The Big Book of HR, Revised and Updated Edition by Barbara Mitchell

Author:Barbara Mitchell
Language: eng
Format: epub
Publisher: Career Press
Published: 2017-07-14T16:00:00+00:00

Mental Health Parity Act, 1996

The Mental Health Parity Act requires the same dollar limits for mental health and medical benefits. It does not apply to substance abuse nor require a plan to offer mental health benefits.

Patient Protection and Affordable Care Act (PPACA or ACA), 2011

The Patient Protection and Affordable Care Act of 2011 is an integral part of healthcare reform. It has placed many new compliance obligations on employers that are complicated and technical. Employers should seek continuing advice from their benefits and legal consultants, especially since many provisions take effect on a phased basis.

Requirements and prohibitions affecting employers and plans include:

Lifetime and annual dollar limits on “essential health benefits” are prohibited.

There can be no retroactive revocation of coverage except for fraud/intentional misrepresentation of a material fact.

Coverage for adult children up to age 26 is required.

There can be no pre-existing condition exclusion for any participant.

Coverage of certain preventive health services and immunizations without cost to covered individuals is required.

Insured plans are now subject to nondiscrimination rules currently applicable to self-insured plans.

Participants may choose any available primary care provider.

Access to emergency services in and out of network without prior authorization must be provided.

Internal and external claim appeal procedures and notification requirements of those procedures are required.

For more information on healthcare reform, including a number of FAQs, please visit www.dol.gov/agencies/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers, and www.hhs.gov/healthcare/about-the-law/read-the-law/index.html.

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