The regulation of most self-funded plans falls under federal law and state mandates don't apply. However, there are many provisions, and keeping up with government compliance can become complex. The greatest challenge for employers offering healthcare benefits today is understanding and complying with ever-changing government regulations. PBA takes the burden of regulatory compliance off the shoulders of employers.
The Employee Retirement Income Security Act of 1974 is the primary law that applies to self-funded plans offered by private employers. The Employee Benefits Security Administration (EBSA) administers these standards and focuses on fiduciary duty. ERISA is the ultimate transparency and consumer protection law with considerable protection and structure for employers and employees.
The Health Insurance Portability and Accountability Act of 1996 requires national standards to protect patients' sensitive health information from being disclosed without their knowledge or consent. The U.S. Department of Health and Human Services (HHS) issued the HIPAA Privacy Rule to address consumers' protected health information by covered entities, which include health plans.
The Consolidated Omnibus Budget Reconciliation Act of 1985 mandates insurance plans to give employees and their families the option of continuing their health insurance coverage for a limited period after leaving their job under certain circumstances. COBRA is a protection contained in ERISA.
The Affordable Care Act of 2010, formally known as the Patient Protection and Affordable Care Act, was enacted to make affordable health insurance available to more people through premium tax credits. It also provides tax credits to certain small businesses that cover specified health insurance costs for their employees. The Center for Consumer Information and Insurance Oversight (CCIIO) oversees the ACA.
Health plan price transparency helps consumers know the cost of a covered item or service before receiving care. Beginning July 1, 2022, most group health plans and issuers of group or individual health insurance will begin posting pricing information for covered items and services. This pricing information can be used by third parties, such as researchers and app developers, to help consumers better understand the costs associated with their health care. More requirements will go into effect starting on January 1, 2023 and January 1, 2024, which will provide additional access to pricing information and enhance consumers's ability to shop for the health care that best meet their needs.
The PBA Difference
PBA is uniquely qualified to assist clients in complying with regulatory requirements that impact employer benefit plans. We partner with law firms specializing in both ERISA & Non-ERISA Plans, and attorneys specializing in employee benefit plans and current ACA issues. PBA is dedicated to helping employers navigate the complex and changing regulatory landscape. We assist our clients with regulation compliance by:
- Assisting with ERISA, COBRA, HIPAA and ACA notices;
- Reviewing all plans for compliance;
- Providing guidance in making the plan compliant;
- Issuing timely notices of regulatory changes and upcoming compliance deadlines;
- Assisting with regulatory reporting to facilitate the payment of fees and taxes; and,
- Sponsoring regulatory training sessions for employers and their broker/consultant representatives.