W-2 Reporting Requirement – New Guidance Released by the IRS

This will mean increased adminstrative responsibility for employer and third-party vendors who complete company W-2s. It will also help employers – and the government – to track the value of tax free health insurance premiums. The penalties for failure to comply are the same as those applicable to W-2 reporting. They range from $30 to $100 per W-2 and is capped for small businesses.

What impact does the reporting have on employees?

Individuals are not impacted by this information on their W-2. The cost of the benefits reported will not increase their taxable income.

Additional information is provided at the IRS website at www.irs.gov

Health Savings Account – 2012 Limits

The IRS has announced the annual limitation on deductions for the 2012 calendar year for individuals and families who have coverage under a high deductible health plan.

The table below reflects a summary of the 2012 HSA contribution and HSA compatible health plan limits.

For additional information go to the US Department of Treasury web site at www.treasury.gov

Voluntary Benefits 101

Are you offering enough value services to attract and retain a quality workforce?

Rising health insurance premiums are not new to employees, high deductible plans are. One of our value services is offering effective and creative ways you can use to help alleviate some of the high deductible burdens your employees are starting to experience. Voluntary benefits are an effective tool to utilize as an employer. These benefits are 100% employee paid through payroll and offer a wide array of coverage, including, but not limited to life insurance, disability and accident insurance.

Voluntary benefits offer a way to off-set the out of pocket costs of the employee’s medical plans with a small per-payroll deduction. They also offer a way to supplement any group life or disability.

In a study conducted by MetLife, you can see the value that voluntary benefits hold in the eyes of employees. Adding these benefits to your arsenal gives employees another reason to stay, and gives prospective employees another reason to consider you.

If you are interested in learning more about the voluntary options, please contact our office at: 508-799-9100

2011 – Upcoming Changes & Reminders

Changes to Flexible Spending Accounts – January 1, 2011
The cost of over-the-counter medicine or drug will no longer be reimbursed, unless a prescription is obtained from a physician. For more information please visit the IRS website or IRS Notice 2010-59.

Reporting Requirement Optional in 2011
Starting in tax year 2011, employers are required to report the aggregate cost of employer sponsored healthcare coverage on Form W-2. The reporting is optional in 2011 for tax year 2010. The IRS has released a revised draft of Form W-2, which includes the codes that employers may use for cost of coverage reporting. The prupose of this reporting is to show employees the value of healthcare benefits. The amount reported has no impact on tax liability.

Prescription Drug Discounts – January 1, 2010
Seniors, who experience the “Donut Hole” coverage gap in Medicare Part D, are entitled to receive a 50% discount when buying covered brand-named prescription drugs. Seniors will continue to receive additional savings on prescription drugs over the next ten years, until the coverage gap is closed in 2020.

Small Business Tax Credit Form
A new Form 8941 with instructions for small businesses was recently released by the IRS. The form is to be used by eligible employers to calculate the tax credit amount for the 2010 tax year. The number is then to be used as part of the general business credit on an employer’s tax return.

For additional information please visit www.irs.gov or www.healthcare.gov.

National Healthcare Reform – 2010 Key Provisions

On March 23, 2010, President Obama signed into law the Affordable Care Act, which puts in place significant changes in the healthcare reform.

In an effort to protect consumers, lower costs, guarantee choices and enhance quality healthcare for all Americans, the Act has put in place some key provisions that took effect in 2010 and additional provisions that will be implemented in the next few years.

This brief timeline highlights some of the key provisions.

Providing Small Businesses Health Insurance Tax Credit – January 1, 2010
This tax credit helps small businesses provide for the first time, or continue to provide health insurance coverage to their employees. The incentive is a credit worth up to 35% of the employer’s contribution to the employee’s premium. This provision also applies to non-profit organizations.

Closing the “Donut Hole” – Starting in 2010
“Donute Hole” refers to the gap in prescription coverage present in most Medicare Part D plans. A $250 tax-free rebate from medicare was issued to about 4 million seniors last year. Starting in 2011, a 50% discount will be in place for Medicare participants who experience the “Donut Hole”.

Expanding Coverage for Early Retirees – Applications started June 1, 2010
The program under the new law allocates $5 billion towards preserving employer-sponsored health insurance for early retirees until 2014, when more affordable coverage will be available through the new Exchanges.

