Bloomberg Law for HR Professionals is a complete, one-stop resource, continuously updated, providing HR professionals with fast answers to a wide range of domestic and international human resources...
The Department of Labor's Employee Benefits Security Administration issued a sixth set of frequently asked questions April 1 regarding grandfather plan status under the Patient Protection and Affordable Care Act.
DOL, which prepared the guidance jointly with the departments of Treasury and Health and Human Services, outlined a number of circumstances under which a plan transferring an employee from a grandfathered plan to another plan for a “bona fide employment-based reason” would not lose grandfather status.
Those circumstances include transferring an employee to another plan if the issuer is leaving the market or discontinues the product. Grandfather status also will continue if a benefits package has low or decreasing participation, making it “impractical” for a plan sponsor to continue to offer it, the departments said. Circumstances outlined in the FAQs are not an “exhaustive list” of cases that will satisfy the bona fide employment-based reason condition, the agencies said.
A plan will not relinquish grandfather status if the cost-sharing level of a plan increases because the generic equivalent of a brand name drug comes onto the market, the FAQs said.
Additionally, plans increasing the copayment for preventive services received in an in-network hospital setting would not cause a plan to give up its grandfather status, provided there is no change to the copayment in an in-network ambulatory surgery center, the FAQs said. The departments added that they are gathering further information on value-based insurance design and wellness programs and will address issues relating to those designs and programs in future guidance.
Amendments to plan terms set to become effective on the first day of the next plan year will lose grandfather status once the amendment to the plan becomes effective, the departments said. The same approach is taken on amendments to plans “operating on a calendar plan year” becoming effective in the middle of a plan year, the FAQs said.
Employer contributions to retiree health plans lose grandfather status when the contributions decrease below 5 percent of the contribution amount that was provided March 23, 2010, the departments said.
Sets of FAQs regarding PPACA requirements were previously posted by the departments last year on Sept. 20, Oct. 8, Oct. 12, Nov. 2, and Dec. 23 (28 HRR 1016, 9/27/10; 28 HRR 1102, 10/18/10; 28 HRR 1186, 11/8/10; 29 HRR 13, 1/10/11).
The latest FAQs are available at http://op.bna.com/dlrcases.nsf/r?Open=mcan-8fltkr.
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to email@example.com.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to firstname.lastname@example.org.
Put me on standing order
Notify me when new releases are available (no standing order will be created)