NovemberReport - page 9

November 2013 CBA REPORT
l
9
feature article
sidered essential health benefits for
purposes of the rules that apply to group
health plans. Until that guidance is is-
sued, employers must make a reasonable
good faith effort to define essential health
benefits in accordance with PPACA.
However, the regulatory agencies
have indicated that they will consider an
employer plan to have used an appropri-
ate definition if the plan uses any state’s
definition of essential health benefits. At
this point, there does not appear to be
any limitation on which state definition
an employer could choose.
For example, an Ohio employer
may decide to use Utah’s definition of
essential health benefits because Utah’s
definition appears to be the least com-
prehensive. Using the Utah definition,
therefore, would allow the plan to impose
annual or lifetime dollar limits on more
benefits than if the plan used Ohio’s
definition.
Because of the lack of clear guidance,
however, employers should consult with
legal counsel in order to confirm which
benefits will be considered essential
health benefits under its group health
plan.
So,Why is it Essential to
understand the Meaning of
Essential?
Individuals need to understand how
they can obtain minimum essential
coverage in order to avoid a tax penalty,
but they should also understand that the
minimum essential coverage they receive
might not cover all of the health care
services they expect.
Employers need to understand that
they do not have to offer essential health
benefits in order to comply with PPACA
or avoid the pay-or-play penalty. How-
ever, they should also understand how to
define essential health benefits in order
to confirm that their plans comply with
the rules applicable to those benefits.
Wilcoxon is a partner inThompson Hine LLP’s
Employee Benefits and Executive Compensation
group and advises employers on the legal requirements
applicable to group health plans.
Todd Bailey, Bea Larsen, Jerry Lawson, Bob Kaiser, Mike Kaufman, Lori Ross
We ARE Mediation
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Todd Bailey
Jerry Lawson
Mike Kaufman
Bea Larsen
Bob Kaiser
Lori Ross
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