Pre-Existing Condition Insurance Plan – July 1, 2010
This new plan provides coverage to individuals who have a pre-existing condition and have been uninsured for at least 6 months. The Department of Health and Human Services of each state will establish plans should the state choose not to run this program.

Extending Coverage for Young Adults – September 23, 2010
Effective for plan years starting on or after Sept 23, 2010, the new law allows dependent children to stay on their parent’s health plan until their 26th birthday, as long as the dependent is not offered coverage through his/her work.

Free Preventive Care – September 23, 2010
Effective for plan years starting on or after Sept 23, 2010, certain preventive services such as mammograms and colonoscopies must be covered by new plans. Services are free of charge (deductible, co-pay or coinsurance).

Eliminating Lifetime Limits – September 23, 2010
Effective for plan years beginning on or after Sept 23, 2010, no lifetime dollar limits will be allowed on essential benefits, like hospital stays.

W-2 Reporting Requirement – New Guidance Released by the IRS

The Patient Protection and Affordable Care Act of 2010 mandates employers to report the aggregate cost of employer sponsored health care coverage on Form W-2, Wage and Tax Statement, beginning January 1, 2011. The IRS (Internal Revenue Service) released Notice 2010-69 (see link below) on October 12, 2010 providing interim relief to employers on this reporting requirement. The reporting is now voluntary in 2011. Furthermore, if employers do not report the aggregate cost of health coverage on Form W-2 in 2011, they are not subject to penalties. This decision made by the Department of Treasury and the IRS provides additional time to employers to make necessary changes to their payroll systems and better prepare to comply with the PPACA reporting requirements.

For additional intormation go to http://www.irs.gov/pub/irs-drop/n-2010-69.pdf

If you have questions, please contact us to discuss these significant health care reform changes.

Dependent Coverage

Effective for health plan years beginning on or after September 23, 2010, the Affordable Care Act requires group health plans and health insurers that offer dependent coverage of children to make coverage available for young adults until age 26. The goal of this policy is to extend coverage to as many employed adults. Enrollees are eligible even if they don’t live with their parents, are no longer a dependent on parents’ tax return, or are no longer students. This law does not apply if the young adult is offered insurance through an employer.

Some important points:

• Special open enrollment opportunity: for a plan/policy years beginning on or after September 23,2010, groups and carriers must give qualifying children an opportunity to enroll on the parents’ plan. The open enrollment period must continue for 30 days and employers must notify employee in writing no later than the first day of the plan’s/policy’s year that begin on of after Sep 23, 2010. See sample “Dependent Notification” at the bottom of this email.
• No changes in benefits or premium: under agency regulations, no benefits coverage or premium amounts may differ from the existing plan/policy, regardless of the chid’s age. This rule is known as “uniformity requirement”.
• Until 2014 “grandfathered plans” do not have to extend this coverage to adult children if the child is eligible for group coverage elsewhere.

For more information on this topic, please visit http://www.hhs.gov/ociio/regulations/dependent/ or www.healthcare.gov

Sample Dependent Coverage Notice

Individuals whose coverage ended, or who were denied coverage (or were not eligible for coverage), because the availability of dependent coverage of children ended before attainment of age 26 are eligible to enroll in [insert name of group health plan or health insurance coverage]. Individuals may request enrollment for such children for 30 days from the date of notice. Enrollment will be effective retroactively to [insert date that is the first day of the first plan year beginning on or after September 23, 2010]. For more information contact the [insert plan administrator or issuer] at [insert contact information].

If you have questions, please contact us to discuss these significant health care reform changes.

Health Care Reform Update Short-term Incentives for Expansion of Health Coverage

Recognizing that the key provisions of the Affordable Care Act do not take effect until 2014, Congress included a number of short-term incentives for the expansion of health coverage during the intervening period. Three of these programs are as follows:

• “Reinsurance” for certain claims incurred by early retirees under an employer-sponsored plan.
• A tax credit for small employers with a low-paid workforce who pay a significant portion of their employees’ health insurance premiums.
• State-wide “high-risk pools” for individuals who are unable to obtain health coverage due to a preexisting condition.

See below for detailed information about these three health care reform incentive programs.

