Nondiscrimination Testing for Health Plans: Code Section 105(h) and Post-ACA Design Alternatives
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Gain a solid understanding of nondiscrimination rules and testing to develop a cost effective compliance program for your organization.
The Affordable Care Act explicitly prohibits eligibility exclusions and discrimination based on compensation, health status, protected classifications, and excess waiting periods. These rules build on prior Internal Revenue Code rules that protected rank and file employees from discrimination and protected certain vulnerable groups, like the sick and disabled. Post Affordable Care Act, employers and health coverage providers are increasingly sensitive to perceived and actual discrimination. There is a renewed effort to design programs to avoid discrimination and to test actual operations to ensure that those designs translate into actual protections. In this topic you will gain a basic understanding of nondiscrimination rules and testing so that you can develop cost effective strategies to meet the compliance obligation, avoid lawsuits, and direct your organization toward health benefit offerings that are both facially and operationally nondiscriminatory.
AuthorsTonie L. Bitseff, Buchalter
IRC Nondiscrimination Rules
• Current Self-Funded Health Plan Nondiscrimination Rules
• The Prohibited Group
• Code §105(h)
- The Benefits Test
- The Eligibility Test
• Insured Health Plan Nondiscrimination Rules
• HHS Rules
• Religious Exemptions
• Communication With Individuals With Limited English Proficiency and With Individuals With Disabilities