USI faculty and staff need to know the federal, state, University workplace laws and regulations listed below. USI satisfies the annual notice requirement by including these notices in your annual open enrollment materials and sending an electronic reminder to faculty and staff annually to visit the HR web page and review this information. Some notice requirements are satisfied by insurer mailings. Other benefits related notices are also available in poster form in HR and have been added to this web site as well.
The Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act of 2010 contain a number of changes that went into effect beginning January 1, 2011, for calendar year plans.
The Anthem plans are not grandfathered, and the University in 2011 added 100% coverage of preventative services as defined under PPACA, in keeping with the University’s increased emphasis on wellness. All Anthem plans have incorporated required changes due to health reform under PPACA including allowing coverage of dependents to age 26, having no pre-existing conditions, ending the plan’s lifetime maximum, and, if applicable, limiting annual maximums on essential benefits. Specific information regarding these changes can be found in your Summary Plan Description (SPD).
Health Insurance Market Place – This notice contains information regarding the Health Insurance Market Place and Health Insurance that USI offers.
Health and Welfare Plans
The following notices can be found in your health plan Summary of Benefits or Certificate of Coverage:
Newborns’ and Mothers’ Health Protection Act of 1996 (Newborns’ Act): This notice establishes minimum inpatient hospital stays for newborns and mothers following delivery.
The Women's Health and Cancer Rights Act of 1998 (WHCRA): This notice covers required benefits for mastectomy-related reconstructive surgery, prostheses, and treatment of physical complications of mastectomy.
Mental Health Parity and Addiction Equity Act of 2008: This law, which applies to employers with more than 50 employees, extends the mental health parity laws to substance-use disorders in two ways. First, benefits for mental health and substance-use disorders must be in parity with medical/surgical benefits with respect to both the application of aggregate lifetime and annual dollar limits. Second, plans may not have different financial requirements (e.g., deductibles, copayments, or coinsurance), treatment limitations (e.g., number of covered visits and days of inpatient coverage), or out-of-network coverage limitations for mental health and substance-use disorder benefits than for medical/surgical benefits.
Claims Review Procedures: Plan sponsors of group health plans that are not grandfathered are subject to new claims, appeals and external review procedures for plan years beginning on or after September 23, 2010. See attached Anthem External Review notice and Grievances and Appeal notice.
Summary Plan Descriptions:
Section 125 Flexible Spending Account Plans
Over-the-Counter Medications: Beginning January 1, 2011 (regardless of the plan year), expenses for over-the-counter drugs (other than insulin) cannot be reimbursed under a flexible spending account or health savings account unless prescribed by a physician. See Nyhart’s notices: Important Flex Plan Rule Change and OTC Drugs and Medicines.
Dependents to 26: Pursuant to IRS guidance, USI’s flex plan has been amended to allow flexible spending accounts and health savings account arrangements to offer tax-advantaged coverage and reimbursements for an employee's child who has not attained age 27 as of the end of the month of that birthday.
Special Enrollment Rights: A group health plan must provide each employee who is eligible to enroll with a notice of his or her HIPAA special enrollment rights at or prior to the time of enrollment. Each benefit-eligible employee receives this notice at benefits orientation and each open enrollment. To review it again, see Special Enrollment Rights notice.
Anthem HIPPA Privacy Notice: This notice from Anthem contains information regarding the handling of your protected health information (PHI). You also received this information via mail from the health insurer.
USI HIPPA Privacy Notice: This notice from USI contains information regarding the handling of your protected health information (PHI).
HITECH: The Health Information Technology for Economic and Clinical Health Act (HITECH) makes significant changes to the privacy and security requirements of HIPAA. HITECH is generally effective February 17, 2010 and includes the following requirements and restrictions. First, HITECH directly expands privacy and security rules to business associates and their subcontractors, which may require covered entities to revise their business associate agreements to comply with the changes. Second, both business associates and covered entities must comply with new security breach rules that require notification to the individual whose protected health information was compromised. Third, a covered entity generally must agree to an individual's request to restrict disclosures to a health plan, if the protected health information pertains solely to services for which the provider has been paid out of pocket in full. Fourth, HITECH imposes new restrictions on disclosures that prohibit the sale of protected health information and imposes restrictions on the use of protected health information for marketing purposes. Fifth, several changes in enforcement have taken place. Civil penalties have been substantially increased, state attorneys general now have enforcement power, and new regulations require the sharing of civil penalties with individuals.
Children's Health Insurance Program Reauthorization Act (CHIPRA):CHIPRA requires group health plans to provide employees with certain information regarding Medicaid and state health assistance programs, and to cooperate with government requests for certain plan information. See CHIPRA notice.
Medicare Part D: Group health plans providing prescription drug coverage must provide a notice to any individual covered by or eligible for the group health plan that is eligible for Medicare (an “eligible individual”). The notice must explain whether the plan’s prescription drug coverage is creditable. Coverage is creditable if it is actuarially equivalent to coverage available under the standard Medicare Part D program; both the Anthem Buy-Up and Core Plans are actuarial equivalent. See Medicare Part D Creditable Coverage notice.
COBRA Notice: Plan administrators must provide a written initial COBRA notice to each employee and his or her spouse when group health plan coverage first commences of his or her rights under the Consolidated Omnibus Budget Reconciliation Act of 1986 (“COBRA”). Each benefit-eligible employee receives this notice upon plan enrollment. To review it again, see initial COBRA notice.
Qualified Retirement Plans
HEART Act Amendments: Generally, all tax qualified plans, both defined contribution and defined benefit, had to be amended to comply with the Heroes Earnings Assistance and Relief Tax Act of 2008 (HEART Act). The two mandatory HEART Act amendments apply to survivor death benefits and differential wage payments. A survivor of a participant who died while performing qualified military service during or after 2007 must receive the same plan benefits, including death benefits, that would be due if the participant had resumed employment with the employer and died the following day, including continuous vesting credit during military leave. Differential wage payments must be included as compensation for purposes of calculating limitations on maximum benefits. The University's retirement plans have been amended to meet HEART Act requirements.
Universal Availability: The University of Southern Indiana Supplemental Retirement Plan is available to all employees with the exception of student workers and non-resident aliens. See the Annual Universal Availability Notice.