Early Retiree Reinsurance Program

According to the Obama Administration, the percentage of large employers offering health coverage to early retirees (i.e., those between age 55 and Medicare eligibility) has declined precipitously in recent years, from 66% in 1988 to 31% in 2008. As a way of stemming that slide, the Affordable Care Act allocates $5 billion to a program under which the federal government will reimburse employer health plans (whether insured or self-funded) for certain claims incurred by early retirees or their covered dependents. During 2010, this program will reimburse 80% of an individual’s claims of more than $15,000 and less than $90,000. These two dollar amounts will be adjusted for inflation in later years.

To be eligible to participate in this reinsurance program, a health plan must submit an application to the Department of Health and Human Services (“HHS”) demonstrating that the plan has implemented “programs and procedures to generate cost-savings with respect to participants with chronic and high-cost conditions.”

As an example of such a cost-savings program, recent HHS regulations mention a diabetes management program that includes monitoring and behavioral counseling to prevent complications and hospitalizations. Those regulations define a “high-cost condition” as one that is likely to result in claims of $15,000 or more during a plan year by any one participant. Any reimbursements received under this program must be used by the plan to “lower costs for the plan.” For example, these funds might be used to reduce retiree premiums, copayments, deductibles, coinsurance, or other out-of-pocket costs. Apparently, they could also be used to reduce any employer premiums for the retiree coverage. However, they could not be used as general revenues of the plan sponsor. HHS is required to audit this program on an annual basis to ensure the appropriate use of all reimbursements. These reimbursements will not be taxable to the plan sponsor

This program is slated to end on January 1, 2014 – or sooner, if the $5 billion appropriation is exhausted before then. Applications to participate in the program will be available by the end of June. Because reimbursements will be made to qualifying plans on a first-come, first-served basis, any sponsor interested in participating in this program should plan to apply early.

Small-Employer Tax Credit

Beginning in 2010, small employers (those with fewer than 25 full-time employees, including full-time equivalents [“FTEs”]) with a relatively low-paid workforce (an average annual wage of less than $50,000) may qualify for a federal tax credit equal to a portion of the amounts the employer pays for its employees’ health insurance.

To receive the full credit, an employer must have 10 or fewer FTEs and an average annual wage of less than $25,000. The credit is phased out for employers with 10 to 25 employees or average annual wages of $25,000 to $50,000. This tax credit is equal to a percentage of the total health insurance premiums paid by the employer. For 2010 through 2013, taxable employers may receive a credit of up to 35% of these premiums, while tax-exempt employers may receive a credit of up to 25%. Taxable employers will claim this amount as a general business credit, thereby allowing it to be carried back one year and forward for up to 20 years. The credit also applies to liability under the alternative minimum tax. Tax-exempt employers will claim the credit as an offset against their payroll tax liability. For such employers, the credit is limited to this annual amount.

Beginning in 2014, the program will be slightly modified. The maximum credit percentage will increase to 50% for taxable employers and 35% for tax-exempt employers. However, the credit will then apply only to coverage purchased through Beginning in 2014, the program will be slightly modified. The maximum credit percentage will increase to 50% for taxable employers and 35% for tax-exempt employers. However, the credit will then apply only to coverage purchased through one of the state-wide exchanges that are to be established under the Act. Moreover, the credit will then be available to an employer for only two consecutive years.

In order to qualify for this credit, an employer must pay at least 50% of the total insurance premiums charged to its employees. For 2010, the employer must simply pay the same dollar amount for each employee, regardless of whether an employee elects single or family coverage. Beginning in 2011, however, the employer must pay a uniform percentage of each employee’s actual premium, even if an employee’s premium is higher due to his or her election of family coverage.

A complicating factor stems from the fact that the credit is actually calculated on the basis of the lesser of (1) the employer’s actual premiums paid on behalf of its employees, or (2) the amount that the employer would have paid (based on the same uniform percentage of the premium) if its employees had enrolled in a plan under which the premiums were equal to the average premiums charged in the small group market in the state where the insurance is purchased. In its recent Revenue Ruling 2010-13, the IRS has listed the dollar amounts of these “benchmark” employee and family premiums to be used during 2010. HHS will redetermine these state-wide benchmarks on an annual basis, and may also establish higher benchmarks for certain areas within a state.

