Home
Forums
New posts
Search forums
What's new
New posts
Latest activity
Members
Current visitors
Log in
Register
What's new
Search
Search
Search titles only
By:
New posts
Search forums
Menu
Log in
Register
Install the app
Install
Home
Forums
Brown Cafe UPS Forum
UPS Discussions
UPS Health Benefits Shock for Retired Union Employees
JavaScript is disabled. For a better experience, please enable JavaScript in your browser before proceeding.
You are using an out of date browser. It may not display this or other websites correctly.
You should upgrade or use an
alternative browser
.
Reply to thread
Message
<blockquote data-quote="Catatonic" data-source="post: 1081626" data-attributes="member: 7966"><p>Google </p><p></p><p>Retiree-only medical plans exempt from lifetime-coverage limits</p><p></p><p>and you will get several results.</p><p></p><p></p><p>Here is one - <a href="https://www.aetna.com/health-reform-connection/questions-answers/retiree-only-plans.html" target="_blank">https://www.aetna.com/health-reform-connection/questions-answers/retiree-only-plans.html</a></p><p></p><p><span style="color: #000000"><strong>Retiree-Only Plans</strong></span>. The preamble to the regulations makes a very important clarification regarding the status of </p><p>retiree-only plans. A plan that only covers retirees and no active employees will not be subject to any of the new </p><p>insurance market reforms. Thus, for example, a retiree-only plan will not have to provide dependent coverage to </p><p>adult children and may continue to include annual or lifetime dollar limits. Retiree-only plans are also exempt </p><p>from the HIPAA portability requirements and other mandates, such as those imposed by the Mental Health Parity </p><p>and Addiction Equity Act.</p><p></p><p><span style="color: #666666"><span style="font-family: 'Arial'"><span style="color: #000000"><span style="font-size: 15px"><strong>Retiree-only plans are exempt from the ACA-mandated "insurance market reforms" listed below:</strong></span></span></span></span></p><p></p><ul> <li data-xf-list-type="ul">Sections 1001(5) and 10101 - No lifetime or annual dollar limits on essential benefits</li> <li data-xf-list-type="ul">Section 1001(5) - Prohibition on rescission</li> <li data-xf-list-type="ul">Section 1001(5) - Coverage of certain preventive health services provided in network</li> <li data-xf-list-type="ul">Section 1001(5) - Extension of dependent coverage</li> <li data-xf-list-type="ul">Section 1001(5) - Development and utilization of uniform explanation of coverage documents and standardized definitions (Summary of Benefits and Coverage)</li> <li data-xf-list-type="ul">Section 1001(5) - Provision of additional information</li> <li data-xf-list-type="ul">Section 1001(5) - Prohibition on discrimination in favor of highly compensated individuals for insured plans</li> <li data-xf-list-type="ul">Section 1001(5) - Ensuring the quality of care reporting</li> <li data-xf-list-type="ul">Section 1001(5) 8 - Medical loss ratio requirements</li> <li data-xf-list-type="ul">Section 1001(5) - Required appeals process and various requirements in the claims and appeals rules</li> <li data-xf-list-type="ul">Section 1001(5) - Patient protections (choice of provider, emergency services requirements)</li> <li data-xf-list-type="ul">Section 1003 - Rate review</li> <li data-xf-list-type="ul">Section 1201 - Prohibition of preexisting condition exclusions or other discrimination based on health status for children under age 19</li> <li data-xf-list-type="ul">Section 1201 - Restrictions on what criteria can be used in rating and rate band limits</li> <li data-xf-list-type="ul">Section 1201 - Guaranteed issue</li> <li data-xf-list-type="ul">Section 1201 - Guaranteed renewability</li> <li data-xf-list-type="ul">Section 1201 - Prohibiting discrimination against individual participants and beneficiaries based on health status</li> <li data-xf-list-type="ul">Section 1201 - Non-discrimination towards health care providers</li> <li data-xf-list-type="ul">Section 1201 - Cost-sharing requirements and essential benefit requirements</li> <li data-xf-list-type="ul">Sections 1201 and 10103 - Prohibition on waiting periods of more than 90 days</li> <li data-xf-list-type="ul">Section 10103 - Coverage for individuals participating in approved clinical trials</li> </ul><p><span style="color: #666666"><span style="font-family: 'Arial'">Retiree-only plans are also exempt from the Shared Responsibility For Employer requirements (ACA §1513) and the Wellness Incentive Requirements (ACA §2507(j)). Until further guidance is provided, we believe health insurance issuers of insured retiree-only plans are also exempt from the transparency requirements (ACA§ 1311(e)(3))</span></span></p><p><span style="color: #666666"><span style="font-family: 'Arial'"></span></span></p><p><span style="color: #666666"><span style="font-family: 'Arial'"></span></span></p><p><span style="color: #666666"><span style="font-family: 'Arial'"><span style="color: #000000"><span style="font-size: 15px"><strong>Retiree-only plans are required to comply with the following ACA requirements.