Global Health Care Update

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1 Global Health Care Update March/April 2013 This bimonthly Update summarizes recent legislative developments and trends related to health care and highlights recently passed and pending legislation that may require employers to take action to comply with new rules or review existing plans. Action May Be Required France The latest Accord National Interprofessionnel (ANI) gives all employees the right to supplemental health care. The ANI was concluded by unions and employers associations in January Employers that do not currently provide supplemental health insurance to their employees must do so by January 1, Unions have until June 1, 2013 to launch industry negotiations and until July 1, 2014 to have an industrywide collective agreement signed. The following provisions may become part of the agreement: --All companies in the same industry must use the same private insurer; --Employers may be permitted to select their own insurer; and --Minimum employer contributions and a minimum level of benefits may be established. Employers will have 18 months from the date the agreement is signed to comply with its terms. If no industrywide agreement is signed by July 1, 2014, employers must negotiate a company collective agreement, which includes the details of a required health insurance plan. In the absence of a company collective agreement, employers must offer their employees a minimum health insurance plan, as stipulated by law, by January 1, A bill reflecting these provisions of the ANI was adopted by the Council of Ministers on March 6, It is expected to be reviewed by the National Assembly and the Senate in April (Refer to the March and February 2013 Updates for additional information on the ANI.) Also, employers are reminded that if they offer a health insurance plan to at least one category of employees, they must offer coverage to all employees by January 1, The same plan does not have to be offered to all employees. Copyright 2013 Aon plc 1

2 Recent Developments U.S. Health Care Reform The Treasury and Internal Revenue Service issued proposed rules that provide guidance on the annual fee imposed on covered entities engaged in the business of providing health insurance for United States health risks, as established by the Patient Protection and Affordable Care Act (Affordable Care Act). The proposed rules would add the health insurance providers fee regulations to the Code of Federal Regulations. The Act imposes an annual fee on each covered entity engaged in the business of providing health insurance. The fee is due by the annual date specified by the Secretary of the Treasury, but in no event later than September 30 th of each calendar year in which a fee must be paid. The aggregate fee amount for all covered entities (referred to as the applicable amount) is USD 8 billion for calendar year 2014, USD 11.3 billion for calendar years 2015 and 2016, USD 13.9 billion for calendar year 2017, and USD 14.3 billion for calendar year The applicable amount for calendar year 2019 and thereafter is the applicable amount for the preceding calendar year increased by the rate of premium growth for the preceding calendar year. The following entities are excluded from being covered entities: 1) any employer to the extent that the employer self-insures its employees health risks; 2) any governmental entity; 3) certain nonprofits; and 4) any entity that is a voluntary employees beneficiary association (VEBA) and is established by an entity (other than by an employer or employers) for purposes of providing health care benefits. Comments on the proposed rules are due by June 3, 2013, and a hearing on the rules is scheduled for June 21, The Department of Health and Human Services (HHS) released a final rule outlining the standards related to the coverage of essential health benefits (EHBs) and actuarial value for health insurance issuers (i.e., nongrandfathered individual and small group plans) and Exchanges. Beginning in 2014, the Affordable Care Act requires that EHBs include at least 10 general categories of health services and have benefits similar to those currently provided by a typical employer, including: 1) ambulatory patient services; 2) emergency services; 3) hospitalization; 4) maternity and newborn care; 5) mental health and substance use disorder services, including behavioral health treatment; 6) prescription drugs; 7) rehabilitative and habilitative services and devices; 8) laboratory services; 9) preventive and wellness services and chronic disease management; and 10) pediatric services, including oral and vision care. The rule also finalizes a timeline for qualified health plans to be accredited in federally facilitated Exchanges (also called marketplaces) and amends regulations providing an application process for the recognition of additional accrediting entities for purposes of certification of qualified health plans. The final rule is effective on April 26, In coordination with the release of the final rule, HHS published a report which details how EHBs for mental health and substance use disorder services will be covered at parity with medical and surgical benefits. The HHS released a final rule on the notice of benefit and payment parameters for It expands upon the standards established in earlier rules and provides further information on the permanent risk adjustment, Copyright 2013 Aon plc 2

