The following list consists of some of the major Federal Legislation that mandates certain benefits related to Banner’s health plans:
NEW FOR 2014:
COBRA – Consolidated Omnibus Budget Reconciliation Act - gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost to the plan. COBRA Notice of Rights
FMLA – Family and Medical Leave Act - entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave.
HIPAA – Health Insurance Portability and Accountability Act - provides rights and protections for participants and beneficiaries in group health plans. HIPAA includes protections for coverage under group health plans that limit exclusions for preexisting conditions, prohibits discrimination against employees and dependents based on their health status, and allows a special opportunity to enroll in a new plan to individuals in certain circumstances. HIPAA Privacy Notice
MHPA – Mental Health Parity Act - provides for parity in the application of aggregate lifetime and annual dollar limits on mental health benefits with dollar limits on medical/surgical benefits. A plan that does not impose an annual or lifetime dollar limit on medical and surgical benefits may not impose such a dollar limit on mental health benefits offered under the plan. MHPA does not apply to benefits for substance abuse or chemical dependency. Health plans are not required to include mental health benefits in their benefits package. MHPA only applies to those plans that do offer mental health benefits.
MCC – Medicare Part D Creditable Coverage Notice - requires health plans that include drug coverage to notify Medicare eligible members annually whether their prescription drug coverage is creditable coverage, which means that the coverage is expected to pay on average as much as the standard Medicare prescription drug coverage. Notice of Creditable Coverage
MSPA – Medicare as Secondary Payer Act - this law requires health plans that cover Medicare eligible employees to pay first and Medicare will pay second. This is referred to as Medicare as Secondary Payer (MSP).
NMHPA – Newborn and Mother Health Protection Act - includes important protections for mothers and their newborn children with regard to the length of the hospital stay following childbirth. The Newborns' Act requires that group health plans that offer maternity coverage pay for at least a 48-hour hospital stay following childbirth (96-hour stay in the case of Cesarean section).
QMCSO – Qualified Medical Child Support Order - requires employment-based group health plans to extend health care coverage to the children of a parent-employee who is divorced, separated, or never married when ordered to do so by state authorities. The group health plan must determine whether the medical child support order is “qualified.”
USERRA – Uniformed Services Employment and Reemployment Act - protects service members' reemployment rights when returning from a period of service in the uniformed services, including those called up from the reserves or National Guard, and prohibits employer discrimination based on military service or obligation. The U.S. Department of Labor’s (DOL) Veterans’ Employment and Training Service (VETS) administers USERRA.
WHCRA – Women’s Health and Cancer Rights Act - includes protections for individuals who elect breast reconstruction in connection with a mastectomy. WHCRA provides that group health plans and health insurance issuers that provide coverage for medical and surgical benefits with respect to mastectomies must also cover certain post-mastectomy benefits, including reconstructive surgery and the treatment of complications (such as lymphedema).