ACA updates and guidance


1. Wellness plans

The FAQs addressed the issue of whether employers have to allow workers to enroll in a wellness plan that included penalties/rewards after the initial sign up period, using the example of a smoking-cessation program.

According to the feds, if a participant is given a reasonable opportunity to enroll in a tobacco-cessation program at the start of a plan year and qualify for that program’s reward — avoiding the tobacco premium surcharge, for example then the employer isn’t required to provide another opportunity to qualify for the reward until renewal or re-enrollment time for the following plan year.

The company is permitted to provide such an opportunity; however, it’s not required by the feds.

2. ‘Reasonable alternative standard’ notice

The FAQs also touched on the reform requirement that plans must provide notice of the availability of a reasonable alternative standard to the company’s wellness offering(s) — and the sample language the DOL provided for this notice.

Plans and issuers can modify the reasonable alternative language the DOL provided to fit the details of their own wellness programs, as long as that modified notice includes all of the DOL’s required content.

3. Preventive services

Employers will also want to take note of what the DOL said regarding preventive services. The FAQs made it known that health plans and issuers can’t impose cost-sharing requirements on any evidence-based items or services that have an “A” or “B” rating in the current recommendations of the U.S. Preventive Services Task Force (USPSTF) and not for the USPSTF recommendations regarding breast cancer screening, mammography and prevention that were issued back in 2009, which aren’t considered current.

And because the USPSTF issued new recommendations on breast cancer just last September, the feds are giving health plans a bit more time to comply with these new recommendations.

The DOL said that for plan or policy years beginning one year after September 24, 2014, non-grandfathered health coverage offered in the individual or group market will be required to cover women’s medications that were listed by the new USPSTF recommendations without cost-sharing.