• Which insurance mandates already apply to all plans (including the adult child coverage requirement and the prohibition on preexisting condition exclusions for children)
• Which insurance mandates apply to plans that have lost grandfathered status (including the revised claims and appeals procedures and the no-cost-sharing-for-preventive-services requirement)
• What steps employers should take to make sure they are in compliance
• Value-based insurance designs that will help control costs within this new regulatory scheme
• The definitions of essential health benefits and minimum essential coverage
• The role of minimum essential coverage under PPACA
• Why essential health benefits are important on the exchanges
• Why essential health benefits are important to employers outside of the exchanges
• How to select a “benchmark” for determining what essential health benefits means to your plan
• What changes are expected in the future
• What notices are required (including the SBC, the annual limit waiver and the grandfathered notice)
• What the timing requirements are for these new notices
• When electronic communication makes sense
• Strategic opportunities presented by the Affordable Care Act notice requirements
• Issues with delivery, can you send out electronic versus hard copy documentation
• What is an exchange and who is eligible for coverage under the exchanges
• What types of benefits will be offered through the exchanges
• Whether the exchanges will prove to be an effective means of delivering insurance
• Whether the private exchanges might prove to be a viable alternative to the state/Federal exchanges or to coverage outside of the exchanges
• The personalization offered to consumers through a private exchange
• A discussion of what size business is considered an “applicable large employer” for purposes of the employer mandate
• An overview of the rules for determining what other businesses within your corporate family must be considered for purposes of this analysis
• A discussion of how to determine whether an individual is an employee for purposes of the mandate
• A discussion of how to determine whether an individual must be treated as a “full-time” employee for purposes of the mandate
• Ways to identify health insurance products in the marketplace that will satisfy the employer’s obligation
• How are penalties calculated and what is the middle group for playing vs. paying
• What is a welfare benefit plan
• What is a “group health plan”
• What are the plan document and participant communication requirements for welfare plans
• What claims and appeals requirements apply to ERISA group health plan
• What penalties apply for ERISA violations and how are these penalties incorporated for violations of PPACA
• The causes of action available to employees seeking mandated benefits and strategies to avoid those actions
• How to develop an employee communication campaign that addresses key PPACA concerns while avoiding unnecessary litigation exposure
• The litigation risks inherent with “workforce realignment” and how to minimize those risks