Seven MORE Things to Consider for Open Enrollment Planning

A few weeks ago, we provided a list of five considerations for open enrollment regarding Affordable Care Act (ACA) compliance, focused on avoiding shared responsibility payments, imbedding deductibles in out-of-pocket limits, and complying with the new ACA reporting requirements. Today’s list addresses some requirements that expand beyond the ACA — including a few items you’ve probably checked off your list but might need to look at again because of recent guidance.

  • Preventive care. Ensure that nongrandfathered group health plans comply with the final ACA rules and recent guidance on cost-free preventive services.
  • Other ACA reporting and disclosure. In addition to the new ACA reporting requirements, review delivery operations for summaries of benefits and coverage (SBCs) and watch for revised SBC templates. Prepare for round two of online submission and payment of ACA’s reinsurance fee.
  • Midyear changes to cafeteria plan elections. Decide whether to permit midyear changes to cafeteria plan elections for either or both of the status-change events in IRS Notice 2014-55.
  • Same-sex marriages and domestic partnerships. Assess how the US Supreme Court’s Obergefell v. Hodges ruling legalizing same-sex marriage nationwide affects your benefit programs and employment policies. Also consider the decision’s indirect implications for domestic partner coverage.
  • Mental health parity. Check that plan designs and operations provide parity between medical/surgical and mental health/substance use disorder (MH/SUD) coverage. Federal audits of health plans now evaluate compliance with the final Mental Health Parity and Addiction Equity Act (MHPAEA) rules that took effect in 2015. In addition, state legislative activity and litigation around parity issues continue.
  • Wellness. Review employee wellness programs against the proposed Equal Employment Opportunity Commission (EEOC) rules requiring voluntary participation and restricting incentives for completing health risk assessments and/or biomedical screenings. Be prepared to make changes after the EEOC finalizes these rules for nondiscriminatory wellness plans under the Americans with Disabilities Act.
  • Fixed-indemnity and supplemental health insurance. Review fixed-indemnity and supplemental health insurance policies to ensure they qualify as excepted benefits under the ACA and the Health Insurance Portability and Accountability Act (HIPAA).

When finalizing health benefit designs and contribution strategies, be sure to update all employee communications materials as well as terms and agreements with your vendors.

Tracy Watts
by Tracy Watts

Senior Partner, National Leader for U.S. Health Policy

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