In determining whether an employer meets the 25 FTE and $50,000 average wage thresholds, an employer may disregard any self-employed individuals, any 2% S-corporation shareholders, and any 5% owners of other entities. The number of FTEs is then determined by dividing the total number of hours worked by all employees by 2080. The applicable wage definition is the one used for FICA contribution purposes, but disregarding the annual FICA wage cap.

Any small employer that would qualify for this tax credit – or that would qualify by making only minor adjustments to the premium amounts it currently pays on behalf of its employees – should investigate the credit’s availability. Claiming the credit may significantly ease the cost of maintaining the employee health plan. Moreover, although an employer may not deduct any premium payments that give rise to the credit, any additional employer premiums will still be deductible.

High-Risk Pools for Long-Term Uninsured

One of the programs included in the Affordable Care Act was proposed by congressional Republicans.  It is designed to encourage states to establish temporary pools to provide health coverage to individuals who are otherwise unable to obtain such coverage due to a preexisting condition.

To qualify for coverage through one of these “high-risk pools,” an individual must be lawfully in the United States, have a preexisting condition (as determined under guidance to be issued by HHS), and not have been covered under creditable coverage (as defined for HIPAA purposes) during the six months prior to applying.

This program is to be available starting on July 1, 2010. It will end on January 1, 2014, when coverage with no preexisting condition exclusions should be available through the exchanges. The Act appropriated $5 billion to support these high-risk pools, which are to be funded entirely by the federal government.

Each state may either establish its own high-risk pool or allow HHS to establish and maintain such a pool for its residents. As of May 3, thirty states had announced that they would maintain their own pools and 17 had elected to allow HHS to do so. The remaining four states were still considering their options.

Although employers will have no direct involvement with these high-risk pools, they should be aware of a provision in the Act that requires an insurer or self-funded plan to reimburse a pool if the insurer or plan sponsor is found to have encouraged an individual to disenroll from existing coverage in order to obtain coverage through a pool.

New Rules on Grandfathered Status under Patient Protection and Affordable Care Act

The Departments of Health and Human Services, Labor and Treasury recently issued an interim final rule on what constitutes a grandfathered health plan under the Patient Protection and Affordable Care Act.

Under the regulations, a grandfathered health plan is defined as an employer-sponsored group health plan, either insured or self-insured, or individual insurance coverage that existed as of March 23, 2010. The rule also lists the changes that may and may not be made to plans seeking the grandfathered status.

Changes that will cause a plan to lose its grandfathered status include:

• Elimination of all or substantially all benefits to diagnose or treat a particular condition, even if that condition affects only a few covered individuals;
• Increases in an individual’s percentage coinsurance requirement (e.g., increasing from 20% to 30% coinsurance);
• Increases in fixed-dollar cost-sharing (such as deductibles and out-of-pocket expense limits, but not co-payments) in excess of the rate of medical inflation since March 23, 2010, plus 15 percentage points;
• Increases in co-payments in excess of the greater of (1) the rate of medical inflation, plus 15 percentage points, or (2) $5.00, as adjusted for medical inflation;
• Decreases in the employer contribution on the cost of any tier of coverage by more than 5% of its contribution rate in effect on March 23, 2010. The total cost of coverage is to be determined in the same manner as the COBRA continuation premium; and
• Certain changes to lifetime and annual benefit limits that would be adverse to plan participants.

Overall, plan changes enacted before March 23, 2010, with an effective date after that date, will not cause a loss of grandfathered status. If an employer or plan sponsor has amended a group health plan since March 23, 2010, that would cause a plan to lose its grandfathered status under the new guidance.

The employer or plan sponsor, however, may reverse those amendments before the first plan year beginning on or after Sept. 23, 2010 (typically, the 2011 plan year) and retain grandfathered health plan status. Health plan changes that are not specifically prohibited (e.g., benefit improvements) will not cause a health plan to lose its grandfathered status.

If you have any questions, please contact us as soon as possible to discuss these significant health care reform changes.

New Health Care Reform Regulations Address Pre-Existing Conditions, Lifetime and Annual Coverage Limits, Restrictions on Rescission, and Patient Protections

The Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010 (collectively, the “Act”) create a broad roster of new requirements and prohibitions affecting individual and group health insurance contracts and employer-sponsored group health plans. These include curbs on lifetime and annual limits, coverage of preventative care, and limitations on waiting periods, among many others.

