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SBANE Member EBS Capstone Press Release: With Election Day Behind Us, Employers Still Uncertain on Impacts of PPACA



Lisa Graziano

EBS Capstone



With Election Day Behind Us, Employers Still Uncertain on Impacts of PPACA

EBS Capstone Provides Decision Support Tools to Businesses Across New England

Newton, MA, November 7, 2012 – Regardless of what happens in Washington, employers will still have a number of obligations and opportunities as the heart of the Patient Protection and Affordable Care Act of 2010 (PPACA) is implemented in 2014. This health care reform law is complicated, and each employer will need to base employee benefit and total compensation decisions on their particular situation. EBS Capstone understands PPACA’s impact on businesses in greater depth than other leading organizations and has analytical tools to help with the top PPACA compliance concerns facing employers. A download of our PPACA Decisions Executive Summary is available by emailing lisa.graziano@ebscapstone.com. The summary includes:
  • An overview of PPACA;
  • Decisions employers need to make regarding PPACA; and
  • Obligations employers must fulfill between now and 2014.
EBS Capstone is counseling employers on changes they should be making in order to comply with PPACA. Among them are that health plans:
  • May not have a lifetime dollar maximum on any "essential health benefit"
  • May not have an annual dollar limit on an "essential health benefit" that is over a certain amount
  • That cover children must extend eligibility until age 26, even if the child is married or has access to coverage through the child’s employer++
  • Cannot deny coverage, or limit or deny benefits for children under age 19 due to a pre-existing condition
  • May not retroactively rescind health care coverage except for fraud, material misrepresentation or for nonpayment of premium by certain terminated employees
  • Must provide first-dollar health care coverage for specific preventive services+
  • Must cover emergency services at in-network level regardless of provider+
  • If a primary care physician (PCP) must be chosen, allow each person to choose their own PCP and allow a pediatrician to be the designated PCP+
  • Must allow women to see an OB-GYN without a referral+
  • Must have a specific and comprehensive process for handling health care claims appeals+
  • May not reimburse over-the-counter drugs under a health flexible spending account, health reimbursement account, or health savings account unless the drug is prescribed by a doctor
+ - Does not apply to grandfathered plans ++ - Limited exception for grandfathered plans
EBS Capstone’s Compliance team continually advises employers on PPACA and related compliance (ERISA, COBRA, HIPAA) issues. Josie Martinez, Senior Partner and General Counsel, and the team have in-depth expertise as it uniquely applies to small businesses (under 50 employees), midsize businesses (50-100 employees) and large employers (more than 100 employees). EBS Capstone can speak to the following topics:
  • The ramifications of PPACA on businesses
  • The most important elements of exchanges, now and in the future
  • Employer responsibilities and obligations under the law, future considerations and penalties
About EBS Capstone EBS Capstone is a full service insurance brokerage firm offering customized solutions in employee benefits, retirement plans and all lines of property/casualty. Visit www.ebscapstone.com to learn more.  
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