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PPACA: What’s Happening Now

Implementation of various provisions of the Patient Protection and Affordable Care Act (PPACA) will become effective in the near term while others engage several years from now. PPACA’s effects on employer-sponsored group health plans differ on whether the plan is “grandfathered,” insured or considered large, but many of the law’s requirements apply regardless.

For plans operating on a calendar year, summaries of benefits and coverage (SBC), as well as a uniform glossary of coverage and medical terms, must be distributed to plan participants. The PPACA SBC rule goes into effect September 23, 2012, and is intended to provide a uniform explanation of coverage.

Beginning January 1, 2013, non-grandfathered LIUNA health and welfare funds must expand the list of women’s preventive healthcare services covered in full to include well-woman visits, screening for gestational diabetes and screening/counseling for domestic violence and for HIV. Unless an exception applies, contraceptives must also be covered without charge to the patient.

Now is the time to start planning for change which will be effective on January 1, 2014. Some of the changes that will affect LIUNA’s health and welfare funds include no annual limits on the dollar value of essential health benefits and extension of coverage to nondependent children up to age 26 regardless of whether coverage under another employer plan is available to them.

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