Benefits Institute White Papers

A health risk assessment is a screening tool that allows individuals to learn more about what health conditions they may be at risk for and what steps they can take to minimize that risk. This white paper will provide an overview of health risk assessments and explain the goals of such assessments for patients and industry representatives.

Most individuals have health insurance through the work place. Private sector employers are generally subject to ERISA, which has procedural requirements for health plan claims and appeals of claims. However, ERISA does not cover health plans of governments, churches, and church-related agencies, as to which healthcare reform will impose new procedural requirements for claims and appeals. State law will set these rules for non-ERISA plans until the healthcare reform law is fully implemented, generally in 2012 as to claims and appeals. PHSA § 2719, as added by the Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act, collectively called Healthcare Reform. The New Mexico Insurance Code has procedural and substantive provisions, and provisions allowing external review by the Division of Insurance of contested claims. NMSA § 59A-1-1 et seq.

On July 23, 2010, the Departments of the Treasury, Labor (“DOL”) and Health and Human Services (“HHS”) released interim final regulations for group health plans and health insurance coverage relating to internal claims and appeals and external review processes under the Patient Protection and Affordable Care Act (“Affordable Care Act”). These regulations are under Section 9815(a)(1) of the Internal Revenue Code (“Code”), Section 715(a)(1) of the Employee Retirement Income Security Act (“ERISA”) and Section XXVII of the Public Health Service Act (26 CFR 54.9815-2719T, 29 CFR 2590.715-27109 and 45 CFR 147.136). The  following will summarize the provisions of these regulations.

In the West, for many years now, the extra ‘employee benefits' derived from a remuneration strategy are as much a part of the ‘take home' as the salary itself. I can distinctly remember my first company car – a bright yellow four door job with a 1.3 litre engine – but it didn't matter that I looked like I was driving a canary - at only 24 years of age I had a brand new car! The fact that I looked like all travelling salesmen, didn't deter my enthusiasm one bit!

Not all people living in the United States are entitled to the same benefits and privileges under the law. For someone who is not a United States citizen, immigration status determines many aspects of daily life including what schools his children can enroll in, whether he can vote, who he can work for or if he can be self-employed,  whether a criminal conviction can affect his immigration status,  whether living abroad can affect his immigration status, and what public services and health care benefits are available to him and his family. With the passage of broad health care reform legislation,
whether someone will be covered, or to what extent coverage is possible, will also depend on a person’s immigration status and the status of people in his household.

On March 21, 2010, Congress passed the Patient Protection and Affordable Care Act ("Act"), which President Obama signed into law on March 23, 2010. The Health Care and Education Tax Credit Reconciliation Act of 2010 ("Reconciliation Act") amended the Act and added several provisions, on March 30, 2010. These two laws are designed to reform the United States health care system and have a broad impact on employee benefits.

The Act will have a significant impact on employers, employees and their group health plans, whether insured or self-insured (with certain exceptions for small employers).