Small and medium enterprises are quickly adopting individual health insurance and better, cheaper employee health benefits to offer premium refund programs. A frequently asked question is how the Affordable Care Act (ACA) implications of this type of health reimbursement plans. This article examines ACA rules for premium reimbursement plans. 
What is a premium refund plan?
Based on a tax preferred premium refund plan, the employer sets up a limited self-insured medical reimbursement plan, commonly referred to as Health Care Reimbursement Plan (HRP), a Section 105 Medical Reimbursement plan or "Pure" Defined Contribution Health Plan.
with ACA provisions of the plan is structured employee for eligible health insurance premiums up to a certain monthly health allowance, and b asic preventive health services without any cost sharing.
Key ACA rules for premium refund to refund plans
There ACA nine keys are rules that premium reimbursement plans applies.
1. annual limit compliance ( "PHS Act 2711")
Section 2711 of the Public Health Services ( "PHS") Act as they added to the ACA, provides that no annual or lifetime limits can be placed on essential health benefits ( "EHB"). PHS Act 2711 provides that annual limits and lifetime limits can be placed on services that EHB are not as health insurance premiums.
As such compliant self-insured medical reimbursement plans designed only to reimburse individual health insurance premiums up to a certain monthly health allowance and basic health care as PHS Act Section 2713 (discussed next) required.
2. Preventive Care Compliance ( "PHS Act 2713")
Section 2713 of the PHS Act, as of the ACA added, requires group health plans (including self-insured medical reimbursement plans) without cost sharing basic preventive health services.
3. 0-day waiting period compliance
The ACA prohibits waiting for 0 days for eligible employees.
4. Internal and external claims appeals process
The ACA has new requirements for internal and external appeals process, including how and when methods participants plan communicated.
5. Dependent Coverage for Adult Children until the age of 26
Section 2714 of the PHS Act, as added by the ACA, provides that a group health plan to provide (including a self -insured medical reimbursement plan) , the coverage of children makes available depending needs such coverage for children up to 26 years.
6. Uniform Explanation of Coverage and definitions
The ACA requires that group health plans, participants and recipients a standardized summary of benefits ( "receive uniform Glossary") and coverage ( "SBC") and a set of common definitions, both equivalent to those described with the requirements in the ACA and existing regulations.
7. Form 720 Comparative Effectiveness Research (CER) Fee
The ACA includes a "research fee", the need to plan sponsors pay on an annual basis every year over form 720.
8. form 5500 series form (annual report)
employers with more than 100 employees have a form 5500 (annual report) Submit.
9. 60-day release material modification
The ACA requires employers 60 days prior notice to the participants to make available, if significant to make changes to their group health plan (including self-insured medical reimbursement plans).
. Tip: To this ACA requirements make compliance easy, most employers use a premium refund provider
Other rules premium reimbursement plans have consequences
Besides ACA rules tax preferred plans premium refund to these rules and regulations to follow:
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IRS (see: IRS rules for premium reimbursement plans)
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ERISA (see: ERISA rules for premium reimbursement plans)
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HIPAA Medical Privacy
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COBRA
in future articles, we will discuss each of these topics in detail. For a complete list of rules and regulations, download the new eBook "101 Compliance".
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