Department of Labor Releases Model Exchange Notice for Employers

May 10th, 2013 § 0 comments § permalink

The U.S. Department of Labor on May 8th released guidance regarding the employer notification about new coverage options through the health insurance exchange (also known as the health insurance marketplace). The guidance includes model notices for employers that provide a health plan and for those that don’t, and a new deadline for distributing the notice to current and new employees.

The Department of Labor originally delayed the deadline to distribute the notice in January. Employers are required to provide the notice to each new employee at the time of hiring beginning Oct. 1, 2013. For 2014, the Department will consider a notice to be provided at the time of hiring if the notice is provided within 14 days of an employee’s start date. With respect to employees who are current employees before Oct. 1, 2013, employers are required to provide the notice not later than Oct. 1, 2013.

The notice is required to be provided automatically, free of charge. It can be provided in writing either by first-class mail, or electronically if the department’s electronic disclosure safe harbor requirements are met.

The guidance also provides an updated model election notice for group health plans for purposes of the continuation coverage provisions under COBRA, to include additional information regarding health coverage alternatives offered through the exchange.

We are currently reviewing the guidance and will provide more information as it becomes available.

SBC Refresher

April 25th, 2013 § 0 comments § permalink

Purpose of SBC

Provide individuals with standard information so they can compare medical plans as they make decisions about which plan to choose. Health insurers and self-funded group health plans must provide the SBC to individuals:

  • When they enroll in coverage for the first time
  • Prior to the beginning of each new plan year (at open enrollment or within 30 days if enrollment is automatic)
  • Within seven business days of a request

Requirements of SBC

The SBC must include a:

  • Four-page overview of plan benefits, cost sharing and limitations
  • Required set of coverage examples explaining how the plan works
  • Phone number and internet address for obtaining copies of plan documents

A standard glossary of medical and insurance terms must also be available.

The penalty for “willful” non-compliance is $1,000 per enrollee. Other ERISA and tax penalties may apply.

Summary of Benefits and Coverage (SBC) – Guidance for 2014

April 25th, 2013 § 0 comments § permalink

On April 23, 2013, the Departments of Labor, Health and Human Services (HHS), and Treasury issued Frequently Asked Questions (FAQs) regarding implementation of the Summary of Benefits and Coverage (SBC) provision of the Patient Protection and Affordable Care Act (PPACA).

What’s New?

  • Effective January 1, 2014, the SBC will need to state whether the plan provides “minimum essential coverage” (MEC) as required by the “individual mandate.”
  • It will also need to state whether the plan meets the “minimum value” (MV) requirement. Minimum value means the plan pays at least 60% of allowed charges for covered services, as required by the “employer mandate.”

The Departments provided a new template that incorporates these statements, but allows plans or issuers that are unable to modify their SBCs to continue using the current template, as long as they provide a cover letter or other disclosure that confirms whether the plan meets the MEC/MV requirements.

What Stayed the Same?

  • Coverage examples have not changed for 2014.
  • The SBC template was not changed to reflect PPACA’s requirement to eliminate annual limits on essential health benefits. Original instructions still apply:
  • Answer “no” where the template asks, “Is there an overall annual limit on what the plan pays?”
  • In the Why This Matters column, state: “The chart starting on page 2 describes any limits on what the plan will pay for specific covered services, such as office visits.”
  • As an alternative, plans/issuers are now permitted, but not required, to remove the entire row from the document if there are no plan level annual dollar limits.

Additional Safe Harbors Extended
Regulators are extending the safe harbors and enforcement relief provided last year. Penalties will not be imposed on plans/issuers that are working “diligently and in good faith” to comply.

The Departments will:

  • Continue to work with plans/issuers to help them come into compliance.
  • Allow modifications to the SBC for plan terms/conditions that do not fit within the SBC requirements, as long as the SBC is completed as closely in line with the instructions as possible.
  • Allow electronic delivery if enrollment/renewal is electronic, if a person requests the SBC be provided electronically or in compliance with ERISA electronic delivery safe harbor.
  • Permit continued use of the HHS coverage examples calculator.
  • Allow carve out benefits to be provided in separate SBCs “until further guidance is issued.”
  • Exempt fully insured and self-insured Expatriate and Medicare Advantage plans for 2014.
  • Extend the anti-duplication rule to student health insurance – if another party (e.g., a health insurance issuer) provides a timely and complete SBC to the individual, the SBC requirement is satisfied.
  • Extend relief to closed blocks of business to September 23, 2014, as long as the product is not actively marketed, never provided an SBC or was not marketed after September 23, 2012. Closed blocks are no longer sold, but may continue to have individuals enrolled in the plans.

Read the SBC FAQs
http://www.dol.gov/ebsa/faqs/faq-aca14.html

Access the New Template (PDF & Word)
http://www.dol.gov/ebsa/pdf/correctedsbctemplate2.pdf
http://www.dol.gov/ebsa/correctedsbctemplate2.doc

View a Sample Completed SBC (PDF & Word)
http://www.dol.gov/ebsa/pdf/CorrectedSampleCompletedSBC2.pdf
http://www.dol.gov/ebsa/CorrectedSampleCompletedSBC2.doc

April 6th is Benico, Ltd.’s 30th anniversary

March 9th, 2013 § 0 comments § permalink

30ann

John and Pam Garven, residents of Huntley and owners of Benico, Ltd., are pleased to announce the 30th anniversary of their firm’s incorporation.  Benico was incorporated on April 6th of 1983.

A Quick History

John and Pam, who were both born and raised in Lake County, Illinois, founded their business, an employee benefits brokerage and consulting firm, in September of 1981.  Prior to Benico’s incorporation the business operated under the DBA of The Greater Northern Illinois Group.

From 1983 until 1990 Benico was associated with a commercial property & casualty firm known as Assurance Agency where John was instrumental in starting this other firm’s employee benefits practice from scratch.

Following John’s tenure with Assurance Agency, Benico’s offices were relocated to the Northwest Corporate Center in Hoffman Estates.  From 1993-1997 office facilities were leased in Hampshire, and then toward the end of 1997 the Garvens moved Benico’s offices to its current location at 11715 E. Main Street in Huntley, an office building they own located directly across from the landmark gazebo in the village’s downtown square area.

