• Applicable to both fully insured and self-funded group health plans
• Financial dependency, living with parent(s), residency, marriage and student status cannot be factors in determining eligibility
• Employers and carriers must provide qualified adult dependents a 30-day special enrollment opportunity even if an enrollment period is not typically available.
• Plans may continue to have different coverage tiers, e.g., employee plus child, and charge rates based on the number of enrolled individuals. However, plans cannot charge a surcharge for the addition and coverage of adult dependent children.
• Adult dependent children who reach age 26 under the plan, if otherwise eligible, will be eligible to elect COBRA continuation coverage.

These highlights are extracted from the 30 pages of HHS, DOL and IRS guidance to only one provision of the law. A full summary of this guidance can be found at www.oswaldcompanies.com. The DOL question and answer summary is available at http://www.dol.gov/ebsa/faqs/faq-depenndentcoverage.html.

The above list of consumer protections applies to "grandfathered" plans, as well as new plans. Currently, one of the most significant interpretation challenges is understanding the definition of a grandfathered plan. If a plan remains grandfathered, certain provisions in the law will not apply until this status is lost. However, guidance on how grandfathered status is lost has not yet been issued, although the law is clear that enrolling new hires to a plan will not change this status. Other specifics are yet to be determined, creating continual questions and confusion.

Multiple interpretations of the law, as well as the recently released regulatory guidance for a few relatively simple initial provisions, such as dependent coverage, illustrates the potential regulatory tsunami to expect in required implementation guidance to reach practical understanding.

The most significant marketplace impact will occur as state-based health care exchanges are implemented in 2014. These Web-based insurance exchanges will create a new marketplace option. It is essential for employers to understand options as plan designs, employee premium contributions and wages will impact potential employer penalties and employee subsidies. New variables and practical evaluative steps will be inevitable.

Beyond understanding a timeline for reform and having patience in the release of ongoing regulatory guidance, employers face immediate strategic decisions in identifying short and long-term group heal plan costs. Premium trends are increasing due to cost projection uncertainty, partly caused by undetermined mental health parity calculations, ongoing extensions to the COBRA premium subsidy and health care reform.

Following reform, managing the administrative process and costs of new compliance mandates and notice requirements will become an additional necessity and cost burden for employers. Revised and updated communication strategies for employees will become increasingly important in the next several years. Employees will continue to rely on employers for access and information regarding health insurance, and for help when trying to understand changes.

Despite the new requirements and enforcement demands on employers, cost drivers will continue to be employer demographics, funding, plan design, group health status, utilization and employee contributions. The new law does not alter these cost drivers, not their annual or long-term impact.

Like it or not, health care reform is here to stay. Unfortunately, it appears that the final interpretation of the statute will make the current (remarkably complex) 17,000 page IRS Code look like a short story.

This article was written by Bob Klonk, Executive Vice President for the Oswald Companies. For more information, Bob can be reached at 216-367-4946 or rklonk@oswaldcompanies.com