</strong></span></span></span></span></p><p></p><ul> <li data-xf-list-type="ul">Section 1103 - Web portal reporting requirements</li> <li data-xf-list-type="ul">Section 1341 - Reinsurance</li> <li data-xf-list-type="ul">Section 1311(e) - Risk pooling (applies to small group retiree-only plans, with the exception of grandfathered plans)</li> <li data-xf-list-type="ul">Section 3141 - Reinsurance</li> <li data-xf-list-type="ul">Section 1342 - Risk corridors (applies to retiree-only qualified health plans)</li> <li data-xf-list-type="ul">Section 1343 - Risk adjustment (applies to small group retiree only plans)</li> <li data-xf-list-type="ul">Section 6301 - Research Trust Fund Health Plan Fee (PCORI)</li> <li data-xf-list-type="ul">Sections 9001 and 10901 - Excise tax on high-cost employer-sponsored health coverage</li> <li data-xf-list-type="ul">Section 9022 - W-2 reporting (applies to employers that sponsor retiree only plans, but only if the retiree otherwise is receiving a Form W-2 from the employer.)</li> <li data-xf-list-type="ul">Section 1502 - Reporting of health insurance coverage</li> <li data-xf-list-type="ul">Section 6005 - Pharmacy benefit managers transparency</li> <li data-xf-list-type="ul">Section 9003 - Exclusion of over-the-counter drugs for group health plans, FSAs, HRAs, HSAs</li> <li data-xf-list-type="ul">Section 9010 - Annual fee on health insurance providers</li> </ul></blockquote><p></p>
[QUOTE="Catatonic, post: 1081626, member: 7966"] Google Retiree-only medical plans exempt from lifetime-coverage limits and you will get several results. Here is one - [url]https://www.aetna.com/health-reform-connection/questions-answers/retiree-only-plans.html[/url] [COLOR=#000000][B]Retiree-Only Plans[/B][/COLOR]. The preamble to the regulations makes a very important clarification regarding the status of retiree-only plans. A plan that only covers retirees and no active employees will not be subject to any of the new insurance market reforms. Thus, for example, a retiree-only plan will not have to provide dependent coverage to adult children and may continue to include annual or lifetime dollar limits. Retiree-only plans are also exempt from the HIPAA portability requirements and other mandates, such as those imposed by the Mental Health Parity and Addiction Equity Act. [COLOR=#666666][FONT=Arial][COLOR=#000000][SIZE=4][B]Retiree-only plans are exempt from the ACA-mandated "insurance market reforms" listed below:[/B][/SIZE][/COLOR][/FONT][/COLOR] [LIST] [*]Sections 1001(5) and 10101 - No lifetime or annual dollar limits on essential benefits [*]Section 1001(5) - Prohibition on rescission [*]Section 1001(5) - Coverage of certain preventive health services provided in network [*]Section 1001(5) - Extension of dependent coverage [*]Section 1001(5) - Development and utilization of uniform explanation of coverage documents and standardized definitions (Summary of Benefits and Coverage) [*]Section 1001(5) - Provision of additional information [*]Section 1001(5) - Prohibition on discrimination in favor of highly compensated individuals for insured plans [*]Section 1001(5) - Ensuring the quality of care reporting [*]Section 1001(5) 8 - Medical loss ratio requirements [*]Section 1001(5) - Required appeals process and various requirements in the claims and appeals rules [*]Section 1001(5) - Patient protections (choice of provider, emergency services requirements) [*]Section 1003 - Rate review [*]Section 1201 - Prohibition of preexisting condition exclusions or other discrimination based on health status for children under age 19 [*]Section 1201 - Restrictions on what criteria can be used in rating and rate band limits [*]Section 1201 - Guaranteed issue [*]Section 1201 - Guaranteed renewability [*]Section 1201 - Prohibiting discrimination against individual participants and beneficiaries based on health status [*]Section 1201 - Non-discrimination towards health care providers [*]Section 1201 - Cost-sharing requirements and essential benefit requirements [*]Sections 1201 and 10103 - Prohibition on waiting periods of more than 90 days [*]Section 10103 - Coverage for individuals participating in approved clinical trials [/LIST] [COLOR=#666666][FONT=Arial]Retiree-only plans are also exempt from the Shared Responsibility For Employer requirements (ACA §1513) and the Wellness Incentive Requirements (ACA §2507(j)). Until further guidance is provided, we believe health insurance issuers of insured retiree-only plans are also exempt from the transparency requirements (ACA§ 1311(e)(3))[/FONT][/COLOR] [COLOR=#666666][FONT=Arial] [/FONT][/COLOR] [COLOR=#666666][FONT=Arial][COLOR=#000000][SIZE=4][B]Retiree-only plans are required to comply with the following ACA requirements.[/B][/SIZE][/COLOR][/FONT][/COLOR] [LIST] [*]Section 1103 - Web portal reporting requirements [*]Section 1341 - Reinsurance [*]Section 1311(e) - Risk pooling (applies to small group retiree-only plans, with the exception of grandfathered plans) [*]Section 3141 - Reinsurance [*]Section 1342 - Risk corridors (applies to retiree-only qualified health plans) [*]Section 1343 - Risk adjustment (applies to small group retiree only plans) [*]Section 6301 - Research Trust Fund Health Plan Fee (PCORI) [*]Sections 9001 and 10901 - Excise tax on high-cost employer-sponsored health coverage [*]Section 9022 - W-2 reporting (applies to employers that sponsor retiree only plans, but only if the retiree otherwise is receiving a Form W-2 from the employer.) [*]Section 1502 - Reporting of health insurance coverage [*]Section 6005 - Pharmacy benefit managers transparency [*]Section 9003 - Exclusion of over-the-counter drugs for group health plans, FSAs, HRAs, HSAs [*]Section 9010 - Annual fee on health insurance providers [/LIST] [/QUOTE]
Insert quotes…
Verification
Post reply
Home
Forums
Brown Cafe UPS Forum
UPS Discussions
UPS Health Benefits Shock for Retired Union Employees
Top