John’s professional credentials

John has made life and career-long learning very much a priority for himself and his staff.  He is a graduate of Trinity International University in Bannockburn, Illinois, where he earned his Bachelor of Arts degree.  Also, John has a number of professional designations including the Chartered Healthcare Consultant™ (ChHC™), Chartered Life Underwriter® (CLU®), and Registered Health Underwriter® (RHU®) designations conferred by The American College, the nation’s leading educational institution serving the insurance and financial services industries.  He also holds the Accredited Investment Fiduciary® (AIF®) designation awarded by The Center for Fiduciary Studies, and recently John completed the requirements leading to being conferred the C(k)P™ (Certified 401(k) Professional) designation from The Retirement Advisor University (TRAU).
Mr. Garven is past president of the Illinois State Association of Health Underwriters, a state affiliate of the National Association of Health Underwriters (NAHU), a national trade organization representing more than 100,000 agents, brokers, and consultants who are professionally engaged in the distribution of private health insurance and related products and services.  John is also an active member of the National Association of Plan Advisors (NAPA), the Society for Human Resource Management (SHRM), the Wellness Council of America (WELCOA), and since 2005 he has been associated with the Heartland Institute in Chicago as a policy advisor covering health care issues.

Scope of products and services

John and his team members are ready to assist any size business or organization by providing service and advice around the design, risk management, communication, and enrollment of its health and welfare and qualified retirement plans and keeping them compliant with respect to the federal and state laws and regulations that impact upon such plans.

Also, through various strategic alliance relationships the firm also offers the following products and services to its clients:

1.     Individual life and health insurance products, include universal, variable, and term life, long term care, disability, and critical illness insurance
2.     HRA and FSA administration
3.     COBRA administration
4.     Assistance with setting up HSAs (health savings accounts)
5.     Payroll services
6.     Outsourced HR services
7.     Web-based benefit communication and enrollment
8.     Total compensation statements
9.     Wellness programs
10.  Population health management
11.  Commercial property & casualty insurance

Benico is a member of the Benefit Advisors Network (BAN – www.benefitadvisorsnetwork.com), a premier network of national credentialed independent benefit advisory and consulting companies. Each firm is individually recognized as a distinguished market leader. BAN promotes “best practices” sharing, technology and human capital investments, and shares expertise to support members in providing “best of class” service for their clients with the highest ethical standards.

Key to Benico’s Success?

Ask John what has been the key to Benico’s success over these past 30 years, and his answer is this – “Benico has grown as a result of two major factors – first, the proactive servicing of its clients’ needs, and second, the ongoing professional development of its staff. The value proposition we bring to our clients is that we are big enough to have the knowledge base, expertise, and depth of staff that is needed to address our clients’ concerns and issues, and yet small enough to be able to respond to client needs on a timely basis and consistently demonstrate to our clients that we care.”

Concerning Benico’s staff, Catherine Munch and Mary Bieker comprise the firm’s account management team. Both are Huntley residents, and they have 21 and 16 years of tenure with the firm, respectively. Chris Saundle, a Lake in the Hills resident, is the company’s information technology manager and network administrator.

Personal information

The Garvens have lived in Huntley since 1993, and have been married for 36 years. The couple’s children and grandchildren all live nearby.

Concerning their community involvement, the Garvens serve as lay pastors at Morning Star Church in Huntley. Also, John has been active over the years in the Huntley Area Chamber of Commerce & Industry, is a former member of the board of Consolidated School District 158 in Algonquin.

Further information about Benico, Ltd. may be found by visiting its website, www.benico.com, or by calling the Garvens at (847) 669-4800.

The current state of Medicaid expansion in the states

March 8th, 2013 § 0 comments § permalink

Medicaid expansion decisions have been among the bigger news items this past month. Some governors of states who weren’t expected to support Medicaid expansion have announced the intention to do so. Still others are holding firm that expanding a system they view as flawed is a recipe for disaster.

Here’s the rundown of the positions taken by governors and leaders on the issue of Medicaid expansion:

Supports Expansion Opposes Expansion Undecided
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Florida
Illinois
Maryland
Massachusetts
Michigan
Minnesota
Missouri
Montana
Nevada
New Hampshire
New Jersey
New Mexico
North Dakota
Ohio
Rhode Island
Washington
Wisconsin
Alaska
Georgia
Idaho
Indiana
Iowa
Louisiana
Mississippi
Nebraska
North Carolina
Oklahoma
Pennsylvania
South Carolina
South Dakota
Texas
Virginia 

 

Kansas
Tennessee
Wyoming

 

Health reform and exchange activity at the state and federal level is also fast and furious. New federal rules are being issued every few days (or so it seems) that will affect implementation of PPACA. The newest final rule on MLR allows tax-exempt not-for-profit issuers to deduct community benefit expenditures (subject to caps) and state premium tax from premium in calculating medical loss ratios and rebates. The rule also pushes back the rebate disbursement date from August 1 to September 30 for 2014.

HHS has given conditional approval for partnership exchanges to Iowa, Michigan, New Hampshire and West Virginia. These states are approved in addition to Arkansas, Illinois and Delaware, which were previously awarded conditional approval.

State legislatures are beginning to push back on Medicaid expansion

March 8th, 2013 § 0 comments § permalink

In recent weeks there has been a lot of buzz over which states will decide to expand their Medicaid programs. There has been a lot of discussion around what the governors will do, but as it turns out, we should have also been focusing on the state legislatures.

The health reform law initially required states to expand the Medicaid eligibility level to 133% of the poverty line across all categories, including uninsured adults with the federal government initially shouldering the entire cost of the expansion population, but gradually shifting at least 10% of expansion costs to the states.  The Supreme Court, in Sebelius V. Florida, et al., ruled that the Obama Administration had to give the states the option of declining to expand their programs or opting into the expansion at any time.

Initially following last summer’s court decision, most Republican-led states indicated that they would not expand their programs, citing flaws in the Medicaid program generally and state funding concerns.  But in recent weeks, GOP Governors like Rick Scott in Florida and Chris Christie in New Jersey have made headlines by changing their minds and opting for a Medicaid expansion. Right now, seven Republican governors have expressed a desire to expand Medicaid in their states.

That number however, may start to decrease. Governor Rick Scott of Florida just decided to expand Florida’s program, noting how the recent passing of his mother changed his perspective on the situation as well as how he could not in good conscience deny the people of his state access to coverage. Problem is, members of the Florida House of Representatives did not have the same change of heart. Just this week, the Florida House Republicans met to explore coverage options that do not include opting into the Medicaid expansion. However, even if they are successful, they will have to fund their solution using state dollars, not federal. The Florida State Senate, on the other hand, agreed to back Governor Scott’s decision to expand Medicaid. Looks like Florida politicians will be losing some sleep over the next few weeks.

