Smart Benefits: When Dental and Vision Don’t Count…Under PPAC, That Is
Monday, October 20, 2014
The IRS, DOL and HHS recently issued final regulations that clarify when vision and dental benefits are “excepted benefits,” meaning they are exempt from many health care reform requirements, such as W-2 reporting and annual dollar limits.
Previously, under HIPPP regulations, vision and dental benefits were excepted if they were limited in scope (i.e. for treatment of the eyes or mouth, respectively) and either 1. Provided under a separate policy, certification or insurance contract or 2. Not otherwise an integral part of a group health plan.
In 2013, the IRS, DOL and HHS issued draft regulations that proposed to eliminate the requirement that participants pay an additional premium or contribution for limited-scope vision or dental benefits to qualify as benefits that are not an integral part of the plan.
GET THE LATEST BREAKING NEWS HERE -- SIGN UP FOR GOLOCAL FREE DAILY EBLASTUnder the final rules, which apply to group health plans and group health insurance issuers for plan years beginning January 1, 2015, these benefits are not considered an integral part of a plan if participants have the right to opt out of coverage or if claims are administered under a separate contract for other benefits administration. To qualify as “non-integral,” employees don’t have to pay a separate premium or contribution for the excepted coverage.
These final rules will make it easier now – especially for self-funded plans – for a stand-alone dental or vision plan to qualify as an excepted benefit.
Amy Gallagher has over 21 years of healthcare industry experience guiding employers and employees. As Vice President at Cornerstone Group, she advises large employers on all aspects of healthcare reform, benefit solutions, cost-containment strategies and results-driven wellness programs. Amy speaks regularly on a variety of healthcare-related topics, and is often quoted by national publications on the subject matter. Locally, Amy is a member of SHRM-RI, the Rhode Island Business Group on Health, and the Rhode Island Business Healthcare Advisory Council.
Related Slideshow: New England’s Healthiest States 2013
The United Health Foundation recently released its 2013 annual reoprt: America's Health Rankings, which provides a comparative state by state analysis of several health measures to provide a comprehensive perspective of our nation's health issues. See how the New England states rank in the slides below.
Definitions
All Outcomes Rank: Outcomes represent what has already occurred, either through death, disease or missed days due to illness. In America's Health Rankings, outcomes include prevalence of diabetes, number of poor mental or physical health days in last 30 days, health disparity, infant mortality rate, cardiovascular death rate, cancer death rate and premature death. Outcomes account for 25% of the final ranking.
Determinants Rank: Determinants represent those actions that can affect the future health of the population. For clarity, determinants are divided into four groups: Behaviors, Community and Environment, Public and Health Policies, and Clinical Care. These four groups of measures influence the health outcomes of the population in a state, and improving these inputs will improve outcomes over time. Most measures are actually a combination of activities in all four groups.
Diabetes Rank: Based on percent of adults who responded yes to the question "Have you ever been told by a doctor that you have diabetes?" Does not include pre-diabetes or diabetes during pregnancy.
Smoking Rank: Based on percentage of adults who are current smokers (self-report smoking at least 100 cigarettes in their lifetime and currently smoke).
Obesity Rank: Based on percentage of adults who are obese, with a body mass index (BMI) of 30.0 or higher.
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