3 transitional reinsurance, and temporary risk corridors programs; advance payments of the premium tax credit; cost-sharing reductions; medical loss ratio (MLR); and the Small Business Health Options Program (SHOP). The Affordable Care Act created three programs (i.e., risk adjustment, reinsurance, and risk corridors) to stabilize premiums as new consumer protections begin in the individual and small group market in Key provisions in the final rule include: Reducing the incentives for health insurance issuers to avoid enrolling people with pre-existing conditions; Stabilizing premiums in the individual market for health insurance; Protecting health insurance issuers against uncertainty in setting premium rates; Providing affordable coverage in the Exchanges (marketplaces); Finalizing provisions for the SHOP; and Amending the MLR to ensure that, beginning in 2014, issuers include premium stabilization amounts in MLR and rebate calculations. HHS is extending the annual MLR reporting deadline from June 1 to July 31, and the rebate disbursement deadline from August 1 to September 30 to take into account the premium stabilization programs. This change will allow issuers to accurately calculate their MLRs while ensuring that consumers receive rebates as quickly as possible. The provisions of the final rule become effective on April 30, 2013, but generally apply beginning in The HHS issued a proposed rule that would implement Affordable Care Act provisions related to the SHOP. The Act directs each state that chooses to operate an Exchange (marketplace) to also establish a SHOP that assists eligible small businesses in providing health insurance options for their employees. The proposed rule would amend existing regulations regarding triggering events and special enrollment periods for qualified employees and their dependents and would implement a transitional policy regarding employees choice of qualified health plans (QHPs) in the SHOP. The proposed rule would amend some of the standards established in the final rule on the establishment of Exchanges and QHPs and the Exchange standards for employers. The rule proposes the following transitional policy: For plan years beginning on or after January 1, 2014 and before January 1, 2015, a SHOP would not be required to permit qualified employers to offer their qualified employees a choice of QHPs at a single level of coverage but would have the option of doing so. For plan years beginning on or after January 1, 2014 and before January 1, 2015, federally facilitated SHOPs would not exercise this option, but would instead assist employers in choosing a single QHP to offer their qualified employees. HHS indicates the transitional policy is intended to provide additional time to prepare for an employee choice model and to increase the stability of the small group market while providing small groups with the benefits of the SHOP in HHS also proposes changes to the effective date of the SHOP premium aggregation function. Copyright 2013 Aon plc 3