Democratic Arkansas Governor Mike Beebe is also running into legislative difficulty after expressing his desire to expand Medicaid in his state. Beebe is up against a Republican-controlled state legislature and so far it does not seem as if his decision will make it through the state chambers. In his proposal, the governor included an interesting condition stating that Arkansas would only expand Medicaid if those dollars could be used to enroll new patients in the same private health plans that will be available for residents with higher incomes. “If the state Legislature approves the plan, all Arkansans earning below 133% of the federal poverty limit—or about $15,000 for a single person—will be able to get health insurance” says The National Journal. While some may claim that private insurance will actually increase the cost of the program, “Obama Administration officials say it could help families whose incomes often fluctuate, leaving them eligible for Medicaid one day and ineligible the next —which in turn would likely make them eligible for subsidized coverage on the exchange” according to Politico.

Also this week, Governor Pat McCrory of North Carolina signed legislation rejecting major components of the health reform law, including the Medicaid expansion that would have expanded Medicaid for 550,000 people. “The measure also prevents North Carolina from establishing a state-sponsored marketplace for health insurance, giving the control to the federal government, which will begin selling policies on the exchange in October” said The News Observer.

The Sequester and Healthcare

March 8th, 2013 § 0 comments § permalink

While Washington may have gotten off easy with this week’s “snowquester,” the sequester is a different story.

First of all, for the most part, funding for PPACA will remain untouched. Also, even though there are going to be delays at the airport and with navy deployments and food inspections, the Administration has made it clear that health reform implementation will be virtually unaffected and run on time! Instead, medical and health research institutions will take the brunt of the sequester cuts. Specifically, the National Institute of Health will be taking a $1.6 Billion cut over the next 10 years.

The PPACA component most likely to be affected by the automatic sequester cuts is the Small Business Health Care Tax Credit (SBTC) that encourages small businesses to provide health coverage to their employees. To qualify for the credit, that can offset as much as 50% of a small business’ health plan premiums, the company must have fewer than 25 full-time equivalent employees with average wages of less than $50,000 a year. These SBTC, which has a famously low take-up rate, will take an 8.7% cut effective immediately.

As for existing public programs, Medicaid is exempt from the cuts. Medicare doctors and hospitals however will see a two percent cut in government reimbursements. Components of Medicare Part D like low-income premium and cost-sharing subsidies and catastrophic subsidy payments and Qualified Individual (QI) premiums will not be harmed by the cuts.

Rate Shock! Insurance Premiums to Spike under Health Reform

March 8th, 2013 § 0 comments § permalink

This comes as no shock to us, but it seems that more people are starting to realize that insurance premiums in almost every state  will spike under the health reform law.

Congressional Republicans on the House Energy and Commerce Committee, the Senate Finance Committee and the Senate Health, Education, Labor and Pensions Committee have been doing their research and recently compiled an 8-page report highlighting how PPACA will cause insurance premiums to skyrocket. The report, released this past Tuesday, was compiled from more than 30 studies and analyses focused on PPACA.

The notion and promise that the health reform law would make health coverage for all Americans more affordable is shattered in this report. One of the first things highlighted is the fact that “President Obama’s promise that premiums would decrease by $2,500 has been broken. Since 2008 the average family premium has instead grown by over $3,000. Even more shocking is that these increases occurred before Obamacare’s most costly requirements go into effect in 2014.”

The report provides a state-by-state analysis of how premium costs are likely to increase under the law and the percentages are shocking. Premiums in the individual and small group market may rise as much as 106% in states such as Indiana, Kentucky, Missouri, Ohio and Wisconsin. Vermont and New York already “hyper-regulate” their insurance markets and will likely not see any premium increases.

The largest price tags are the guaranteed community rating, essential health benefits and taxes and fees on plans, drugs and medical devices. The law also fails to account for the relationship between premium increases and health insurance costs. Since premium costs are based on healthcare spending growth and the law makes already unaffordable coverage even more unaffordable, premium costs will inevitably skyrocket.

The Energy and Commerce Health Subcommittee was set to hold a hearing about the reports findings yesterday however, due to the “snow” that failed to stick in DC, the House adjourned a day early. The hearing will be rescheduled.

Regulations, regulations, and more regulations!

March 8th, 2013 § 0 comments § permalink

Last Friday the Obama Administration released five regulations on various provisions in the health reform law.

First, the proposed rule on SHOP Exchanges for small businesses delayed two key aspects of the SHOP exchange for one year in federally facilitated and partnership exchanges. State-based SHOP exchanges will have the option of offering employees greater choices of SHOP plans in 2014, but for at least the first year of operations SHOP exchanges with a federal presence won’t.  Federally facilitated and partnership exchanges also will not aggregate premiums for employers. These two changes are likely to significantly impact enrollment in and success of SHOP exchanges, since both are viewed as key reasons why employers and employees might like the SHOP option, especially when you consider the wide variety of private exchange options there are likely to be for small employers in 2014.

HHS decided to go with the one-year delay to respond to concerns about “whether issuers could meet the deadlines for submission of small group market [qualified health plans] given the new small group market rating rules; whether issuers could complete enrollment and accounting system changes required to interact with the SHOP enrollment and premium aggregation systems required by employee choice; and whether there would be adequate time to educate employers, employees and brokers about the employer and employee choices available in the SHOP.”

We have been speculating about low SHOP exchange take-up from the get-go, but we really predict it now.

The Office of Personnel Management (OPM) issued its final rule on Multistate Plans. The Multistate plan provisions in PPACA are a nod to two very different ideas that never made it into the final law—coverage across state lines and a government-run public plan option. The provision requires OPM (which runs the Federal Employees Health Benefit Plan) to contract with private insurers to offer at least two national plan options in health insurance exchanges. Multistate plans will be offered in exchanges in more than 30 states next year and in all 50 states and the District of Columbia within four years.

The final rule kept intact a provision that NAHU (my principal trade organization), many health insurers, and the National Association of Insurance Commissioners opposed when it was originally proposed in November 2012. Multistate insurance plans will not have to use the state-selected essential health benefits benchmark, but can instead decide to match any of the benchmark plans selected by the OPM. This idea was opposed due to unlevel playing field concerns, but OPM responded with the comment that “we are not aware of any compelling evidence that multiple benchmarks would lead to adverse selection or consumer confusion.” This rule is now slated to go into effect 60 days from its publication in the March 11th Federal Register.

