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Essentials of Healthcare Reform HS: 345

Essentials of Healthcare Reform HS: 345. Assignment 2. Updates. Assignment 2: Overview of Healthcare Reform. Assignment 1 Learning Objectives. Overview of Healthcare Reform Sources of Law Governing Reform Timeline of Reform PHSA Mandates Insurance Definitions and Applicability

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Essentials of Healthcare Reform HS: 345

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  1. Essentials of Healthcare Reform HS: 345 Assignment 2

  2. Updates

  3. Assignment 2: Overview of Healthcare Reform

  4. Assignment 1 Learning Objectives • Overview of Healthcare Reform • Sources of Law Governing Reform • Timeline of Reform • PHSA Mandates • Insurance Definitions and Applicability • Excepted Benefits

  5. Healthcare Reform: Sources of Law • Patient Protection and Affordable Care Act • Health Care and Education Reconciliation Act • Affordable Care Act • Amends Several Major Laws: • IRC, ERISA, SSA, PHSA, FLSA • HHS, DOL, IRS

  6. 2010 Changes • Dependent Coverage Age Extension • ERRP • High Risk Pools • Healthcare.gov • Patient Protections • PCE Prohibition • Lifetime Limits • Annual Restrictions • Rescission Prohibition • Automatic Enrollment • Preventive Care

  7. 2011 Changes 2012 Changes • HSA Tax Increase • OTC Reimbursement Rules • MLR Regulations • Small Business Grants (pending) • Four-Page Summary of Benefits • W-2 Reporting (exceptions created)

  8. 2014 Changes 2013 Changes • Health FSA Cap for Cafeteria Plans • Notice of Exchange • HIPAA Regulations • Increase in Medical Deduction • Fair Premiums • Reporting Requirements • Exchanges • Individual Mandate

  9. 2014 Continued • Play or Pay Tax • PCE Total Prohibition • Annual Limits Prohibition • Waiting Period Limits • Availability and Renewability Requirements • Clinical Trial Coverage • Comprehensive Coverage

  10. Provisions of Healthcare Reform • What coverage do mandates and other provisions of healthcare reform apply to? • Answer: Group Health Plans, Individual Policies, Self-Insured Plans, Insurers, Church Group Plans, Wellness Programs that are attached to a group health plan, Governmental Health Plans

  11. ERISA Definition of Group Health Plan • ERISA & PHSA Definition • Employee Welfare Benefit Plan? • Plan, Fund, Program • Maintained by Employer • Benefits Provided to Participants or Beneficiaries

  12. Codes Definition of Group Health Plan • A Plan (including a self-insured plan) of, or contributed by, an employer (including a self-employed person) or employee organization to provide health care (directly or otherwise) to the employees, former employees, the employer, others associated or formerly associated with the employer in a business relationship, or their families.

  13. Excepted Benefit Types • Accident-Only • Disability Income • Liability Insurance • Worker’s Comp • Automobile Medical • Credit-Only • On-Site Medical Clinics • Limited-Scope Benefits • Noncoordinated Benefits • Certain Supplemental Benefits • Medicare and Tricare Supplements • Safe Harbor Rules

  14. Immediate Changes to Social Programs • Changes to Medicare • Improving of Quality of Care • Reform of Healthcare Delivery System • Pricing Services and Modernizing Financing Systems • Fighting Waste, Fraud, and Abuse • Changes to Medicaid and CHIP • Expansion of both programs

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