HIPAA
Final HIPAA nondiscrimination and wellness programs rules
were published on February 12, 2007 and effective July 1, 2007.
A lot of attention has been focused on the portion of the
new rules covering wellness plans and many companies without wellness plans may
assume they are in the clear. However, nondiscrimination rules apply to any
company sponsored health insurance plan.
Employers need to be careful that types of medical care not
covered by the insurance policy do not discriminate against a set of
workers. For example, a company could
not stop coverage for insulin in its health plan because that could be
interpreted as the company does not want employees with diabetes. The area, most often under the microscope, is
exclusions for coverage of prescription contraceptives like the birth control
pill. If an insurance plan does not
cover prescription birth control pills, but does cover other kinds of
contraception, such as vasectomies, courts in some cases have found those policies
to be discriminatory against women.
Click on the following link for complete text of final
rules:
http://www.dol.gov/ebsa/regs/fedreg/final/2006009557.pdf
WHCRA
The Women’s Health and Cancer Rights Act (WHCRA) is a
federal law that provides protections for patients who elect breast
reconstruction or certain other follow-up care in connection with a
mastectomy. This law applies to both
persons covered under group health plans and persons with individual health
coverage. WHCRA does not require health
plans to pay for mastectomies. If a
group health plan chooses to cover mastectomies, then the plan is generally
subject to WHCRA requirements.
The law requires group health plans and health insurance
issuers, including insurance companies and health maintenance organizations
(HMOs), to notify individuals regarding coverage required under the law. Notification is required at two separate
times: upon enrollment and annually.
Employers should make sure their health insurance companies
are complying with this law.
Medicare Part D
Employers who currently provide prescription drug coverage
must notify all members eligible for Medicare as to whether the employer
coverage is creditable prescription drug coverage. The purpose of this notice is to help
Medicare beneficiaries understand whether they will need to enroll in a Part D
plan during the initial enrollment period or whether they can maintain their
existing coverage and avoid a late enrollment penalty should they decide to
enroll in Part D at a later date.
Employer must provide this notice by the later of their annual
enrollment period or November 15. Employers must also provide a disclosure of
creditable coverage status to CMS on an annual basis.
Please note, the member notice must be provided to all
members, which includes the spouses of employees. While the employee may not be eligible for
Medicare, the spouse may be. It is
better to send the notice to all employees via mail, to ensure Medicare
eligible spouse’s receive the notice rather than be penalized for not providing
the notice to all members.