A final rule entitled the Notice of Benefit and Payment Parameters for 2014 was also published and it includes details on risk adjustment, the temporary transitional reinsurance program and temporary risk corridors and a related interim final rule makes amendments to the Notice. The biggest takeaway we have had from this regulation so far is that HHS will extend medical loss ratio deadlines in 2014 by two months, meaning that MLR reporting will not occur until July 31st and rebates will not need to be issued until September 30th for MLR rebates based on calendar year 2014 on forward. This change is being made so that carriers will be able to adjust their MLRs for their insurance and other premium stabilization program contributions, since those new fees will be excluded from the MLR just as other taxes are excluded. This change will not impact the next two years, since this year’s rebates will focus on the 2012 calendar year and rebates issued in 2014 will cover the 2013 calendar year.

Finally, a proposed rule from the Department of Treasury details exactly how the new national health insurance tax on premium volume that will impact all individual and group fully insured health plans beginning January 1, 2014 will work.

The power of mobile apps

March 5th, 2013 § 0 comments § permalink

This morning I stopped by my remote office (the new Starbucks on Route 47 in Huntley, Illinois), and while I was sipping on some java and working on a project I struck up a conversation with a fellow Huntley resident, John, who is on the Mobile App development team for Walgreens.  John actually works in downtown Chicago and generally commutes on the train but was working remotely this morning because of the inclement weather here (7-8 inches of snow is expected).

I mentioned to John how I love the Starbucks mobile app which has its Starbucks Rewards loyalty program embedded in it.  What I like about it is the fact that I am easily able to see exactly where I am at relative to getting a free reward of beverage or food.  Also, managing point of sale payments with the app is a cinch, and I never have to “think” about where my Starbucks card is at or, worse yet, be faced with the prospect of losing my stored value Starbucks card because everything is “on my smartphone” (and I am less likely to misplace my phone than I am my stored value card).

After hearing my experience John shared with me something that he observes every day on his commute into the Ogilvie Transportation Center in Chicago.  There is a food court on the lower level, and sure enough Caribou Coffee, Dunkin Donuts, and Starbucks are all located in the same general area.  Typically John observes at peak commuter times perhaps a couple people in line at Caribou Coffee, 5-6 people in line at Dunkin Donuts, and a line of 15-20 customers at Starbucks.  The differentiator you ask?  THE MOBILE APP!

If you do a search on the Android Play Store or the iPhone App Store on your smartphone for “Caribou Coffee”, this company does NOT currently have an app!  What?!?  Are you kidding me?  They offer stored value cards and gift cards, but no app?!?  Seriously?!?  Conversely, do a search for either Dunkin Donuts or Starbucks.  Both offer mobile apps for payment that are integrated with their customer loyalty programs.  Since he is a mobile app developer, John observed that a very large % of customers at the Dunkin Donuts and Starbucks stores at Ogilvie pay with their smartphone apps.  Therefore, I submit to my readers, not the least bit coincidentally both of these chains’ food court stores at the Ogilvie Transportation Center in Chicago dominate the foot traffic during the morning commute!

Memo to Caribou Coffee.  You have great products, but you’re WAY BEHIND THE CURVE on the technology side!  Get the app, please!

 

 

 

DOL Releases New Final FMLA Regulations

March 4th, 2013 § 0 comments § permalink

In early February, the Department of Labor issued new final regulations regarding the amendments to military family leave, flight crew eligibility and a handful of other relatively minor issues.

Because of the changes in the regulations, there is an obligation to begin using updated FMLA notice and certification forms and to post the new FMLA poster, effective March 8, 2013.

The following is an explanation of the changes:

Q. Why is the Department of Labor revising the Family and Medical Leave Act regulations?

A. The Department is revising the regulations to implement and interpret two statutory amendments to the Family and Medical Leave Act (FMLA): the National Defense Authorization Act for Fiscal Year 2010 (FY 2010 NDAA) and the Airline Flight Crew Technical Corrections Act (AFCTCA).

Q. How did the FY 2010 NDAA change the military leave entitlements?

A. The FY 2010 NDAA amended the FMLA’s military family leave provisions to expand the availability of military caregiver leave and qualifying exigency leave. The FY 2010 NDAA extended military caregiver leave to eligible employees whose family members are recent veterans with serious injuries or illnesses, including conditions that do not arise until after the veteran has left the military. The FY 2010 NDAA also expanded the definition of a serious injury or illness for both current servicemembers and veterans to include serious injuries or illnesses that result from a condition that existed before the servicemember’s active duty service and was aggravated by service in the line of duty on active duty.

In addition, the FY 2010 NDAA expanded qualifying exigency leave to eligible employees with family members serving in the Regular Armed Forces, in addition to the National Guard and Reserves. The FY 2010 NDAA also added the requirement that for all qualifying exigency leave the military member (National Guard, Reserves, Regular Armed Forces) must be deployed to a foreign country.

Q. How does the Final Rule change the military caregiver leave provisions?

A. Military caregiver leave entitles an eligible employee who is the spouse, parent, son, daughter, or next of kin of a covered servicemember with a serious illness or injury to take up to a total of 26 workweeks of unpaid, job-protected leave during any single 12-month period to care for the servicemember. Before the FY 2010 NDAA was enacted, military caregiver leave was limited to eligible employees who were the family members of current servicemembers with a serious injury or illness incurred in the line of duty on active duty. The Final Rule expands military caregiver leave to eligible employees who are the family members of certain veterans with a serious injury or illness incurred or aggravated in the line of duty on active duty and that manifested before or after the veteran left active duty. The Final Rule expands the definition of serious injury or illness for a current servicemember to include injuries or illnesses that existed prior to the servicemember’s active duty but were aggravated in the line of duty on active duty.

Q. Does the Final Rule allow eligible family members to take FMLA military caregiver leave for all veterans with a serious injury or illness?

A. No. The Final Rule limits FMLA military caregiver leave to family members of certain covered veterans. A veteran who is undergoing medical treatment, recuperation or therapy for a serious injury or illness is a covered veteran if he or she: (1) was a member of the Armed Forces (including a member of the National Guard or Reserves); (2) was discharged or released under conditions other than dishonorable; and (3) was discharged within the five-year period before the eligible employee first takes FMLA military caregiver leave to care for the veteran.