On June 22, 2010, the Internal Revenue Service, U.S. Department of Labor, and U.S. Department of Health and Human Services issued an interim final regulation (the “Regulation”) interpreting the following provisions of the Act:

• Prohibition on Preexisting Condition Limitations
• Prohibition on Lifetime and Annual Limits
• Prohibition on Rescission of Coverage
• New Patient Protections

This Alert highlights some of the key provisions of the Regulation. (Note that we refer to “grandfathered” plans throughout this alert.

Prohibition on Preexisting Condition Limitations (PHSA §2704)

The Act prohibits any preexisting condition exclusion2 from being imposed by group health plans or group or individual health insurance coverage.

This prohibition generally is effective with respect to plan years beginning on or after January 1, 2014, but for enrollees who are under 19 years of age, this prohibition is effective for plan years beginning on or after September 23, 2010 (for calendar year plans, January 1, 2011).

The Regulation makes clear that the prohibition applies not just to the exclusion of a specific benefit relating to a preexisting condition, but also to a complete exclusion from a plan or coverage based on a preexisting condition.

Grandfathered group health plans must comply with this provision, with one limited exception: grandfathered individual health insurance coverage is not required to comply.

Practitioner’s Observation: This prohibition applies to “enrollees” under age 19. Thus, the provision picks up not only children and dependents of plan participants, but also young workers who may themselves be participants.

Prohibition on Lifetime and Annual Limits (PHSA §2711)

Effective for plan years beginning on or after September 23, 2010, the Act prohibits group health plans and group or individual health insurance issuers from imposing lifetime or annual limits on the dollar value of health benefits.

Effect on Account-Based Plans

The Regulation clarifies that PHSA §2711 does not apply to Flexible Spending Account plans, Medical Savings Plans, or Health Savings Accounts. Health Reimbursement Account (HRA) plans coupled with other coverage will not violate PHSA §2711, so long as the other coverage does not violate §2711. A stand-alone retiree-only HRA will not violate PHSA §2711, but the fate of stand-alone HRA plans covering active participants is not yet settled (the regulators have asked for comments on this item).

“Essential Health Benefits”

The Regulation makes clear that a plan or issuer may impose annual or lifetime per-individual dollar limits on specific covered benefits that are not “essential health benefits.” 3 The Act also allows “restricted annual limits” with respect to “essential health benefits” for plan years beginning before January 1, 2014 (discussed in further detail below).

Because regulations defining “essential health benefits” have not been issued, the Regulation (in the preamble) notes that the Departments will take into account good faith efforts to comply with a reasonable interpretation of the term “essential health benefits,” so long as the definition is applied consistently.

Phase-Out of Restricted Annual Limits

The Act prohibits annual limits on the dollar value of benefits generally, but allows “restricted annual limits” with respect to “essential health benefits” for plan years beginning before January 1, 2014. The restricted annual limits may be no less than:

• $750,000, for plan or policy years beginning on or after September 23, 2010 but before September 23, 2011;
• $1.25 million, for plan or policy years beginning on or after September 23, 2011 but before September 23, 2012; and
• $2 million, for plan or policy years beginning on or after September 23, 2012 but before January 1, 2014.

Waiver Program

The Regulation provides for the Secretary of Health and Human Services to establish a program under which the requirements relating to restricted annual limits may be waived if compliance would result in a significant decrease in access to benefits or a significant increase in premiums. This provision is targeted to “limited benefit” (or “mini-med”) plans, which typically contain annual limits well below those contemplated by the Regulation.

Special Enrollment Right

Under the Regulation, individuals who reach a lifetime limit under a plan or health insurance coverage prior to the effective date and are otherwise still eligible under the plan or health insurance coverage must be provided, no later than the effective date, with (1) a notice that the lifetime limit no longer applies and (2) an enrollment or reinstatement opportunity.

