Happy Anniversary Health Care Reform

We just passed the first anniversary of PPACA (Patient Protection and Affordable Care Act).  Many positive things have happened as a result of the law.  Things that needed to happen.  The insurance carriers could have added these enhancements all by themselves without the law forcing their hand, just because it’s a good thing to do, but they weren’t listening to me!


Coverage for children up to age 26

Elimination of lifetime and most annual limits on benefits

No pre-existing condition exclusions for children under age 19 (remember the carriers have open enrollment periods now and can still rate higher for some conditions)

The creation of PCIP (pre-existing condition insurance plan) through MRMIB program for adults who have been declined for coverage and uninsured for at least six months


No deductibles, co-payments or co-insurances for immunizations or designated types of preventive care

Women can see an OB/GYN without a referral (this was already done in California)

A child’s primary care physician can be a Pediatrician (again already done in California)

Equal coverage for emergency services from in-network providers as well as out-of network providers

Process for internal appeals and external review of claims are required


Starting next year there will be new rules for plan summaries and other disclosures to participants.  As yet I haven’t read any detail but my guess is clear and timely information will be on the agenda.

Form W-2 reporting will require employers to disclose the dollar amount/value for health coverage.  We’ve had a bit of a reprieve on this mandate.  Originally it was to show on the W-2 in 2011 for the amount spent in 2010.  But there really wasn’t enough time to get the Treasury Department and Internal Revenue Service in sync for that to happen.   At this point it will be used for informational purposes, but there is rumor that the idea is to make the value of benefits a taxable event for those lucky enough to receive richer than average benefits in the future.  More than likely your payroll vendor is already working on this issue and if you are the one doing the payroll, be sure and update your software so you aren’t in trouble later on.

There is sure to be more information in the near future, especially about the W-2 requirements.  Like who will be capturing that information?  Let’s hope the insurance carriers will be helping with that information, other wise you might want to start a new excel spreadsheet.


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