New Rules: Internal Claims and Appeals and External Review Process

The government published rules on July 23 implementing new internal claims and appeals and external review processes under health care reform. The rules, effective for plan or policy years beginning on or after September 23, address new requirements for state external review processes that apply mainly to fully …

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When are annual and lifetime limits allowed?

Recent regulations confirm that the general prohibition on annual and lifetime limits applies only to "essential health benefits." That is, annual and lifetime limits are permissible for "non-essential" health benefits. In addition, for plan years beginning before January 1, 2014, group health plans may establish …

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What is an “essential health benefit”?

The health care reform statute provides that "essential health benefits" must be defined to include the following categories of services: Ambulatory patient services; Emergency services; Hospitalization; Maternity and newborn care; Mental health and substance use disorder services, including behavioral …

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I hear that beginning in 2011, the value of group health plan benefits has to be reported on Form W-2. Does this mean the benefits are taxable?

No.  While it is true that employers must begin reporting the value of certain group health plan benefits on employees’ Form W-2 wage reports beginning in 2011, the benefits are NOT currently subject to taxation.  For now, the government has stated that these benefits are being reported for informational …

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Are employer-sponsored group health plans covering retirees subject to health care reform?

Maybe.  If both active employees and retirees are combined in one plan, then health care reform applies, even to the retiree portion of the plan.  However, plans that are separate and do not include any active employees – so called “retiree-only” plans – may avoid government enforcement of health care …

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Therapeutic Discovery Tax Credit Applications Now Available

IRS application forms and instructions relating to the Qualifying Therapeutic Discovery Project ("QTDP") tax credit, created by the Patient Protection and Affordable Care Act of 2010, are now available on the IRS website. This tax incentive will provide either a tax credit or a direct grant to eligible taxpayers …

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