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5500 Preparer's Manual for 2012 Plan Years
The premier resource in the field of Form 5500 preparation, 5500 Preparer's Manual will help you handle the required annual Form 5500 filings for both pension benefits and welfare benefit plans.
from Spencer’s Benefits Reports: For the next few weeks, Spencer’s Benefits Reports will highlight specific provisions in the new health reform law which affect employer-sponsored plans.
So what’s included in Sec. 10101(h) of the Affordable Care Act, concerning patient protections?
Group and individual health insurance plans must allow plan enrollees to select, when the plan requires it, any primary care provider that participates in the plan’s network.
Pediatric care access. An individual or group health plan that requires enrollees to designate a primary care physician (PCP) must allow parents or legal guardians of a child enrollee to designate a physician who specializes in pediatric care as the child’s PCP if that physician participates in the plan’s network. This provision does not waive any exclusions of coverage under the terms and conditions of the plan or health insurance coverage with respect to coverage of pediatric care.
OB/GYN specialist. Plans must allow female enrollees to obtain OB/GYN specialist services without seeking a PCP referral. The OB/GYN specialist must adhere to the health plan’s or insurer’s policies and procedures for referrals and prior authorization and provide services according to a treatment plan approved by the plan or insurer. For a plan or insurance policy that covers OB/GYN services and that requires an enrollee to designate a PCP, provision of OB/GYN care and related services will be treated the same as authorization of the PCP. However, the plan or insurer’s terms and conditions for OB/GYN coverage still apply and the plan or insurer may require the OB/GYN to notify the patient’s PCP of treatment decisions.
Coverage of emergency services. When services are provided in an emergency services department of a hospital, emergency services must be covered:
(1) without any required prior authorization;
(2) regardless of whether or not the provider participates in the plan’s network; and
(3) nonparticipating provider services must be covered without any limitations and in the same manner, with the same cost-sharing requirements, as coverage for emergency services from a participating provider.
Effective date. This provision is effective for plan years beginning on or after Sept. 23, 2010 (six months after the date of enactment).
CCH Law, Explanation And Analysis Of Health Reform Act Available Soon
CCH’s Law, Explanation And Analysis of the Patient Protection and Affordable Care Act of 2010 provides the most comprehensive and practical guidance available to professionals needing to make sense of this historic legislation. A hard-copy version of the book is available for $149.
Spencer’s Benefits Reports subscribers have access to the Law, Explanation And Analysis with their Internet susbcription:
(2) To access the legislation on the Internet Research Network, click on “Patient Protection and Affordable Care Act: Law, Explanation, and Analysis” on the “Health Care Reimbursement” tab, under the “Medicare and Medicaid Guide” blue bar.
For more information or to order the hard-copy version of the book, please call (800) 248-3248 or click http://hr.cch.com/Product/Product-ID7127.asp. Discounts are available for multiple copies.
For more information on this and related topics, consult the CCH Pension Plan Guide, CCH Employee Benefits Management, and Spencer's Benefits Reports.
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