The health care reforms introduced in 2010 take effect in stages. The IRS, DOL and HHS delayed the enforcement of some market reforms that took effect for group health plans in plan years beginning on or after September 23, 2010. Others require regular review to ensure continued adherence. In addition, it is not yet clear whether compliance with notification provisions intended to take effect in 2012 will be postponed. Some deadlines for plans with a calendar year plan year to keep in mind for 2012 are listed below.

January 1, 2012 –

• This is the deadline for plans that are not grandfathered under the Patient Protection and Affordable Care Act, and thus must provide coverage for recommended preventive health services without cost-sharing, to reflect changes to recommended services that took effect January 2, 2010, through January 1, 2011.
• Enforcement grace periods apply to several portions of the internal claims and appeals and external review rules applicable to plans that are not grandfathered. This is the deadline by which plans generally must fully implement certain internal claims procedures. Self-insured plans’ external review processes may be eligible for an enforcement safe harbor if they contract with and rotate assignments among at least two Independent Review Organizations (IROs).

March 23, 2012 –

• This is the date by which self-insured plans and insurance issuers (or the insured plans to which they provide coverage), whether or not grandfathered, must supply a summary of benefits and coverage explanation (in addition to the summary plan description). This SBC must be provided before any enrollment restriction to applicants when they apply and to enrollees before they enroll or reenroll. Rules on how the SBC must be compiled and provided were proposed in August 2011. It appears that the agencies intend to stick to the compliance date unless swayed by “factors that may affect the feasibility of implementation within this time frame.” Also, plans must provide notice of any material modification in any plan terms or coverage that is not reflected in the most recently provided SBC at least 60 days before the modification becomes effective.
• This is the date by which the Secretary of HHS must develop reporting requirements for plans that are not grandfathered to reveal information regarding plan or coverage benefits and health care provider reimbursement structures to enrollees and the government. Once these “quality of care” requirements apply, plans must make the annual report available to enrollees during each open enrollment period. Thus, absent any delays in implementation or application of the rules, plans would have to report during their Fall 2012 open enrollment period for 2013.

July 1, 2012 – Self-insured plans’ external review processes may be eligible for an enforcement safe harbor if they contract with and rotate assignments among at least three IROs.

December 31, 2012 – This is the deadline for plans that want to extend waivers of restricted annual limits to resubmit application information.

?? – Another health care reform prohibits insured plans that are not grandfathered from discriminating in favor of highly compensated individuals starting with the 2011 plan year. However, plans will not have to comply until “plan years beginning a specified period after issuance” of administrative guidance.

For a discussion of these health care reforms, see 389 T.M., Medical Plans – COBRA, HIPAA, HRAs, HSAs and Disability.

-- Nadia Masri, Tax Law Editor (Compensation Planning)