Making sense of new benefit rules under Obamcare

Chances are your HR and Benefits staffers have been trying to make heads or tails of “excepted benefits.” 

The Affordable Care Act – aka Obamcare – allows for excepted benefits that:

• don’t count as employer-provided healthcare benefits
• are offered as additional benefits, or
• aren’t coordinated with benefits under another plan.

Some common examples that meet the excepted benefits rule include dental coverage, vision plans and Employee Assistance Programs (EAPs).

The feds just published a final rule on excepted benefits (Federal Register 10/1/2014, page 59,130).

Now’s a perfect time to verify that your staffers understand the ins and outs of the rule. Have your staffers read these statements and decide if they’re True or False. Then check their answers below.

1. Under the final rules, EAPs are exempt from the health reform law as long as they meet certain criteria.

2. EAPs that include coverage for medical services may be subject to health reform provisions.

3. Benefits such as limited scope vision, dental and long-term care must be offered in connection with a separate offer of major medical insurance to count as “excepted.”

ANSWERS TO THE QUIZ

1. True. The final rule spells out four specific criteria EAPs must meet in order to qualify as excepted benefits, such as the EAP can’t impose cost-sharing requirements.

2. True. EAPs may be subject to the ACA if they include coverage for medical sessions. In order for an EAP to be exempt from health reform law provisions, an EAP can’t provide significant amount of medical care, such as coverage for medical sessions.

3. False. These types of visison and dental benefits don’t have to be offered in connection with a separate offer of major medical or “primary” health care under a plan “to meet the statutory criterion that such benefits are ‘otherwise not an integral part of the plan.’”