Q. How is the five-year period for a covered veteran determined?

A. The Final Rule permits eligible employees to begin taking military caregiver leave up to five years after their family member was discharged or released from the military. The employee’s first date of leave must be within the five-year period; however, the employee may continue to take such leave throughout the “single 12-month period” that is applicable to military caregiver leave, even if the leave extends beyond the five-year period.

For a veteran who was discharged before the effective date of this Final Rule, the Final Rule excludes the period of time between October 28, 2009 (the FY 2010 NDAA’s enactment date) and the effective date of this Final Rule in calculating the veteran’s five-year period. By excluding this period of time, the Final Rule protects the military caregiver leave entitlement for the family members of veterans whose five-year period either expired or was diminished between October 28, 2009 and the effective date of this Final Rule. For example, if a servicemember retired on October 28, 2007, on October 28, 2009 he or she would have had three years remaining of the five-year period. The family member will have three years, starting on March 8, 2013, within which he or she can begin to take military caregiver leave to care for that veteran. Likewise, if a servicemember was discharged on December 1, 2010, the five-year period will begin on March 8, 2013 and extend until March 8, 2018. If the servicemember is discharged on or after March 8, 2013, the five-year period begins on the date of discharge.

Q. What is a serious injury or illness for a covered veteran?

A. The Final Rule defines a serious injury or illness for a covered veteran as an injury or illness that was incurred by the veteran in the line of duty on active duty in the Armed Forces or that existed before the veteran’s active duty and was aggravated by service in the line of duty on active duty, and that manifested before or after becoming a veteran, and that is either:

  1. a continuation of a serious injury or illness that was incurred or aggravated when the veteran was a member of the Armed Forces and rendered the servicemember unable to perform the duties of the servicemember’s office, grade, rank, or rating; or
  2. a physical or mental condition for which the veteran has received a U.S. Department of Veterans Affairs Service-Related Disability Rating (VASRD) of 50 percent or greater, and the need for military caregiver leave is related to that condition; or
  3. a physical or mental condition that substantially impairs the veteran’s ability to work because of a disability or disabilities related to military service, or would do so absent treatment; or
  4. an injury, including a psychological injury, on the basis of which the veteran is enrolled in the Department of Veterans Affairs Program of Comprehensive Assistance for Family Caregivers.

The family member of a veteran only needs to show that the veteran meets one of these definitions to establish that the veteran has a serious injury or illness.

Q. Has the definition of a serious injury or illness for a current servicemember changed?

A. Yes. The Final Rule expands the definition of serious injury or illness for current servicemembers to include preexisting conditions that were aggravated by service in the line of duty on active duty.

Q. Have the medical certification requirements for military caregiver leave changed?

A. Yes. The Final Rule expands the list of health care providers who can provide a medical certification to support FMLA military caregiver leave to include health care providers who are not affiliated with the military. If a medical certification is obtained from a health care provider who is not affiliated with the military, the employer may request a second (or third) opinion from the employee. The Final Rule retains the provisions that healthcare certifications obtained from healthcare providers associated with the military may not be subject to second and third opinions. In either situation, employers are not permitted to request recertifications.

The Final Rule also allows eligible employees to submit a copy of a VASRD rating determination or documentation of enrollment in the Program of Comprehensive Assistance for Family Caregivers from the Department of Veterans’ Affairs to certify that the veteran has a serious injury or illness. However, if an employee submits such documents, the employee may still be required to provide additional information.

Q. How does the Final Rule change the qualifying exigency leave provisions?

A. Qualifying exigency leave entitles an eligible employee whose spouse, son, daughter, or parent is a military member on covered active duty to take unpaid, job-protected leave to address any of the qualifying exigencies listed in the regulations. Before the FY 2010 NDAA was enacted, qualifying exigency leave was limited to eligible employees whose family member was a military member of the National Guard and Reserves. The Final Rule implements the FY 2010 NDAA amendments expanding qualifying exigency leave to eligible employees with a spouse, son, daughter, or parent in the Regular Armed Forces on covered active duty . The Final Rule also includes a foreign country deployment requirement in the definition of covered active duty for both members of the Regular Armed Forces and members of the National Guard and Reserves.

In addition, the Final Rule adds a new category of qualifying exigency that allows employees to take qualifying exigency leave for certain activities related to the care of the military member’s parent who is incapable of self-care where those activities arise from the military member’s covered active duty. The Final Rule also increases the amount of time from five days to up to 15 calendar days that an eligible employee may take to spend with his or her military family member during the military member’s Rest and Recuperation leave.

Q. What is covered active duty?

A. For a member of the Regular Armed Forces, covered active duty or call to covered active duty status means duty during the deployment of the member with the Armed Forces to a foreign country.

For a member of the Reserve components of the Armed Forces (members of the National Guard and Reserves), covered active duty or call to covered active duty status means duty during the deployment of the member with the Armed Forces to a foreign country under a Federal call or order to active duty in support of a contingency operation.

Q. What is the definition of deployment of a member with the Armed Forces to a foreign country?

A. Deployment to a foreign country means the military member is deployed to an area outside of the United States, the District of Columbia, or any Territory or possession of the United States. Deployment to a foreign country includes deployment to international waters.

Q. Under what circumstances can qualifying exigency leave be taken for the care of the military member’s parent?

A. The Final Rule creates a new qualifying exigency leave category that allows an eligible employee to take qualifying exigency leave for certain activities related to the care of the military member’s parent who is incapable of self-care where those activities arise from the military member’s covered active duty, such as arranging for alternative care; providing care on a non-routine, urgent, immediate need basis; admitting or transferring the military member’s parent to a new care facility; and attending certain meetings with staff at a care facility, such as meetings with hospice or social service providers.

Q. What are the Airline Flight Crew Technical Corrections Act (AFCTCA) amendments?

A. The AFCTCA established a special hours of service eligibility requirement for airline flight crewmembers and flight attendants (as those terms are defined by the Federal Aviation Administration) that reflects the unique scheduling requirements of the airline industry. The Final Rule provides that an airline flight crewmember or flight attendant (collectively referred to in the Final Rule as an airline flight crew employee) will meet the FMLA hours of service eligibility requirement if he or she has worked or been paid for not less than 60 percent of the applicable total monthly guarantee (or its equivalent) and has worked or been paid for not less than 504 hours (not including personal commute time or time spent on vacation, medical, or sick leave) during the previous 12 months. Airline employees who are not flight crew employees continue to be covered under the general hour of service eligibility requirement which requires 1,250 hours of service in the previous 12 months.

