs, which are available on the DOL website*
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