1. Industry Updates April, 2011
The Gardner Group is pleased to present our tenth newsletter. We look forward to continue sharing our experience and timely industry updates.
Health Reform Timeline
2010 2011 2012 2013 2014
•Small Business Tax •Minimum Medical •Fraud and Abuse •State Notification • Free Choice
Credit Loss Ratio for Prevention Regarding Vouchers
•Adult Dependent Insurers •Pharmaceutical Exchanges •Health Insurance
Coverage to Age •Changes to Tax- Industry Fees •Flexible Spending Exchanges
26 Free Savings •Accountable Care Account Limits •No Annual Limits
•Coverage of Accounts Organizations •Improving on Coverage
Preventive •Grants to Establish incentives Preventive Health •Essential Health
Benefits Wellness Programs •Voluntary Options Coverage Benefits
•Consumer •Funding for Health for Long-Term •Additional Funding •Employer
Protections in Insurance Care Insurance for the Children’s Requirements
Insurance Exchanges Health Insurance •Wellness Programs
Program in Insurance
Special Rules for Treatment of Preventive Services Covered
Student Health Plans Under Under the Health Reform
Health Reform If you have a non-grandfathered group health insurance plan
Because college student health plans are regulated by states, effective on or after September 23, 2010, the following preventive
covered benefits, benefit limits, governing rules and services are some of those that must be covered without having to
premiums vary widely. Most of these plans are fully insured, pay a copayment, co-insurance or meet a deductible. This applies
but a few are self funded. Most colleges work with one health only when these services are delivered by a network provider. The
insurer and set up a group or association policy with a preset health plan may include a more generous prevention policy, but
benefit plan design for each student who participates. Most cannot be less generous than required under Health Reform.
plans cover the student for the full calendar year.
Adults:
Health Reform does not prevent colleges from offering these • One time screening for Abdominal Aortic Aneurysm for
plans going forward and includes a provision specific to this certain men
type of coverage. New regulations effective January 1, 2012 • Blood Pressure screening
include special rules for fully insured student health plans, but • Cholesterol screening at certain ages or at high risk
do not apply to the few self insured plans. Because all student • Colorectal Cancer screening over 50
plans are not employment based, Health and Human Services • Type 2 Diabetes screening for those with high blood pressure
has determined they will be regulated under Health Reform as • Immunization vaccines based on recommended doses, ages
individual plans. and populations
• Tobacco Use screening for all and cessation interventions for
The special rules for student health plans include: users
• Anemia screening for pregnant women
Annual Dollar Limits:
• BRCA counseling about genetic testing for women at higher
• Before September 23, 2012 = $100,000 minimum
risk
• After September 23, 2012 = $2,000,000 minimum
• Mammograms over 40
• After September 23, 2014 = No annual limit allowed
• Cervical Cancer screenings
Guaranteed Availability/Renewability Rule:
• Osteoporosis screening for women over 60 or at high risk
• Not applicable under proposed regulations using
“bona fide association” exception
Preventive Services and Cost-Sharing Rule: Children:
• Proposed regulations provide that fee charged to all • Autism screening for children at 18 and 24 months
students does not violate rule • Blood Pressure screening
Notice Requirement: • Congenital Hypothyroidism screening for newborns
• Must provide notice regarding compliance with • Developmental screening for children under age 3
Health Reform • Hearing screening for newborns
• Notice must include exceptions provided to student • Sickle Cell screening for newborns
health plans • Immunization vaccines from birth to age 18 based on
• Plan materials must include notice on front page recommended doses, ages and populations
• Iron supplements for children ages 6 to 12 months at risk for
Finally, questions have also been raised regarding how anemia
provider choice, medical loss ratio and student fee rules will • Lead screening for children at risk of exposure
apply later to student health plans. These are not addressed • Vision screening for all children
in the current regulations, but may be in the future.
-HealthCare.gov website
-2011 Buck Consultants

2. Industry Updates April, 2011
Health Reform Opinions the Same One Year Later
A recent survey by the Kaiser Family Foundation shows that since the passage of the Patient Protection and Affordable Care Act (ACA)
a year ago, Americans remain divided in their views of the new law, and more than half say they are still confused about the law and
its impact.
About half of Americans (53% ) continue to
say that they are “confused” about the health
reform law. A close percentage, (47%) say
they lack sufficient information about the law
to know how it will impact them personally.
Overall opinions remain divided, with slightly
more unfavorable (46%) than favorable (42%).
In addition, a new Gallup survey finds about
the same result. In this survey, 46 percent
thought Health Reform is a good thing vs. 44
percent who thought it was bad. As
suspected, opinions remain sharply divided
along partisan lines, with Democrats typically
favoring and Republicans not favoring the law.
Interestingly, Independents were 49 percent
against Health Reform.
Brendan Nydan of the Robert Wood Johnson Foundation feels real change in opinion may come in 2014 when the more advanced
initiatives take effect.
-www.huffingtonpost.com
We Want to Know Your Thoughts On Florida Judge says Health
Health Reform Reform Unconstitutional
Are you on board with Health Judge Roger Vinson, U.S. District Court for the Northern
Reform, oppose Health Reform or District of Florida, struck down Health Reform as
just confused? We want to know. unconstitutional. So far, 26 states have challenged
Share your thoughts or concerns Health Reform and the rulings are evenly divided
with us and other viewers on The regarding the constitutionality of the law. Vinson’s
Gardner Group’s Facebook page. If ruling is the first to find that if one provision is
you are not yet a fan, use the link offending, that negates the entire law.
below to access The Gardner
Group’s Facebook page. The one provision that led to this ruling was the
individual mandate – the provision that requires
virtually all citizens to obtain health insurance by 2014
or pay a monetary penalty. The government vowed to
Visit us at: http://www.facebook.com/pages/The-Gardner-Group/123662150999462 appeal the decision indicating they strongly disagree
with the court’s ruling and believe Health Reform is
constitutional. Florida Attorney General Pamela Bondi
Let Us Treat You to a Jacksonville Suns called the ruling an important victory for every person
who believes in the freedoms granted to us by our
Game! Constitution.
In Support of one of our clients, Baseball Jax, The Florida based district court is the second to rule the
The Gardner Group has purchased a supply individual mandate unconstitutional and first to strike
of Jacksonville Suns tickets. These tickets are the entire law. Judge Henry Hudson, U.S. District Court
good for any home game. In appreciation of for the Eastern District of Virginia, struck down the
your business we would like to treat you and individual mandate, but ruled the provision is severable
your employees to a Jacksonville Suns Game. from the remaining provisions of the law. The U.S.
If you are interested, please email us at District Court for the Western District of Virginia held
contacttgg@thegardnergroup.com. the key Health Reform provision constitutional.
The Department of Justice said in a press release it was
Client Satisfaction Survey Coming Soon “analyzing this opinion to determine what steps, if any –
including seeking a stay – are necessary while the
appeal is pending to continue our progress toward
As part of our ongoing efforts to ensure our ensuring that Americans do not lose out on the
Clients’ satisfaction with our services, we will be important protections this law provides, that the
creating and sending out a Client Survey. The millions of children and adults who depend on Medicaid
Gardner Group is looking for your opinions and programs receive the care the law requires, and that the
suggestions. Please look for the survey in your millions of seniors on Medicare receive the benefits
email within the next few weeks. they need”.
Wolters Kluwer – Law & Business