By Mike Scott
For The Legal News
Health care reform under the Affordable Care Act is giving law firms an opportunity to share guidance with corporate clients, giving firms a reason to informally market their services.
In fact, there are so many specifics to health care reform that it should keep many of the nation’s health care practices within firms busy for the next few years.
One of the issues that at least one statewide law firm is focusing on next week is nondiscrimination testing, a topic of specific interest given the timing.
Many companies currently are trying to finalize their calendar year health plans and are preparing for an open enrollment period, said Norbert Kugele, a partner with Warner Norcross & Judd with offices throughout southeastern Michigan.
The firm is hosting an open webinar on nondiscrimination testing and other recent updates at 12 p.m. on Tuesday, Nov. 9.
The majority of the webinar will cover two issues that recently have received issued guidance from the federal government: Internal claims and appeals and external review processes, and mandated first dollar reimbursement of preventive care.
The issues are important both for grandfathered and non-grandfathered plans.
In the past self-insured health plan arrangements have been subject to non-discrimination rules, allowing employers and employees in some cases to benefit from various tax deductions, Kugele said.
However once Congress took up the topic of health care reform it added provisions to make the availability of tax deferral available to individuals under insured plans as well. That would also make those people eligible for non-discrimination rules.
The webinar will also cover what the various non-discrimination rules mean and what the impact is on Warner Norcross business clients, Kugele said.
Specifically attendees will understand how the various tests that employers need to take to could determine their eligibility and compliance.
“You don’t necessarily need to meet all the tests but you do want to look at plan designs that could cause some problems,” Kugele said. An example of that is a plan design that allows executives to receive better benefits than lower-level professionals.
“If there is a distinction between two different groups of employees, that raises the possibility of discrimination,” Kugele said.
In addition to the webinar Warner Norcross is one of many law firms that have held in-person and remote training and information sessions on the impact of health care reform as it now stands.
The approach from a legal standpoint has been to inform clients of what their legal team has learned and what the clients should follow and act on both now and in the future.
Non-discrimination testing for example has been clarified by the Affordable Care Act in terms of self-funded and insured plans. While the impact on individuals who have been covered by self-funded plans is relatively small, the new tax laws and other considerations will have a significant impact on insured plans for both employers and their workers.
The value of the webinar is that it is a strategy that can allow clients to get information specific to them without leaving their office, Kugele said. One way to keep the webinar more interesting is to frequently change speakers and presenters so that different voices are presenting information.
“Ultimately our goal is to communicate the details,” Kugele said. “There are a number of issues that employers and employees need to be aware of.”
Other such events and webinars will be held over the next four years by Warner Norcross and other firms as the Affordable Care Act is implemented in stages.
“You have some immediate reforms (that took place) in September,” said Sue Conway, a Warner Norcross partner who concentrates her practice in employee benefits law. “While many significant changes will not take place until 2014, others are more imminent. Employers and health plans should begin preparing for them now.
Other major health care reform changes that will impact employers by 2014 include:
• Mandated insurance coverage for all Americans by 2014
• Penalties for large employers who offer no or unaffordable health coverage by 2014
• Refundable tax credits and reduced cost-sharing requirements, as well as an expansion of Medicaid, to offset expenses for those with lower incomes
• Establishment of health insurance exchanges for families and small employers
• Elimination of certain restrictions, such as pre-existing conditions, for employer-sponsored health plans
• Elimination of life-time coverage limits
• Extension of coverage for children up to age 26
• Uniform benefit descriptions to allow employees to more easily compare coverage options
• New reporting requirements
• New programs that offer tax credits on health insurance premiums for small employers
• Early retiree reinsurance
“While these changes are being phased in gradually, individuals and businesses cannot afford to postpone planning for the necessary changes to their employee health plans,” Conway said. “Many of the provisions are complicated and will require modifications to existing plans. Companies that do not comply with health reform face stiff financial penalties.”
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