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A Better Partnership


Jul 2012
July 03, 2012

Health Care Reform Deadlines Loom Large for Employers

Now that the Patient Protection and Affordable Care Act has been deemed largely constitutional by the Supreme Court of the United States, employers who sponsor group health care plans will be expected to comply with several near-term deadlines.

Concerted efforts to repeal all or part of the health care reforms may occur if Republicans take the White House and the Senate in November, but if employers delay action until after the election, they may miss deadlines and may face significant fines and penalties.

In the near term, employers need to focus on the following:

  • Provide comprehensive women's preventive care services with no cost-sharing for plan years beginning on or after August 1, 2012 (applicable to non-grandfathered group health plans only)
  • Issue a Summary of Benefits and Coverage to all group health plan enrollees, describing key aspects of the plan for open enrollment periods that begin on or after September 23, 2012
  • Evaluate the impact on retiree prescription drug plans of the Medicare Part D subsidy taxation
  • Establish the framework to properly record and timely report the aggregate value of certain group health plans on employees' Form W-2.  For large employers with more than 250 employees this notification must be included on Box 12, using Code DD for any 2012 W-2 that is issued in January 2013
  • Provide advance notice of material modifications that impact the content of the Summary of Benefits and Coverage
  • Receive and distribute any Medical Loss Ratio rebates for 2011 insured group health plan coverage
  • Implement a $2,500 limit on employee contributions to a medical flexible spending account for plan years beginning on January 1, 2013, including amending any corresponding cafeteria plan
  • Increase Medicare payroll tax withholding by 0.9% on high-income individuals beginning January 1, 2013
  • Notify employees of the availability of health insurance exchanges in March 2013

For 2014, employers will need to:
  • Determine how to strategically address the "play or pay" mandate which requires businesses with more than 50 employees to either offer affordable health care that provides minimum essential coverage or face the imposition of a penalty. Many employers are contemplating whether to keep, add or eliminate employer-sponsored group health plan coverage in light of this mandate
  • Provide a certification to the U.S. Department of Health and Human Services regarding whether the group health plan provides minimum essential coverage
  • Potentially implement a requirement to automatically enroll new employees in a group health plan (applicable only to employers with more than 200 employees)
  • Restrict waiting periods for participation in group health plans to no more than 90 days
  • Determine whether to increase incentives for participation in wellness programs as the permissible rewards may increase from 20% to 30% of single coverage premiums
  • Provide coverage for certain approved clinical trials (applicable to non-grandfathered group health plans only)
  • Eliminate any pre-existing condition limitations for adults
  • Remove any annual dollar limitations

Various governmental agencies will be providing key regulations in the upcoming months. We will send out additional alerts about any significant developments that may impact your group health plans.

If you haven’t already, you also might be interested in signing up for our complimentary Webinar, which will take place noon to 1 p.m. on Wednesday, July 11. You may register here.

If you have any questions about how this ruling will impact your group health plan or about Health Care Reform generally, please contact  April Goff ( or 616.752.2154), Norbert F. Kugele ( or 616.752.2186), or any other member of the Warner Norcross & Judd Health Care Reform Task Force or Employee Benefits Group.

NOTICE. Although we would like to hear from you, we cannot represent you until we know that doing so will not create a conflict of interest. Also, we cannot treat unsolicited information as confidential. Accordingly, please do not send us any information about any matter that may involve you until you receive a written statement from us that we represent you.

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