A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

Employee Benefit Security Administration

Tri-agency rules address 90-day waiting period limit

Posted on February 20, 2014

The US Department of Health and Human Services (HHS), the Internal Revenue Service (IRS) and the Employee Benefits Security Administration (EBSA) released several rules today concerning the 90-day waiting period limitation before insurance coverage can become effective. The final rule states that group health insurance plans cannot apply a waiting period that exceeds 90 days beginning January 2015. The proposed rule clarifies the 90-day limitation in terms of the length of employment-based orientation periods, stating that one month is the reasonable limit for employment-based orientation periods.

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Administration releases contraceptive coverage final rule

Posted on June 28, 2013

In a joint rule released by the US Department of Health and Human Services (HHS), the US Department of the Treasury (DoT), and the US Department of Labor (DoL), the administration finalized the requirement for employers to offer contraception coverage through their workplace health insurance policies. The rule defines a “religious employer” to include predominantly churches and houses of worship. For religiously-affiliated institutions, such as universities, the rule provides a simplified process by which insurance companies can cover contraceptives for employees. Religiously-affiliated entities using self-insured plans can use the same streamlined approach for a third-party administrator to provide contraceptives. In addition to the rule, the administration extended the safe harbor for religiously-affiliated hospitals and universities, which prevented those institutions from fines associated with non-compliance to the contraception mandate, through January.

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Interview of Phyllis Borzi, Assistant Secretary of Labor of the Employee Benefits Security Administration (EBSA), United States Department of Labor

Posted on June 11, 2013

Recently, Sara Rosenbaum, the Hirsh Professor of Health Law and Policy at the GW Department of Health Policy, had an opportunity to interview Phyllis Borzi, the federal official in charge of overseeing the Employee Benefits Security Administration (EBSA), for Health Reform GPS. EBSA is an agency of the United States Department of Labor responsible for administering, regulating and enforcing the provisions of Title I of the Employee Retirement Income Security Act of 1974 (ERISA), and the agency is playing an important role in the implementation of the Affordable Care Act….

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Administration released final rule on employee-sponsored wellness programs

Posted on May 29, 2013

A joint rule released by the US Department of Labor (DoL), the US Department of the Treasury (DoT), and the US Department of Health and Human Services (HHS) addresses new provisions regarding participatory wellness programs in the workplace. Workplace wellness programs are designed to reduce the prevalence of chronic disease, stifle growing health care costs, and improve overall health by rewarding employees for participating in certain activities, such as educational classes or obtaining memberships to fitness centers. The final rule sets the maximum reword for completion of a nondiscriminatory health-contingent wellness program to 30% of coverage costs, up from the original 20%. Employees that successfully complete tobacco-related wellness programs are eligible for up to 50% of cost of coverage.

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EBSA preliminary guidance requires employers to notify employees about insurance options

Posted on May 10, 2013

The Employee Benefits Security Administration (EBSA), a division of the Department of Labor, published guidance concerning employer notification of insurance options in the health insurance marketplaces established by the Affordable Care Act (ACA), including model language for employers to notify their employees on marketplaces and employer-sponsored coverage. Technical Release Number 2013-02 states that employers must begin to inform their employees about available insurance options beginning October 1st, and the guidance contains a model notice for employers to utilize. EBSA released this guidance in advance of the proposed rule so that employers are equipped with the appropriate knowledge so they may begin to notify employees as soon as they desire.

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IRS and EBSA issue next set of ACA FAQs

Posted on April 30, 2013

In the 15th set of Affordable Care Act (ACA) FAQs, the Internal Revenue Service (IRS) and the Employee Benefit Security Administration (EBSA) answer questions posed by the public and stakeholders to demystify the implementation of various components of the ACA. This particular set discusses annual limit waivers, stating that an alteration to a health plan or policy year will not impact the expiration of an annual limit waiver. The FAQs also indicate that IRS, EBSA and the US Department of Health and Human Services (HHS) will not issue guidance on provider nondiscrimination prior to January 1st, 2014, because the statutory language on the topic is “self-implementing.” In regards to transparency reporting, the FAQs clarify that plans are not beholden to the transparency provisions of the ACA until the plans have been certified as a qualified health plan (QHP) for one benefit year.

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EBSA posts FAQs on summaries of benefits and coverage

Posted on April 25, 2013

The US Department of Labor Employee Benefits Security Administration (EBSA) published their 14th set of frequently asked questions regarding the implementation of the Affordable Care Act (ACA). One key topic covered by the FAQs addresses disclosure requirements for individual or group plan summary of benefits coverage (SBC). In regards to disclosure of minimum essential coverage and the attainment of minimum value requirements, the guidance does not make notable changes for the SBC during 2014, the second disclosure year. The FAQs also state that plans unable to alter their SBC for 2014 are permitted to use the authorized year template without penalty if they also provide a cover letter stating whether or not the minimum value requirements are met.

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Federal regulations limit wait for employer health plan to 90 days

Posted on March 19, 2013

A proposed rule issued yesterday by the US Department of Labor, US Department of Treasury, and the US Department of Health and Human Services (HHS) implements a provision in the Affordable Care Act (ACA) that requires employer-sponsored health plans to be activated for employees within 90 days. In addition, employers cannot require employees to accrue a minimum number of hours before the 90 day wait period starts. The rules specifically state the 90 day wait limit in and of itself is not an employer mandate.

Comments on the proposed rules will be due by May 20, 2013.

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DOL/CMS issue joint FAQ extending deadline for employers to notify workers about exchange options

Posted on January 24, 2013

The Employee Benefit Securities Administration (EBSA) of the U.S. Department of Labor (DOL) and the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) have jointly released a Frequently Asked Questions (FAQ) document addressing multiple issues related to Affordable Care Act (ACA) implementation. Most notably, the FAQs extend the deadline by which employers must notify their employees about coverage options in the Exchanges from March 1, 2013, to sometime in “the late summer or fall of 2013, which will coordinate with the open enrollment period for Exchanges.” DOL made the determination in part because they feel the notifications should coincide with HHS outreach and educational efforts and IRS guidance on Exchange Qualified Health Plan (QHP) minimum value. Furthermore…

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Department of Labor releases FAQs on mental health parity compliance

Posted on May 10, 2012

The Department of Labor’s Employee Benefits Security Administration published a set of frequently asked questions (FAQs) regarding implementation of the Mental Health Parity and Addiction Equity Act of 2008.

Amongst other topics, the FAQs address…

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