As many construction employers are trying to figure out exactly what health care reform will mean for them, one issue that raises questions for employers, insurers and employees alike is that of a "qualified health benefits" plan. As mentioned in ÎÚÑ»´«Ã½'s , employers will be required to provide a "qualified health benefits" plan for all employees and their dependents or face stiff penalties. That is, if H.R. 3200, the much-debated proposed bill known as America's Affordable Health Choices Act of 2009, is passed by Congress.
According to H.R. 3200, employers must provide health benefits plans deemed "qualified" by the federal government, or face penalties of up to $100 per day, per employee. A newly appointed Commissioner of the Health Choices Administration would set many of the standards that would be designed to:
- Prohibit coverage exclusions of pre-existing health conditions;
- Require premiums to be determined using adjusted community rating rules, which prohibit insurers from pricing health insurance policies based on health factors;
- Require coverage to be offered on both a guaranteed issue and guaranteed renewal basis;
- Impose new, non-discrimination rules; and
- Comply with a medical loss ratio - the portion of health plan revenue that does not cover administrative or marketing expenses, taxes and profits.
- Hospitalization;
- Outpatient hospital and clinic services, including emergency room services;
- Services of physicians and other health professionals;
- Services, equipment and supplies necessary to the services of a physician or health professional in appropriate settings;
- Prescription drugs;
- Rehabilitative and "habilitative" services (i.e., services to maintain the physical, intellectual, emotional and social functioning of developmentally delayed individuals);
- Mental health and substance use disorder services;
- Certain preventive services (with no-cost-sharing permitted) and vaccines;
- Maternity care;
- Well-baby, well-childcare, oral health, vision, hearing services, equipment and supplies for those under age 21.
- Compare actuarial rates and cost-sharing ratios to the proposed mandate;
- Begin introducing wellness and prevention elements into current plans;
- Check out what other employers have done to contain cost and partner your employees to do the same;
- Gradually implement changes during your open enrollment periods now through 2012; and
- Communicate honestly and often with employees.