Application to Grandfathered Plans

PHSA §2711 applies to all group health plans and group health insurance, whether or not grandfathered. However, the Act and the Regulations relating to the prohibition on annual limits, including the special rules regarding restricted annual limits for plan years beginning before January 1, 2014, do not apply to grandfathered individual health insurance coverage. In addition, certain changes to annual limits will end grandfathering treatment:

• A plan or health insurance coverage that, on March 23, 2010, did not impose an overall annual or lifetime limit on the dollar value of all benefits imposes an overall annual limit on the dollar value of benefits.
• A plan or health insurance coverage that, on March 23, 2010, imposed an overall lifetime limit on the dollar value of all benefits but no overall annual limit on the dollar value of all benefits adopts an overall annual limit at a dollar value that is lower than the dollar value of the lifetime limit on March 23, 2010.
• A plan or health insurance coverage that, on March 23, 2010, imposed an overall annual limit on the dollar value of all benefits decreases the dollar value of the annual limit (regardless of whether the plan or health insurance coverage also imposed an overall lifetime limit on March 23, 2010 on the dollar value of all benefits).

Practitioner’s Observation: Changes to annual limits will end grandfathering treatment, even if the post-modification limits are above the “restricted annual limits” thresholds.

Exclusion of a Benefit

The Regulation notes that an exclusion of all benefits for a condition is not considered to be an annual or lifetime dollar limit.

Restrictions on Rescissions (PHSA §2712)

Effective for plan years beginning on or after September 23, 2010, the Act prohibits plans and issuers from rescinding coverage once an individual is enrolled in coverage, unless the individual was involved in fraud or made an intentional misrepresentation of material fact. This standard applies to all rescissions, whether in the group or individual insurance market, whether coverage is insured or self-insured coverage, and whether or not a plan is grandfathered.

The Regulation provides the following guidance and clarifications:

• A rescission is defined as a cancellation or discontinuance of coverage that has retroactive effect. A prospective cancellation or discontinuance of coverage is not a rescission. Nor is a retroactive cancelation or discontinuance of coverage, to the extent it is attributable to a failure to timely pay required premiums.
• PHSA §2712 applies whether a rescission pertains to a single individual, an individual within a family, or an entire group of individuals.
• Omissions may be grounds for rescission, but only if fraudulent. However, inadvertent omissions should not be considered “fraudulent” or “an intentional misrepresentation of material fact.”
• The standards apply to representations made on behalf of an individual or group seeking coverage, such as by an employer seeking to obtain coverage for its employees.
• 30 days’ advance written notice must be provided to each participant who will be affected by a rescission.
• PHSA §2712 does not preempt other federal or state laws pertaining to rescissions, so long as the laws are more protective of individuals than PHSA §2712.

Patient Protections (PHSA §2719A)

Effective for plan years beginning on or after September 23, 2010, the Act establishes new requirements relating to the choice of a health care provider and availability of emergency services. These rules do not apply to grandfathered plans.

Choice of Health Care Provider

With respect to the choice of a health care provider, the Regulation provides:

• If a plan requires the designation of a primary care provider, a participant may designate any primary care provider who participates in the plan’s network and who is available to accept the participant. For children, a pediatrician may be designated as the primary care provider.
• Plans and issuers that provide coverage for obstetric or gynecological care may not require prior authorization in order for a participant to obtain access to obstetrical or gynecological care from a obstetrics or gynecology specialist in the plan’s network. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals.
• The Regulation requires a plan to give notice of the above rights whenever the plan issues a Summary Plan Description or other similar description of benefits, and provides model language for the disclosure.

Emergency Services

If a plan or issuer covers any emergency services, it must provide for the services:

• without a prior authorization requirement, even for out-of-network services;
• without regard to whether the provider of the services is in-network;
• if the services are out-of-network, without any administrative requirements or coverage limitations that are more restrictive than those imposed on in-network services; and
• without regard to any other term or condition of the coverage, other than (1) The exclusion of or coordination of benefits; (2) An affiliation or waiting period permitted under ERISA, the PHSA, or the Internal Revenue Code or (3) Applicable cost sharing.

In addition, if the emergency services are provided out-of network, the plan or issuer must comply with additional rules set forth in the Regulation regarding the minimum reimbursements for such services. The Regulation provides three alternate means of calculating the reimbursement amount, based on, respectively (1) the median charge for in-network services, (2) the amount the plan generally uses to calculate in-network services, and (3) the Medicare reimbursement rate. The reimbursement for out-of-network services must be the greatest of the three amounts.

Effective Date

The Regulation is effective 60 days following publication in the Federal Register. However, as noted above, the provisions discussed in this alert are all effective for plan years beginning on or after September 23, 2010 (for calendar year plans: January 1, 2011).

If you have any specific questions about implementation, please contact us as soon as possible to discuss these significant health care reform changes.