Q. Where in the FMLA regulations are the regulations related to airline flight crew employees?

A. The Final Rule incorporates the provisions relating to airline flight crews into Subpart H of the regulations, Special Rules Applicable to Airline Flight Crew Employees. This subpart previously contained the definitions of significant terms under the FMLA, which have been moved to § 825.102. Using a single subpart for the special rules for airline flight crew employees should enhance the clarity and utility of the regulations applicable to this specific group of employees, and prevent confusion about the applicability of the special rules for airline flight crew employees to any other types of employees.

Q. How will usage of FMLA leave for airline flight crew employees be calculated?

A. Eligible airline flight crew employees are entitled to 72 days of leave during any 12-month period for FMLA-qualifying reasons other than military caregiver leave, and 156 days of leave during any single 12-month period for military caregiver leave. If an airline flight crew employee takes leave intermittently or on a reduced schedule, the employer must account for the leave using an increment no greater than one day. This method of leave calculation applies only to airline flight crew employees.

Q. Are there special recordkeeping requirements for employers in the airline industry?

A. Yes. In addition to the existing FMLA recordkeeping requirements, covered employers of airline flight crew employees must maintain records or documents containing information specifying the applicable monthly guarantee for each category of employee to whom the guarantee applies, including copies of any relevant collective bargaining agreements or employer policy documents. Covered employers of airline flight crew employees must also maintain records of the airline flight crew employees’ hours worked and hours paid.

MISC.

Q. Are all of the provisions of the Final Rule in effect now?

A. No. The regulatory changes contained in the Final Rule will not take effect until 30 days from the date the Final Rule is published, including an eligible employee’s entitlement to take military caregiver leave to care for certain veterans. However, the AFCTCA amendment and certain statutory provisions of the FY 2010 NDAA amendments to the FMLA are already in effect. Eligible airline flight crew employees were entitled to take FMLA leave beginning on December 21, 2009. As of October 28, 2009, eligible employees were entitled to take FMLA leave for qualifying exigencies related to their spouse, parent, or child’s deployment to a foreign country with the Regular Armed Forces. The foreign deployment requirement is also in effect as of that date for eligible employees taking qualifying exigency leave due to the call-up of a covered family member in the National Guard or Reserves. Additionally, as of October 28, 2009, eligible employees were entitled to take military caregiver leave to care for a current servicemember whose serious injury or illness is caused by the aggravation in the line of duty of a preexisting condition.

Q. Are the FMLA optional use forms removed from the regulations as was proposed?

A. Yes, the optional use forms are removed from the regulations’ appendices. Removal of the forms from the regulations will allow the Department to make non-substantive changes to the forms in a more effective manner while still offering the public an opportunity to comment on proposed changes. The Department’s authority for the collection of information in the FMLA forms stems from the statute and/or the implementing regulations and changes to the information included in the forms will continue to require rulemaking. Additionally, the forms are subject to the requirements of the Paperwork Reduction Act of 1995 (PRA) which provides the general public and Federal agencies with an opportunity to comment on proposed and/or continuing collections of information every three years. The removal of the forms will give the Department the ability to maintain one version of the FMLA forms, thereby lessening the confusion among employees and employers currently resulting from the existence of multiple versions of the forms. The forms will continue to be available on the WHD website (www.dol.gov/whd).

Q. Does the Final Rule contain changes to the manner in which employers calculate intermittent or reduced schedule leave?

A. The Final Rule does not make any substantive changes in the way that employers calculate intermittent or reduced scheduled leave. But the Final Rule does add language clarifying the calculation of leave provision. The Final Rule also establishes new rules for calculation of leave applicable only for airline flight crew employees.

Q. Are there any other changes to the regulations in the Final Rule?

A. Yes. Additional changes include moving the definitions section from § 825.800 to § 825.102 to enhance the utility of the regulations by defining terms before they are used in the substantive provisions and be more consistent with other regulations implementing statutes administered by the WHD. The Department also added language in the Final Rule to the Recordkeeping provision setting forth an employer’s obligation to comply with confidentiality requirements of the Genetic Information Nondiscrimination Act of 2008 (GINA), and amended references to the Uniformed Services Employment and Reemployment Rights Act (USERRA) to more closely mirror the USERRA regulations.

For a copy of the final regulations, please click on the link below:

https://www.federalregister.gov/articles/2013/02/06/2013-02383/the-family-and-medical-leave-act

Important near term fiscal considerations for Medicare Advantage plans

March 4th, 2013 § 0 comments § permalink

It seems that essential health programs, such as Medicaid and Medicare, are always the first on the chopping block when it comes to budget cuts. This is largely due to the fact that these programs consume an enormous percentage of federal and state budgets. While there are components of each program that are in serious need of a fix, the cuts always seem to come from the wrong place. The Medicare Advantage plan is the most recent plan being threatened.

Embedded in PPACA are $716 billion in Medicare cuts, many of which come from Medicare Advantage. Right now, the insurance industry is fighting with Centers for Medicare and Medicaid services (CMS) regarding a proposal to cut 2.2% of Medicare Advantage payments beginning in April. This payment cut would likely result in higher out-of-pocket costs for seniors and reduce their benefits and healthcare choices. CMS on the other hand, argues that this payment cut would give interested parties more of an incentive to fight harder to repeal the Sustainable Growth Rate (SGR) formula; a fatally flawed formula that has unsuccessfully been used for years to predict Medicare payments. Despite the fact that the SGR formula has virtually been flawed since its inception, it has yet to undergo a long-term fix. While developing a long-term SGR formula fix would save money and potentially boost Medicare Advantage payments in the future, cutting payment and subjecting seniors to higher out-of-pocket costs and different benefits and health services in the meantime to us seems just a little too risky.

The America Health Insurance Provider (AHIP) Center for Policy and Research recently published a report that shows when coupled with other health reform related changes, CMS’ most recent proposal for the program will reduce Medicare Advantage payments next year by more than eight percent, or approximately $11 billion. Obviously, cuts of this magnitude will have a destabilizing effect on the program and be putting at risk the healthcare coverage upon which millions of beneficiaries rely.

Another Exchange Deadline Has Come and Gone, States Still Left Undecided

March 4th, 2013 § 0 comments § permalink

February 15th was the final deadline for states to decide whether or not they wanted to enter into a partnership with the federal government or default to a federally facilitated exchange. Leading up to the deadline, six states had yet to make a decision and some still remained undecided. States that failed to formally notify the federal government of their decision automatically defaulted to a federally facilitated exchange. As of the deadline, the federal government will be implementing 26 state exchanges, which is way more than they had originally anticipated.

