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Your Health Plans Hidden Dangers: Litigation and Compliance Risks in the New Health Reform Environment

January 23, 2012


Many employers are suffering from health care reform fatigue. After the implementation of plan design changes for 2011, many employers hoped for a healthy break to prepare for the play or pay requirement and plan design mandates of 2014. Unfortunately, there is no rest for the weary as the biggest traps are not the costs looming in the future, but rather the new litigation and regulatory risks that are present today.

Todays employer-sponsored group health plan is riddled with potential compliance missteps that could cost employers thousands of dollars in penalty taxes and even more in potential Employee Retirement Income Security Act litigation exposure. Employers now need to take proactive steps to shield themselves from these hidden dangers.

This article addresses five aspects of the Patient Protection and Affordable Care Act (PPACA or the Act) that could result in significant costs to a plan sponsor if steps are not taken to ensure compliance: plan design mandates, internal and external claims review, enhanced notification requirements, nondiscrimination, and play or pay. This article analyzes the risks associated with noncompliance and provides a list of action items employers should implement to mitigate the risk of noncompliance.

Reproduced with permission from Pension & Benefits Daily

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