Health Plan Self-Compliance Tool
EBSA plans to enhance health benefit security by publishing compliance assistance guidance regarding the health plan coverage provisions of ERISA, including the Genetic Information Nondiscrimination Act (GINA), the Mental Health Parity and Addiction Equity Act (MHPAEA), and the special enrollment and notice provisions added by the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), supporting the Secretary's good jobs for everyone policy.
Key Action: Compliance Assistance Checklist
The Department's EBSA plans to publish a compliance assistance checklist no later than September 2010. This guidance will provide clarifications to group health plans, health insurance issuers, participants, beneficiaries, and other interested stakeholders regarding the minimum health plan coverage requirements in Part 7 of ERISA.
Key Concern and Issues to be Addressed
The Departments of Labor, HHS, and the Treasury published regulatory guidance implementing GINA in October 2009. Guidance regarding mental health parity and CHIP followed in February 2010. The Compliance Assistance Checklist will address key implementation provisions for group health plans and health insurance issuers to facilitate broad-based compliance.
GINA generally adds to the HIPAA portability and nondiscrimination provisions to provide additional protections against collection and use of genetic information in health coverage.
MHPAEA generally provides that group health plans and health insurance issuers cannot impose financial requirements or treatment limitations on mental health or substance use disorder benefits that are more restrictive than the predominant limits applied to substantially all medical surgical benefits.
CHIPRA allows states to offer premium subsidies for certain low-income children who have access to employer-sponsored group health coverage, but do not have the means to pay for it. CHIPRA gives individuals new special enrollment rights in the plan upon a determination of eligibility for premium assistance under CHIP and upon loss of eligibility for CHIP coverage. CHIP also includes new disclosure requirements, including an employer notice provision that requires employers to inform employees of potential opportunities currently available in the State in which the employee resides for group health plan premium assistance under Medicaid and CHIP.