As part of the Core Content for this program participants must read our Bi-Weekly ACA Thursday Newsletter Updates and attend our webcast updates to understand the changing landscape of the ACA and healthcare reform.

The Affordable Care Act enacted a number of insurance market reforms intended to expand insurance coverage. Many of these provisions are already effective for employer-sponsored health plans, and many more could become effective on the date these plans lose grandfathered status. Navigating through this maze of mandates is a daunting task; learn what is applicable and what is not especially given the new political platform with every changing politics related to the ACA.  In this session, you will learn:
• 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 Affordable Care Act creates two new concept known as “essential health benefits” and “minimum essential coverage, which have huge significance under the law. Unfortunately, few understand exactly what these terms mean and often confuse the two as being one and the same. In this session, you will learn:

• 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

The Affordable Care Act creates a whole host of new employee reporting and disclosure requirements. It also provides employers with a good opportunity to demonstrate to employees the value of the benefits they are receiving. Active coordination and participation between both parties will create a more efficient ease of transition in this significant reform adaptation period. In this session, you will learn:

• 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

The Affordable Care Act creates a new marketplace for individuals and small employers to purchase health insurance, known as “exchanges” or “marketplaces.” The exchanges will be operated by states, or if the states are unwilling or unable to set up an exchange, the Federal Government. Not to be outdone, many private organizations have begun establishing private exchanges that will serve a broader audience and compete with the state and Federal exchanges. In this session, you will learn:

• 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

The employer mandate regulations offer guidance and a set of complicated rules for determining the employers that are subject to the mandate, when they are subject to the mandate, and how to determine the potential penalties under the mandate. These regulations also define who is and who is not an employee for purposes of determining whether the employer has the requisite number of “full-time employees” and “full-time employee equivalents” to be subjected to the employer mandate and, if so, how many of those employees will count towards penalty determinations under the mandate. This session will include:

• 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

This continues the discussion on the employer mandate regulations and applies it to the following:
• 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
Understanding PPACA starts with a basic understanding of what ERISA requires. After all, existing rules under ERISA formed the building blocks for health care reform. Moreover, an inadvertent ERISA or PPACA violation could expose the plan or its fiduciaries to massive liability. This session will cover background information intended to help form a basic understanding of ERISA principles, including:

• 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

As employers struggle with technical compliance, there are a number of litigation hazards that must be considered in implementing PPACA. From employee communications to the provision of mandated benefits, employers and ERISA plan fiduciaries have litigation exposure under PPACA. Moreover, as employers realign their workforces to avoid a penalty under PPACA’s employer mandate, they may be opening themselves up to a significant litigation downside that includes awards of special damages, emotional distress, back pay, reinstatement and other remedies. In this seminar you will learn:

• 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