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HRAT Alerts

WS+B's Healthcare Reform Advisory Team (HRAT) is comprised of our most seasoned healthcare and tax professionals, whose mission is to answer and address client questions and issues related to this new federal policy. Join the conversation in our HRAT Knowledge Center.

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The Medical Loss Ratio: What is it, how is it calculated... and what if I get a rebate check?

The Medical Loss Ratio ("MLR") was introduced as a provision in The Patient Protection and Affordable Care Act ("ACA") of March 23, 2010. This provision requires that all health insurers,as of January 1, 2011, spend a percentage of each premium dollar received to pay claims and related expenses and activities that improve health care quality. The goal of the MLR provision is to ensure that a minimum percent of premiums are being used to pay claims and to maximize the value of health care dollars spent for all participants in group medical plans.
 
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U.S. Supreme Court Upholds the "Individual Mandate" and Majority of the Affordable Care Act - But Will Taxpayers Agree in November?

In a surprising 193-page landmark decision on June 28, 2012, the U.S. Supreme Court, in a 5-4 vote, upheld the "individual mandate" and the majority of the Patient Protection and Affordable Care Act ("ACA"). Employers and taxpayers alike await further clarification on what will be deemed "minimum essential health coverage" and how it will potentially affect their bottom line, while recognizing that the upcoming November election may dismantle much of this healthcare legislation. In the meantime, however, all must assume that many key provisions will go into effect in 2013 and beyond, or risk being unprepared to fully comply in time for the law's complex provisions.

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Healthcare Reform Developments: Women's Preventative Services Rule Issued

As posted by PPC's Health Care Reform Update
August 3, 2011

Women's Preventive Services Rule Issued

The IRS, DOL, and HHS have jointly issued an interim final rule that requires health insurance plans that are not grandfathered under the Affordable Care Act to cover certain women's preventive health services without charging copayments, co-insurance, or deductibles for plan years beginning on or after August 1, 2012. The agencies adopted guidelines recommended by the Institute of Medicine that will require plans to cover a wide range of preventive services, including contraception, well-woman visits, screening for gestational diabetes, and other services. The IRS also issued a separate proposed regulation that amends the excise tax regulations applicable to a plan's failure to provide required preventive services. Preventive services are discussed in section 807 of PPC's Guide to Health Care Reform.bbb

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