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Proposed health reform rules require clarity on abortion and other coverages

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Proposed health reform rules require clarity on abortion and other coverages

Employers would have to state clearly whether or not their health plans pay for abortion services among other requirements under health care reform law rules issued last week.

Under the rules proposed by the Health and Human Services, Labor and Treasury departments, employers would have to revise what are known as summaries of health benefits and coverage, or SBCs, under the Patient Protection and Affordable Care Act for health plan years that begin on or after Sept. 1, 2015.

“That is not a lot of extra time, but it should be sufficient time” for employers to make the necessary changes, said Gretchen Young, senior vice president of health policy at the ERISA Industry Committee in Washington.

Like the current summaries, employers must give examples of how coverage applies in two specific situations: having a baby and managing Type 2 diabetes.

The proposed rules issued last week would add a third example: a foot fracture with an emergency room visit. “This example is proposed as a health problem that most individuals could experience, whereas having a baby and Type 2 diabetes affect a subset of the population,” HHS, Labor and Treasury said in the proposal.

Richard Stover, a principal at Buck Consultants at Xerox in Secaucus, New Jersey, said that would require employers to update the benefits summaries they provide to employees.

The rules also would require employers to make it clear whether or not coverage is provided for abortion services.

“Explicit disclosure of abortion coverage would be required,” said Barbara McGeoch, a principal at Mercer L.L.C. in Washington.

The SBCs would have to state whether or not a plan provides minimum essential coverage and minimum value, which the reform law broadly defines as paying for 60% of covered services.

In addition, following earlier guidance, the proposed rules say separate SBCs would not be required for flexible spending accounts, health savings accounts and health reimbursement arrangements integrated with medical plans, nor would they be required for stand-alone dental and vision care plans.

As is currently the case, employers do not have to provide employees with paper summaries for every plan in which new employees are eligible to enroll. Instead, employers can provide a website on which to view them.

For employees already enrolled in a health plan, employers would have to provide an online SBC only for the plan in which the employee is covered, with electronic links to other available plans.

Plan participants also have the right to request paper copies of SBCs.

The deadline for submitting comments on the proposed rules is March 2.