Wagner Header

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 23 attorneys engaged exclusively in employee benefits, estate planning and employment law. Seven 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) 358-8300

315 Montgomery Street

Suite 904

San Francisco, CA 94104

 

www.wagnerlawgroup.com

 

 

 

 

January 16, 2014

 

 State and Federal Law Alert

 

 

 

DOL Issues FAQ Part 18 on Implementing PPACA

 

 

 

The DOL recently released Part 18 in its set of Frequently Asked Questions ("FAQs") regarding the Patient Protection and Affordable Care Act ("PPACA"). FAQ Part 18 addresses a variety of questions related to the implementation of PPACA, including PPACA's interaction with the Mental Health Parity and Addiction Equity Act ("MHPAEA").   The following is a summary of some of the points covered in FAQ Part 18:

 

Coverage of Preventive Services. For plan years beginning on or after September 24, 2014, non-grandfathered group health plans must cover certain medications that reduce the risk of breast cancer, without imposing cost-sharing.  

 

Cost-sharing Limits. For plan years beginning in 2014, the out-of-pocket maximums for essential health benefits ("EHBs") provided under a non-grandfathered plan are $6,350 for self-only coverage and $12,700 for coverage other than self-only coverage.

 

In a prior FAQ, the DOL provided transition relief for plans that use more than one service provider. The relief applies only to the first plan year beginning on or after January 1, 2014. For that plan year only, a plan using multiple service providers will satisfy the out-of-pocket maximums if: (i) major medical coverage remains subject to the maximum out-of-pocket limits; and (ii) out-of-pocket limits that are separately imposed under coverage provided by other service providers do not exceed the maximum out-of-pocket limits.

 

Wellness Programs. If, at the time of enrollment or re-enrollment, a participant is offered a reward for joining a tobacco cessation program but does not join, he need not be eligible for the reward if he joins the program at a later date. However, tobacco cessation programs may provide the reward on either a full or pro-rated basis to a participant who joins the program mid-year.

 

Where a physician advises the plan that a standard under an outcome-based, health-contingent wellness program is medically inappropriate for a participant, plan sponsors may retain discretion regarding the reasonable alternative standard that is used, but must engage in a meaningful discussion with the participant and physician about different options available to the participant.

 

PPACA's Interaction with MHPAEA. EHBs include mental health and substance use disorder services, and PPACA extends mental health parity protections to both grandfathered and non-grandfathered coverage. Non-grandfathered, small-group market coverage must generally include mental health and substance use disorder coverage for plan years beginning on or after January 1, 2014, and the coverage must comply with the MHPAEA rules. Grandfathered small group market coverage, however, is not required to comply with the EHB or MHPAEA rules. Nevertheless, to the extent that a grandfathered plan does provide mental health or substance use disorder coverage, such coverage must comply with the MHPAEA rules.

 

A copy of FAQ Part 18 can be accessed at: http://www.dol.gov/ebsa/pdf/faq-aca18.pdf 

 

      

 

 

 

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.