The Department of Labor's Employee Benefits Security Administration has posted a notice of publication of an Employer's model notice regarding eligibility for premium assistance under Medicaid or the Children's Health Insurance Program (CHIP). The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) includes a requirement that the Departments of Labor and Health and Human Services develop a model notice for Employers to use to inform Employees of potential opportunities currently available in the Employee's state of residence for group health plan premium assistance under Medicaid and the CHIP.

Click here to view the Federal Register notice.

Click here to view the model notice.

The Governor of Illinois signed a bill yesterday to ensure the right to an independent review of denied claims to all Illinois residents with health insurance coverage. Consumers will have the right to have their denied claims reviewed by a physician independent of the insurance company and at the plan’s expense. The new law will take effect July 1 and will affect about 4 million people who are insured by private plans. It was built upon a state law enacted in 1999 that allowed only HMO-covered consumers whose claims were denied.

For more information, click here.

On November 4th, voters in Montana, Colorado and Arizona to vote on unprecedented changes to their health care systems. Each state would be affected in different ways. 

To read more about these health care measures, click here.

The Massachusetts Health Insurance Connector Authority approved revisions to the 2006 law which seeks to move the state closer to universal coverage. The revisions are expected to move about 350,00 previously uninsured out of uninsured status.

To read more about the approved revision, click here.

For more information, click here. 

San Francisco recently passed the San Francisco Health Care Security Ordinance which mandates that certain employers spend a certain amount of money for their covered employees. The Ordinance also requires the creation of a Health Access Plan (HAP) by the SF Department of Public Health (“Healthy San Francisco”.) The Health Care Security Ordinance will be enforced by the Office of Labor Standards and will require employers to file annual reports with the OLS. The Healthy San Francisco” plan is just one way employers can satisfy their requirements under the Health Care Security Ordinance.

For more information regarding the this ordinance and “Healthy San Francisco,” click here.

Some states require continued health care coverage for adult children under their parents’ health insurance policies. Colorado, Maryland, Massachusetts, New Jersey, and Utah are among the states that recently passed health insurance continuation laws.

The issue this raises for employers is that these laws conflict with Internal Revenue Code rules. The Internal Revenue Code states that an employer must include in the gross income of an employee any part of a health plan premium payment paid by the employer and attributable to someone who is not an employee, a spouse or a dependent. The problem is that the mandatory state laws require continuation coverage for a category of children who no longer qualify as a dependent under the Code. The dependent must be a qualified child or qualified relative as defined in code 152. If an employer wants to continue to pay all or part of the premium for employee’s dependents under the state-extended definition, the tax-free benefits that were previously available for the parents pursuant to federal law my no longer apply.

Also if an employer offers health insurance coverage to their employees through a cafeteria plan arrangement, they will find that premium payments are not excludable from the employee’s gross income (as with domestic partners who may not be dependents), as they would not constitute the type of qualified benefit that can be offered under a cafeteria plan.

For example, New Jersey law permits eligible dependents to be covered until their 30^th birthday. To qualify as a dependent under New Jersey law, an individual must be (1) under age 30; (2) unmarried; (3) without dependents of their own; (4) a resident of the State of New Jersey or enrolled as a full time student and (5) not covered under any other group or individual health benefits plan or entitled to Social Security benefits.

In contrast, the IRS and the Code define dependent as a person other than the taxpayer or taxpayer’s spouse who is a qualifying child or qualifying relative. A qualifying child age requirements are “has not attained the age of 19 as of the close of the calendar year, or is a student who has not attained the age of 24."

Non-152 dependent (a dependent over the age of 24 who is not a qualifying relative) premium payment is not prohibited, but it is not a qualified benefit that can be offered under a cafeteria plan arrangement. Therefore, while employers are permitted to pay part or all of the premiums for non-152 dependents, only coverage for an employee, spouse and qualifying child, or qualifying relative will be eligible for the exclusion from gross income of the employee (i.e., employees can not pay on a pre-tax basis for employer provided health premiums for non-152 dependents and the employer paid portion of such premiums is also treated as income to the employee.)

Several states enacted laws expanding coverage for children. Connecticut, Illinois, New York, Pennsylvania and Tennessee require extending dependent coverage to ages ranging from 23 to 30 sometimes without regard to student status.

Five states include grandchildren in their dependent definition, making it mandatory for insurance policies to cover these children (Maryland, Minnesota, New York, Texas and Wisconsin).

New Hampshire has passed a bill to extend health insurance coverage to divorced spouses. The bill would require health insurers to allow the spouse of divorced members to remain covered under the policies of their former spouses for up to 3 years or until one of them remarries.

Seven states enacted laws allowing insurers to offer subscribers premium rebates or other incentives through their wellness programs, those seven states are Arizona, Indiana, Maryland, Iowa, Oregon, Texas and Utah.

Many states in their hope to curtail rising health costs, including Arizona, Connecticut, Florida, Illinois, Maine and Washington are reviewing proposals requiring insurers to cover screening tests for breast, cervical, colorectal and prostrate cancers. Lawmakers in states like Missouri will also consider mandating coverage for obesity treatments, while states like Indiana and New York will debate bills mandating coverage for smoking-cessation programs.

Arizona also revised a 2006 law known as Mandate-Lite, which allows insurers to offer small businesses health plans without some previously State mandated benefits, making them less expensive. Since 2001, Arkansas and North Dakota have also permitted insurance companies to sell policies without all of the benefits they mandate. In many cases, these mandate exemptions are allowed only for certain types of policies, such as small employer plans.

A number of states are also debating new or expanded employee leave laws. Pending proposals would provide paid sick days or paid leave to care for sick family members. Other bills would require offering paid leave to employees for certain events related to a family member’s active military duty.

Paid sick leave. In the wake of San Francisco’s successful ballot initiative last year, similar measures in Connecticut, Massachusetts and other states would require employers to provide paid sick leave, mandate year-to-year accrual of sick leave up to a certain cap and allow employees to use that time for their own illness or to care for an ailing family member.

Paid family leave. A few states, including Arizona, Massachusetts, New Jersey and Washington, will consider providing limited income support to residents taking leave from work because of their own serious illness or the need to care for a seriously ill family member.

Military family leave. Hawaii, Indiana, Maine and New York are considering bills that would allow employees to take an unpaid leave when a family member in the military is deployed, returns from duty, or suffers injury or dies while performing military service.

New York recently passed a law, effective August 15, 2007, requiring all employers to permit nursing mothers to express breast milk in the workplace. Thirteen other states have enacted similar laws (California, Connecticut, Georgia, Hawaii, Illinois, Minnesota, New Mexico, Oklahoma, Oregon, Rhode Island, Tennessee, Texas and Washington). 

The New York law requires employees to provide reasonable unpaid break time, or to permit employees to use paid break time or meal time, to express breast milk. Employers are required to make reasonable efforts to provide a private room or other location, in close proximity to the work area, to express milk. These protections apply for up to three years following the birth of a child.

This new law only addresses the expression of breast milk, and not the right to breastfeed a baby in the workplace, however, employers should be aware of another New York law dealing with breastfeeding. Civil Rights Law Section 79-e protects the right of a nursing mother to breastfeed her baby in any location, public or private.