What Should Employers Already Be Doing To Comply With PPACA?

Plans:

• May not have a lifetime dollar maximum on any “essential health benefit”

• May not have an annual dollar limit on an “essential health benefit” that is over a certain amount

• Must cover the employee’s dependent children until the dependent reaches age 26 – even if the child is married or employed++

• May not exclude pre-existing condition limitations for children under age 19

• May not retroactively rescind coverage, except for fraud or material misrepresentation or for nonpayment of premium by certain terminated employees

• Must provide first-dollar coverage for specific preventive services+

• Must cover emergency services at in-network level regardless of provider+

• If a primary care physician (PCP) must be chosen, allow each person to choose their own PCP and allow a pediatrician to be the designated PCP+

• Must allow women to see an OB-GYN without a referral+

• Must have a specific and comprehensive process for handling claims appeals+

• May not reimburse over-the-counter drugs under a health FSA, an HRA or an HSA unless the drug is prescribed by the doctor

• Does not apply to grandfathered plans

++Limited exception for grandfathered plans