New versions of the Summary of Benefits and Coverage (SBC) template, instructions, uniform glossary, and related documents are required for use on or after April 1, 2017. Under the Affordable Care Act, group health plans and health insurance issuers are generally required to provide a written SBC to plan participants and beneficiaries at specified times…
A revised model notice is now available for all employers that provide group health coverage in states with premium assistance through the Children’s Health Insurance Program (CHIP), or Medicaid, to inform employees of potential opportunities for assistance in obtaining coverage. The employer CHIP notice must be furnished to all employees annually before the start of…
SIMA was delighted to share information and good times with the members of the Association of Legal Administrators at their annual retreat this past month in Williamsburg, Virginia. Consultant Chris Nagle and Marketing Coordinator Kerri White discussed ways in which administrators in legal offices can work smarter, not harder, to alleviate many of the burdens…
A good basketball team is at its best when its top players are on the floor. Similarly, a company is the most productive, efficient and innovative when its best employees are in the right positions, doing great work. Unfortunately, it’s not uncommon for good employees to battle personal problems, such as substance dependence, financial and…
The Medicare Modernization Act requires employers that provide prescription drug coverage to Medicare-eligible individuals to complete the Online Disclosure Form to the U.S. Centers for Medicare & Medicaid Services (CMS) to report whether such coverage is creditable prescription drug coverage (“creditable coverage”). Creditable coverage is coverage that is expected to pay, on average, as much…
The U.S. Department of Labor (DOL) has extended the effective dates of its model Employer CHIP Notice, General Notice of COBRA Rights, and COBRA Election Notice through December 31, 2019. Previously, these model notices expired on December 31, 2016. No other changes have been made to these notices. For the latest guidance regarding these notices,…
President Trump has signed an executive order calling upon federal administrative agencies to minimize the economic burden of the Affordable Care Act (ACA), pending repeal of the law. Until further guidance is issued or legislation is signed, however, all ACA requirements remain in effect, including penalties for noncompliance. In addition to making clear that the…
President Trump has signed an executive order calling upon federal administrative agencies to minimize the economic burden of the Affordable Care Act (ACA), pending repeal of the law. Until further guidance is issued or legislation is signed, however, all ACA requirements remain in effect, including penalties for noncompliance. In addition to making it clear that…
The goal of the Anthem National Drug List is to provide access to drugs and therapies with clinical evidence to improve the health of our members, while keeping health care affordable. Our drug lists include brand-name and generic prescription medications that have been reviewed through our Pharmacy and Therapeutics (P&T) process. Through the P&T process,…
A new law allows certain small employers–those with fewer than 50 full-time equivalent employees who do not offer a group health plan–to offer new “qualified small employer health reimbursement arrangements” to reimburse employees for qualified medical expenses, including individual health insurance premiums, for years after December 31, 2016. The law also includes a notice requirement…
