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The Wagner Law Group Description 

The Wagner Law Group, A Professional Corporation, is a nationally recognized ERISA & employee benefits, estate planning, employment, labor & human resources practice. 

 

Established in 1996, The Wagner Law Group has 22 attorneys engaged exclusively in employee benefits, estate planning and employment law. Five of our attorneys are AV rated by Martindale-Hubbell as having very high to preeminent legal abilities and ethical standards. The firm is among the largest ERISA boutiques in the country. Our practice is national in scope, with clients in more than 40 states and several foreign countries.

 

 

Contact Info

The Wagner Law Group

 

  Integrity | Excellence

  

Massachusetts Office 

Tel: (617) 357-5200 

Fax: (617) 357-5250 

99 Summer Street 

13th Floor

Boston, MA 02110


Florida Office 

Tel: (561) 293-3590
Fax: (561) 293-3591
7108 Fairway Drive
Suite 125
Palm Beach Gardens, FL 33418

   

San Francisco Office

Tel: (415) 625-0002

Fax: (415) 829-4385

315 Montgomery Street

Suite 902

San Francisco, CA 94104

 

www.wagnerlawgroup.com

 

 

May 2, 2013 

 State and Federal Law Alert

 

 

Health Care Reform FAQs Update SBC Guidance

 

The DOL, HHS and Treasury have jointly issued the fourteenth set of FAQs to address the Summary of Benefits and Coverage ("SBC") disclosure requirements under the Patient Protection and Affordable Care Act ("PPACA"). In particular, these FAQs explain changes for SBCs that relate to coverage during the 2014 plan year (i.e., a plan year beginning on or after January 1, 2014, and before January 1, 2015). DOL has also released updated versions of the SBC template and sample completed SBCs.

 

The FAQs cover the following changes made to the SBC requirements for the 2014 plan year:

 

Additions to SBCs. The 2014 plan year SBCs must include statements addressing whether the group health plan: (i) provides minimum essential coverage ("MEC") (see the Alert of 2/14/13); and (ii) satisfies PPACA's minimum value ("MV") requirements (see the Alert of 12/6/12). Group health plans can, however, provide this information without modifying their SBCs. Specifically, the FAQs explain that DOL will not take action against group health plans that use the 2013 plan year template for 2014 if the SBC is distributed with a cover letter explaining whether the plan provides MEC and satisfies the MV requirements. The FAQs include model language for plans to use for the MEC and MV disclosures.

 

Elimination of Annual Limits on Essential Health Benefits. PPACA generally prohibits group health plans from imposing annual limits on essential health benefits for plan years beginning on or after January 1, 2014. Accordingly, SBCs distributed for the 2014 plan year must reflect this fact. The FAQs provide guidance on how to complete portions of the SBC involving the annual limit prohibition. Group health plans must also include information in their SBCs about lifetime and annual dollar limits for specific covered benefits.

 

Coverage Examples. In prior FAQs, the DOL indicated that additional coverage examples would be included in subsequent SBC templates. However, to help the transition for market changes scheduled for 2014, DOL believes it is prudent to maintain the 2013 coverage examples. As a result, the 2014 SBCs need only include coverage examples for having a baby and managing type 2 diabetes.

 

Extension of Certain Enforcement Relief. The DOL previously extended enforcement relief from certain SBC disclosure requirements for the 2013 plan year. These FAQs explain that, in order to facilitate a smooth transition for the 2014 market changes, DOL has decided to extend most of its previous enforcement relief through the end of the 2014 plan year. This basically means that the agencies will focus on assisting, rather than penalizing, plan sponsors who are working diligently and in good faith to comply with the final regulations.

 

The updated guidance and templates can be accessed at:

 

This Newsletter is protected by copyright. Material appearing herein may be reproduced with appropriate credit.

  

Pursuant to Internal Revenue Service Circular 230, we hereby inform you that any advice set forth herein with respect to US federal tax issues is not intended or written by The Wagner Law Group to be used and cannot be used, by you or any taxpayer, for the purpose of avoiding penalties that may be imposed on you or any other person under the Internal Revenue Code.

 

This Newsletter is provided for information purposes by The Wagner Law Group to clients and others who may be interested in the subject matter, and may not be relied upon as specific legal advice.  This material is not to be construed as legal advice or legal opinions on specific facts. Under the Rules of the Supreme Judicial Court of Massachusetts, this material may be considered advertising.