The state-based exchange provision of PPACA was put in place to give state officials more control over their state’s health coverage marketplaces. But instead of embracing the idea of state control, many states took the “you want it, you build it” approach to exchange creation and implementation. The sheer workload, future costs and lack of guidance from the Administration also did not make the idea of creating a state-based exchange appealing to many states.

Among the states that had not made an official decision leading up to the deadline was New Jersey. Governor Chris Christie, who has repeatedly stated that the Administration had not provided the states with enough information to make a sound decision on exchanges, sent a letter to Secretary Kathleen Sebelius on Friday announcing his choice to default to a federally facilitated exchange. Governor Rick Scott of Florida, unsurprisingly, also defaulted to a federally facilitated exchange.

Iowa, Michigan, New Hampshire and West Virginia all submitted applications for federal partnership exchanges just before the February 15th deadline.

Following the deadline, Secretary Kathleen Sebelius of HHS, in a blog post, reminded the states that the decision they make now does not dictate their exchange model forever, it just determines what model they will use in preparation for the October 1st open enrollment date. States will have the opportunity to run their own exchanges in future years, said Sebelius.

 

Final rule covering the definition of essential health benefits (EHBs) and the determination of actuarial value for the individual and small group markets

March 4th, 2013 § 0 comments § permalink

HHS released a final rule on Wednesday, February 20 that covers the definition of essential health benefits (EHBs) and the determination of actuarial value for the individual and small group markets. The new rule also sets the minimum value of coverage that large employers need to meet to avoid the health reform law’s employer mandate excise tax penalties. HHS released calculators for determining actuarial value in individual and small group plans and minimum value for employer plans subject to the responsibility requirements. If some of these documents looks familiar to you that is because the final rule is extremely similar to the proposed version that was issued in November 2012.

We still have affordability concerns with regard to the EHB and actuarial value requirements and this final rule is by no means perfect. But a few places where the final rule differs from the proposed version are key, and we are pleased to say a number of changes requested by our national trade association, the National Association of Health Underwriters (NAHU) in its formal comment letter were granted. First of all, with regard to the minimum value standard, NAHU members have been privately communicating to HHS that employers who have to buy small group market coverage, but also have to comply with the employer mandate provisions of the law, should not have to do any additional verification of their plan’s actuarial value for over a year. NAHU made this point again in official comments on the proposed rule, noting that requiring small employers to meet both standards would be “duplicative, unnecessary and overly burdensome.” Fortunately, HHS took NAHU’s recommendation seriously and created the exact safe harbor it requested for small employer plans.

The final rule also stipulates that the EHB requirements will apply to individual plans on a plan year basis, not on January 1, 2014. This change was requested by NAHU specifically, since many individual policies renew at other times of the year and the idea of significant benefit and policy changes hitting all of these policies and consumers mid plan-year scared us. Or, as NAHU put it to HHS, “created significant consumer protection and education concerns.”

Another important clarification was made in the final regulatory language that employer contributions to a health savings account (HSA) and amounts newly made available under an integrated health reimbursement account (HRA) that may be used only for cost sharing will be taken into account for determining a plan’s minimum and actuarial value. In addition, the final rule gives health plans an out with regard to the law’s small group $2000/$4000 deductible limit if they think it will prevent them from offering bronze level coverage options. We are still waiting for sub-regulatory guidance about how exactly that out will work, but it is good news nonetheless.

Finally, HHS granted a NAHU request regarding stand-alone dental plans, allowing them to be sold in combination with a QHP outside of state-based exchanges in order to satisfy the pediatric dental EHB requirement. Previously it was only clear that stand-alone plans could be used in conjunction with a QHP in exchange-based plans.

The final rule is a quick read—just 149 pages! But if you are pressed for time, courtesy of NAHU’s retained council Ernst and Young, key provisions of the rules are highlighted below.

Minimum value, actuarial value
The rule does not make major changes to minimum value ted provisions laid out in a proposed rule from HHS published in the November 26, 2012, Federal Register, and in Treasury Notice 2012-31. The rule outlined a number of ways to determine whether employer-sponsored self-insured group health plans and insured large group health plans meet the MV standard:

MV calculator. The rule states that employers will be able to determine whether a plan meets the MV standard by using an MV calculator, which HHS and the Internal Revenue Service posted online today. The calculator is similar to an actuarial value (AV) calculator that HHS also released today for use in the individual and small group markets. However, the MV calculator relies on continuance tables and a standard population reflecting claims data of self-insured employer plans, while the AV calculator has been developed using a set of claims data weighted to reflect the standard population projected to enroll in the individual and small group markets for the identified year of enrollment.

Design-based safe harbors. The proposed rule states that employers also can determine whether a plan meets the MV standard by using an array of design-based safe harbors published by HHS and IRS in the form of a checklist. As outlined in the November 26, 2012, proposed rule, each checklist would describe the cost-sharing attributes of a plan that apply to the following four categories of benefits and services:

  • Physician and mid-level practitioner care
  • Hospital and emergency room services
  • Pharmacy benefits
  • Laboratory and imaging services

HHS has stated that the four categories of benefits and services comprise the majority of group health plan spending.

Certified actuary. Employers could use a certified actuary to determine whether an employer-sponsored plan meets the MV standard only if the plan contains non-standard features and neither the MV calculator nor the design-based checklists applies to the plan.

Small group market metal categories. The final rule states that any plan in the small group market that provides the bronze, silver, gold or platinum level of coverage based on an actuarial value test will be considered to satisfy the MV requirement.

The final rule clarifies that employer contributions to a health savings account (HSA) and amounts newly made available under an integrated health reimbursement account (HRA) that may be used only for cost sharing will be taken into account for determining MV. An accompanying Minimum Value Calculator Methodology document explains that the MV calculator treats such contributions as covered “first-dollar” spending for covered services (see page 8 of “Minimum Value Calculator Methodology”). In addition, the final rule’s preamble states that the Administration is giving “further consideration” to the question of whether other integrated HRAs might be counted toward MV.

HHS asks that technical issues and operational concerns about the MV calculator be sent to minimumvalue@cms.hhs.gov.

