One of the most challenging aspects of health care reform for companies that provide employer-sponsored health coverage is informing employees of the upcoming changes to their plans, as required under the Patient Protection and Affordable Care Act (PPACA).  

Manager Makeover: How to tell employees about changes to their health plans

One of the most challenging aspects of health care reform for companies that provide employer-sponsored health coverage is informing employees of the upcoming changes to their plans, as required under the Patient Protection and Affordable Care Act (PPACA). 

Below is a communication you can use this open enrollment period or as your company prepares to head into the 2011 plan year. It lets your employees know how their health plans will be affected, and where they can go for more information: 

Dear Employee,

Because of health care reform, there are new changes to your health plan that you should know about. 

For instance, you may now have new rights under provisions in the health care reform law, effective the beginning of our new plan year. A key change is that you may cover adult children under the age of 26 under your health plan. Also, your insurer cannot cancel your policy just because you get sick, and you may obtain some types of preventive care without paying any deductibles or co-payments. 

These changes are part of the Patient Protection and Affordable Care Act, often called the Affordable Care Act. The provisions of this law go into effect on the first day of the plan year after September 23, 2010. For plans based on a calendar year, the changes begin on January 1, 2011. 

 

Here are some of your rights under the new law:
  • You may cover an adult child under the age of 26 if your health plan covers dependent children. You may do this whether your child attends school, lives at home, is married, or is claimed as a dependent on your income tax return. Learn more about adding a child and about the tax benefits.
  • Your insurer may not retroactively cancel your policy simply because you get sick. Your insurer may end your coverage only for specific reasons - for example, if you commit fraud or intentional misrepresentation (or, if you don't make your premium payments on time).
  • Your insurer may not set a lifetime limit on the dollar-value of your coverage for essential health care benefits, and must phase out any annual limits.
  • Your plan must pay for certain types of preventive care without requiring you to meet a co-pay or deductible requirement. These types of care include immunizations, screenings for diabetes and mammograms for women in some groups.
  • Your insurer must cover children under the age of 19 with pre-existing conditions.
  • You have the right to appeal if a health plan won't pay for treatment you believe is necessary. If your claim or request for coverage is denied, the law gives you the right to an independent review by someone who doesn't work for the plan.
Here are some of your responsibilities under the new law:
  • You must pay an added penalty for nonqualified withdrawals from a Health Savings Account (HSA). The penalty increases from 10 percent to 20 percent for distributions occurring in 2011 and later years.
  • You must provide a prescription or additional documentation in order to be reimbursed for over-the-counter (OTC) medications from Flexible Spending Accounts, HSAs or HRAs.