Updated March 13, 2012

The Texas Association of Counties Health and Employee Benefits Pool (TAC HEBP) understands that Pool members want to know the impact of Health Care Reform. TAC HEBP has compiled a list of those changes already impacting members as well as provisions that will be in effect in the near future. TAC HEBP continues to diligently pursue those still undecided issues and will update this page as clarification and guidance is given.

HCR provisions already in effect:

• Lifetime limits - Effective on plan anniversary dates after Sept. 23, 2010, lifetime limits to coverage are no longer allowed.
• Pre-existing condition exclusions - Pre-existing condition exclusions for children under age 19 are no longer allowed.  Beginning in 2014, pre-existing limitations will be prohibited for everyone.
• Coverage for dependent children - Dependent children may remain on a health plan to age 26, including married children. However, if the plan has grandfathered status, this does not apply to dependents that are employed and are eligible for benefits provided by their employer.

Updates:

• W-2 Reporting – As of Jan. 1, 2012, employers with 250 or more employees are required to track combined costs of medical, dental and vision (if you have a separate vision plan) for 2012 W-2 forms to be issued in 2013. This excludes salary deductions for FSAs and HSAs, and costs associated with an Employee Assistance Program, wellness program, or on-site medical clinic.

Small employers filing fewer than 250 W-2 forms have the option of reporting costs for 2012.   This optional treatment for smaller employers may be extended, but further guidance needs to be issued for confirmation.  For more information, see the 2011 Form W-2, IR-2011-31, Notice 2010-69, Notice 2011-28, Notice 2012-9,  and frequently asked questions.

TAC HEBP members will be provided a report of their total applicable costs toward the end of 2012 to use as a guide for reporting costs. 

• Summary of Benefits and Coverage (SBC) – Group health plans and health insurance issuers offering group health insurance coverage are required to provide applicants, enrollees, and policyholders with an accurate summary of benefits and coverage beginning with plan years starting Sept. 23, 2012 or later.  The Department of Health and Human Services (HHS) has issued guidance on completing the SBC and has provided templates.  For more information, please visit this website.

TAC HEBP is preparing the SBC and will be providing those to members prior to your applicable plan year anniversary date after Sept. 23, 2012.