Essential health benefits
Large group plans and grandfathered plans are not required to cover the 10 benefit categories that the ACA requires EHBs to include; however, such plans may not impose lifetime or annual limits on any essential health benefit that they do offer. Plans offered in the individual and small group markets, whether inside or outside state-based Exchanges, must cover EHBs beginning in 2014. To define EHBs, HHS proposed that states select a benchmark plan from the following four options:

  1. The largest plan by enrollment in any of the three largest small group insurance products in the State’s small group market;
  2. Any of the largest three State employee health benefit plans by enrollment;
  3. Any of the largest three national Federal Employee Health Benefits Program plan options by enrollment; or
  4. The largest insured commercial non-Medicaid Health Maintenance Organization (HMO) operating in the State.

Twenty-six states selected their own benchmark plan from the above options, and HHS designated the largest small-group product in the state as the default benchmark in the remaining states.

The rule requires qualified health plans (QHPs) in an Exchange to cover either one drug in each class or as many drugs as are covered in the state benchmark plan, whichever is greater. The November 26, 2012, proposed rule would have required QHPs to cover just one drug per class. HHS will issue future guidance directing plans to include procedures to allow individuals to gain access to clinically appropriate drugs.

Stand-alone dental coverage. With regard to the pediatric dental coverage category of EHB, the final rule states that stand-alone dental plans will be subject to a “reasonable” out-of-pocket maximum separate from the out-of-pocket maximum for the rest of the EHBs covered by QHPs in an Exchange. Exchanges will determine what constitutes a “reasonable” out-of-pocket maximum.

In addition, the final rule recognizes that the actuarial value calculator available for QHPs “would be inappropriate for stand-alone dental plans” and provides for stand-alone dental plans to be categorized as “high” (actuarial value of at least 85%) or “low” (actuarial value of at least 70%, reduced from 75% in the November 26, 2012, proposed rule). The rule requires the above actuarial values to be certified by a member of the American Academy of Actuaries using generally accepted actuarial principles.

The final rule also states that plans outside of the Exchange may sell products that do not include pediatric dental coverage if they are “reasonably assured” that such coverage is sold only to individuals who purchase Exchange certified stand-alone dental plans.

HHS issues final market reform regulations for the individual and small group markets that take effect in 2014

March 4th, 2013 § 0 comments § permalink

On Friday, February 22nd HHS issued a final version of the market reform regulations for the individual and small group markets that take effect in 2014. For those of you not interested in slogging through 145 pages of requirements, HHS produced a handy one-page fact sheet on their work. On February 22, the Department of Labor (DOL) also issued interim final regulations on procedures for addressing complaints by employees that have suffered retaliation from their employers because they reported violations of the health reform consumer protections or because they have received advance premium tax credits.

The market rules set the final standards for the new modified community rating requirements that all individual and small group insurers will be subject to in the years ahead.  Notably while everyone from employers to insurance commissioners to carriers to NAHU begged in their formal comment letters to HHS for transition relief for the new rating requirements to prevent rate shock, HHS did not yield. Therefore, unless Congress takes action to stop it, rates could raise significantly for small employers and younger individuals in the individual and small group markets. An Oliver Wyman study shows that rates for young participants in the individual market would increase 45% and a survey of insurers conducted by the American Action Forum shows that rates could go up for young, healthy individuals by 189%.

While HHS made no changes on the age rating requirements, other parts of the regulation did change significantly from the proposed rule. Key changes include:

  • Allowing state discretion on geographic rating zones instead of mandating a maximum of seven zones as originally proposed.  The final rule expands state discretion, continuing to require rating areas to be based on counties, three-digit zip codes, or MSAs, but permitting states to use geographic rating areas legally established by January 1, 2013, or after January 1, 2013, as long as the number of rating areas does not exceeding the number of MSAs in the state plus one. States may also establish more geographic rating areas with HHS approval.
  • The final rule clarifies how tobacco rating will be handled and requires small group plans to offer tobacco cessation wellness-program discounts. The final rule defines “tobacco use” as the use of any tobacco product four or more times a week on average (other than for religious or ceremonial purposes) within the last six months. States can enact more consumer protective definitions or look-back periods, or reduce or eliminate the tobacco surcharge altogether. Insurers cannot rescind or deny coverage based on misrepresentations of tobacco use, but can recoup premiums that should have been paid based on tobacco rating since the beginning of the policy year.
  • States who wish to establish stricter age or tobacco bands than what HHS requires or merge their individual and small-group risk pools, must report these decision to HHS within 30 days.
  • The final rule does not permit insurers to impose small group market contribution or participation requirements on small-group employers, but they may limit msmall groups that do not meet minimum participation or coverage requirements to a one month open enrollment period annually between November 15 and December 15.
  • The rule clarifies that student health insurance coverage is not subject to the single risk pool requirement of the law and that the premium rate charged by an issuer offering student health insurance coverage may be based on a school-specific group community rating. HHS also finalized its decision to exempt student health insurance coverage from the guaranteed availability and the guaranteed renewability requirements of the Public Health Service Act.
  • The final rule does not specifically address penalties to prevent adverse selection in the individual and small group markets as many suggested, but it does promise future guidance on permissible approaches to this problem.  The rule also requires an annual, end of the year, open enrollment period, and provides a one-time 30-day special enrollment period for 2014 for individuals whose policy years are not on a calendar year basis. States are permitted to establish more frequent open enrollment periods.  Individuals are also able to purchase individual coverage at any time if they experience one of the “qualifying events” that would qualify them for COBRA coverage. Furthermore individuals will get limited open enrollment periods of 60 days if they experience any of the following triggering events: loss of minimum essential coverage; an individual gaining or becoming a dependent through marriage, birth, adoption, or placement for adoption; errors in enrollment; violation of a material provision of the insurance contract by the insurer; eligibility or ineligibility for premium tax credits or changes in eligibility for cost-sharing reductions; or an individual’s permanent move.

The DOL also issued an interim final rule to establish protection of employees who may have been subject to retaliation for 1) reporting violations of the ACA’s consumer protections, or cooperating in the investigation or prosecution of such violations, or 2) receiving premium tax credits, thereby exposing their employer to liability for failing to provide adequate and affordable health coverage. The rule includes procedures and time frames for employees to make complaints to the Occupational Safety and Health Administration (OSHA) and for investigations by OSHA, appeals of OSHA determinations to an administrative law judge (ALJ), review of ALJ decisions by the Administrative Review Board (ARB) (acting on behalf of the Secretary of Labor), and judicial review of the Secretary’s final decision.

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