A Checklist for Your Employee-Sponsored Health Plan

Health Coverage

The information found at www.isurepro.com can help employers of all sizes understand the actions needed to be taken in order to maintain employee benefits compliance. There are numerous requirements imposed by federal law on employers for the health coverage plans provided to employees. Many of these laws apply to any size group health plan, although larger companies have additional regulations imposed by the Affordable Care Act.

Health Coverage Checklist

For larger companies (those with more than 50 employees), the following checklist presents a basic overview of the requirements for employer health plans.

  1. Comprehensive health coverage that consists of the essential health benefits package must be offered to employees.
  2. The essential health benefits packages cannot have annual or lifetime dollar limits.
  3. New guidelines for the out-of-pocket maximums have established limits at family coverage of $13,700 and self-coverage of $6,850.
  4. Waiting periods for coverage cannot exceed 90 days.
  5. Covered individuals are no longer subjected to pre-existing condition exclusions.
  6. Discrimination against plan participants who also take part in clinical trials is forbidden.
  7. The annual pre-tax salary reduction to a health flex spending account has been limited to $2,500.

Plans must also cover preventive care services, extend adult children coverage to age 26, and incorporate patient protections for physician choice. Check with your health coverage provider to ensure your company is compliant with federal requirements.