For Healthier Employees and Healthier Businesses

Now that the sixth month anniversary of the passing of PPACA, which was passed on March 23, 1010, has come and gone, the media is full of news about the changes in health care as a result of PPACA.  Consequently, you may have employees coming to you to ask how they go about adding their children up to age twenty-six to their coverage or about your health plan’s removal of lifetime benefit maximums and/or pre-existing conditions because that is what is being reported in the media.

For those employers who maintain self-funded programs, these health plans are not required to make these mandated changes until their first renewal on or after the passing of PPACA (September 23, 2010).  For example, a health plan which has a renewal date of January 1^st, will not have to comply with the law’s changes until that time.  Below is a brief summary of the most common PPACA provisions about which your employees may pose questions:

ELIMINATION OF LIFETIME LIMITS

PPACA mandates that a group health plan may not establish lifetime limits on the dollar value of essential health benefits for any participant; or unreasonable annual limits.

Effective Date :  Plan years beginning on or after September 23, 2010.

ELIMINATION OF PRE-EXISTING CONDITIONS

PPACA mandates that a group health plan may not impose any preexisting condition exclusion.

Effective Date :  Plan years beginning on or after January 1, 2014.   However, for children under the age of 19, the prohibition of preexisting conditions starts earlier – plan years beginning on or after 9/23/10.

EXTENSION OF DEPENDENT COVERAGE TO OVER AGE DEPENDENTS

PPACA mandates that a group health plan that provides dependent coverage for children must continue to make such coverage available for an adult child until the child turns 26 years of age. Over age children who are eligible to enroll in an employer sponsored health plan arising from their own employment are not eligible for this provision. Plans are not required to make coverage available for a child of a child receiving dependent coverage.

Effective Date:   Plan years beginning on or after September 23, 2010.