4 Comments on the proposed rule are due by April 1, The Departments of Labor, HHS, and the Treasury (the agencies) released a frequently asked question (FAQ) that clarifies the extent expatriate group health insurance coverage is subject to the provisions of the Affordable Care Act. In the guidance, the agencies recognize that expatriate health plans may face special challenges when complying with certain provisions of the Affordable Care Act, notably challenges in reconciling and coordinating the multiple regulatory regimes that apply to expatriate health plans that might make it impracticable to comply with all the relevant rules at least in the near term. While the agencies gather further information to determine what actions may be appropriate regarding the current requirements under the Affordable Care Act, the agencies have determined that, for plans with plan years ending on or before December 31, 2015, with respect to expatriate health plans, the agencies will consider the requirements of subtitles A and C of Title I of the Affordable Care Act satisfied if the plan and issuer comply with the pre-affordable Care Act version of Title XXVII of the Public Health Service Act. For purposes of the temporary transitional relief, an expatriate health plan is an insured group health plan with respect to which enrollment is limited to primary insureds who reside outside of their home country for at least six months of the plan year and any covered dependents, and its associated group health insurance coverage. Finally, the Department of Labor s Employee Benefit Security Administration (EBSA), the HHS Centers for Medicare and Medicaid Services (CMS), and the Internal Revenue Service (IRS) jointly released proposed rules that implement the 90-day waiting period limitation under the Affordable Care Act on March 18, Under the health care reform law, a group health plan or health insurance issuer offering group health insurance coverage may not apply a waiting period for eligible new employees that exceeds 90 days. The proposed rules also would amend regulations to conform to existing Affordable Care Act provisions, including those that will become effective beginning in The proposed conforming amendments make changes to existing requirements such as pre-existing condition limitations and other portability provisions added by the Health Insurance Portability and Accountability Act (HIPAA). Comments on the proposed rules are due by May 20, Americas British Columbia s (Canada) 2013 Budget announced the Medical Services Plan (MSP) premium rates for Maximum monthly premium rates will increase by about 4% or CAD 2.75 per month to a total of CAD for single persons; by CAD 5.00 per month to a total of CAD for two-person families; and by CAD 5.50 per month to a total of CAD for families of three or more persons. Amounts will be formally amended by regulation later this year. Also effective January 1, 2014, premium assistance will be enhanced to ensure those receiving assistance will not be affected by the MSP premium increase. The British Columbia government will release further details on this matter later in Alberta s (Canada) 2013 budget includes provisions affecting health care. Under the proposed budget, a new Alberta PharmaCare program would be implemented on January 1, Generic drug prices would be lowered from 35% to 18% of brand name prices on May 1, Also, Type 1 diabetes care would be enhanced through a new insulin pump therapy program, started in 2012, to provide 100% coverage for Albertans who meet the Copyright 2013 Aon plc 4

5 eligibility criteria (less any amounts covered through government-sponsored and patients private insurance programs). Asia China s Ministry of Health announced that 20 provinces are piloting a pay after health care treatment system. Currently, citizens must pay for medical services before receiving them and apply for reimbursement from their medical insurance plan. Following widespread criticism over delays in urgent care, the government rolled out the pilot program in local hospitals. The Ministry of Health cautions that the pay after system will not be instituted nationwide in the near future. Instead, local governments will be permitted to determine its feasibility. The Australian government has rolled out a trial living-donor paid leave program. Employees who are living donors will be paid the minimum wage for six weeks. The funds will be paid to employers that will, in turn, pay employees. The government will review the outcome of the trial program in Europe Officials from Romania s Ministry of Health confirm the amount of the new copayments. The issue of copayments for hospitalization under the national health care system was included in the latest agreement the government reached with the International Monetary Fund. Officials argue that they kept the copayments as low as possible to minimize hardship. Effective April 1, 2013, the minimum copay is RON 5 and the maximum fee is RON 10, both to be collected upon discharge from the hospital. The chronically ill, children under age 18, pregnant women, disabled persons, and pensioners with monthly income up to RON 740 are exempt from copays. * * * * For more information on the topic and countries in this newsletter, please refer to the Aon Hewitt Country Profiles eguide. You can learn more about the Country Profiles eguide here. Copyright 2013 Aon plc 5

6 About Aon Hewitt Aon Hewitt empowers organizations and individuals to secure a better future through innovative talent, retirement and health solutions. We advise, design and execute a wide range of solutions that enable clients to cultivate talent to drive organizational and personal performance and growth, navigate retirement risk while providing new levels of financial security, and redefine health solutions for greater choice, affordability and wellness. Aon Hewitt is the global leader in human resource solutions, with over 30,000 professionals in 90 countries serving more than 20,000 clients worldwide. For more information on Aon Hewitt, please visit Copyright 2013 Aon plc This document is intended for general information purposes only and should not be construed as advice or opinions on any specific facts or circumstances. The comments in this summary are based upon Aon Hewitt's preliminary analysis of publicly available information. The content of this document is made available on an as is basis, without warranty of any kind. Aon Hewitt disclaims any legal liability to any person or organization for loss or damage caused by or resulting from any reliance placed on that content. Aon Hewitt reserves all rights to the content of this document. Copyright 2013 Aon plc 6

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