Stay Connected with HealthCare.gov Widgets and Badges.  They are supplying coding and graphics for use on websites.

HHS seems to really be trying to use the internet and social media.  Thier latest is widgets and gadets for the new section of the HHS website about how to find health care programs for you where you live.  They call it “What insurance options are available to you?” 

They also have new tabs for understanding the new law, Prevention, and quality.

The Centers for Disease Control released a new report this month on Emergency Room visits. Among the report findings:

• There were 39.4 ER annual visits per 100 persons
• There were 88.5 ER annual visits per 100 U.S. infants
• Persons aged 75 years and over had an annual ER visit rate of 62.0 visits per 100 person
• The visit rate for homeless persons was almost twice that of those living in private residences (71.8 compared with 35.9 visits per 100 persons per year)
• There were about 222 visits to U.S. ERs every minute
• Annual ER visits increased 23% from 1996 to 2007
• 25.2% of ER visits were covered by Medicaid SCHIP (39% Private Insurance; 17% Medicare)
• There were 121 ER annual visits for asthma per 10,000 children under 5 years of age
• 2% of visits resulted in admission to an observation unit

Source: CDC. National Hospital Ambulatory Medical Care Survey: 2007 Emergency Department Summary National Health Statistics Reports. August 6, 2010

(From the latest MCOL Newsletter - subscribe today.)

NBCH Announces New Board Officers & Members
Congratulations to NBCH’s newly elected Board Officers: Carolyn Pare, Chair; Cristie Travis, Immediate Past Chair; Barbara Wallace, Vice Chair; Sue Szymanski, Secretary/Treasurer; and Cheryl DeMars and Gary Rost, At Large Representatives to the Executive Committee. Newly elected Board Members include incumbents Marilyn Bell, Becky Cherney, Don Creveling, and Elizabeth Mitchell as well as two newly electedmembers, Marianne Fazen and Ron Whiting. NBCH also wishes to thank Jerry Custer, who recently came off the Board, for his continued service and commitment to the organization. Please visit the press release announcing new Board Officers.

What are the advantages to being a grandfathered plan?

 

Grandfathered plans basically have more time. Grandfathered plans must comply with all of the health reform laws and are required to implement them this September (or the next anniversary date).  Grandfathered plans are free from certain mandates that all other plans must do, until 2014.

·         Cover preventive services without cost-sharing;

·         Do not discriminate in favor of highly compensated individuals;

·         Report on their quality of care improvement activities;

·         Provide their enrollees internal and external appeal procedures against claims denials (although group plans must already provide internal appeals under ERISA and most states require that plans provide both internal and external appeal procedures);

·         Provide unimpeded access to emergency, pediatric, clinical trials, obstetric, and gynecological care; and

·         Reporting on quality and wellness to HHS.

Grandfathered plans can lower patient deductibles, co-pays and premiums and can add additional benefits and coverage.  Grandfathered plans are limited on cost share increases and cannot impose additional restrictions or remove covered benefits.  All changes have to be in the favor of the patient.

 

http://www.healthreform.gov/about/grandfathering.html

http://www.mcguirewoods.com/news-resources/item.asp?item=4719

 

 

 

 

 

HHS released the interm rules for health plan gradfathering today.

The written rules are here and the video of the press conference is here.

Compared to their polices in effect on March 23, 2010, grandfathered plans:

• Cannot Significantly Cut or Reduce Benefits.  For example, if a plan decides to no longer cover care for people with diabetes, cystic fibrosis or HIV/AIDS.
• Cannot Raise Co-Insurance Charges.  Typically, co-insurance requires a patient to pay a fixed percentage of a charge (for example, 20% of a hospital bill).  Grandfathered plans cannot increase this percentage.
• Cannot Significantly Raise Co-Payment Charges.  Frequently, plans require patients to pay a fixed-dollar amount for doctor’s office visits and other services. Compared with the copayments in effect on March 23, 2010, grandfathered plans will be able to increase those co-pays by no more than the greater of $5 (adjusted annually for medical inflation) or a percentage equal to medical inflation plus 15 percentage points.  For example, if a plan raises its copayment from $30 to $50 over the next 2 years, it will lose its grandfathered status.
• Cannot Significantly Raise Deductibles.  Many plans require patients to pay the first bills they receive each year (for example, the first $500, $1,000, or $1,500 a year). Compared with the deductible required as of March 23, 2010, grandfathered plans can only increase these deductibles by a percentage equal to medical inflation plus 15 percentage points.  In recent years, medical costs have risen an average of 4-to-5% so this formula would allow deductibles to go up, for example, by 19-20% between 2010 and 2011, or by 23-25% between 2010 and 2012.  For a family with a $1,000 annual deductible, this would mean if they had a hike of $190 or $200 from 2010 to 2011, their plan could then increase the deductible again by another $50 the following year. 
• Cannot Significantly Lower Employer Contributions.  Many employers pay a portion of their employees’ premium for insurance and this is usually deducted from their paychecks. Grandfathered plans cannot decrease the percent of premiums the employer pays by more than 5 percentage points (for example, decrease their own share and increase the workers’ share of premium from 15% to 25%).
• Cannot Add or Tighten an Annual Limit on What the Insurer Pays.  Some insurers cap the amount that they will pay for covered services each year.  If they want to retain their status as grandfathered plans, plans cannot tighten any annual dollar limit in place as of March 23, 2010.  Moreover, plans that do not have an annual dollar limit cannot add a new one unless they are replacing a lifetime dollar limit with an annual dollar limit that is at least as high as the lifetime limit (which is more protective of high-cost enrollees). 
• Cannot Change Insurance Companies.  If an employer decides to buy insurance for its workers from a different insurance company, this new insurer will not be considered a grandfathered plan.  This does not apply when employers that provide their own insurance to their workers switch plan administrators or to collective bargaining agreements.

SBG is proud to announce that we have executed a new long term agreement with MDI to provide claims data technology services for the members of the coalition.  Services to SBG members will include the use of MDI’s new Insight Series software package.  The Insight Series is made up of:

o   Predictive Index™ - uses claims data and outcomes from more than 2 billion historical claims to make informed forecasts of future healthcare costs, high-risk situations and provider treatment comparisons.

o   E.A.R.L® - a revolutionary application that translates health data, claims histories and treatments into a visual representation of the patient’s body for quick assessment of high-risk situations.

o   Global Analysis Reporting – a standard and customized report to classify and trend information based on utilization, cost, chronic disease, or other specific needs.

o   Data Analytics –ad-hoc reporting tool that allows user to design, build, and manipulate complex medical and pharmaceutical data, at the group summary and the patient level.

 

SBG was introduced to MDI through our work with Wells Fargo Insurance Services.

 

MDI is located in Ponte Vedra Florida. 

Health reform is moving – glacially; but once that hunk of ice gets moving its going to swoop down and crush us – if we are still in its path.  Now is not the time to be idle and sitting by and watching.  Now is the time to evaluate and review options.  It’s called contingency planning and employers need to be looking at all possibilities now.

 

Small employers – especially small small employers – are being told through this law that they do not have to provide coverage. Only about 30% provide health benefits now so I see this lowering to near zero.

Do the incentives outweigh the penalties?  For the middle group of employers  (10 to 100) this is the question.  Since they are not negotiating health care prices and networks they are at the mercy of the carriers. I do not think owners are going to put their business at risk (that is pay fees and fines) because of carriers actions or in actions.

 

Over 100 – now is the time to self fund. Price is going to be king over the next 5 years and self funded employers who direct contract will be in the right position.

ASO self funded employers could have the same issue as the mid-sized groups unless they are highly pro active.

 

I was meeting with Medical Mutual of Ohio this week and for them the number one determinant of whether an employer provides a network is the paternal nature of the company.

So let people complain that employers are evaluating options - we do it all the time.  Its good planning. 

I have been asked a lot about what I thought will be the impact of the new health reform law on employers and the Coalition’s members.  The health reform law is getting a lot of attention right now but this new law is only one of 4 laws that employers are preparing for.  In addition to health reform there are the new HIPAA rules, along with the new mental health parity law, and the CHIP (Children’s Health Insurance Program) reauthorization law.  Any one of these laws is a lot of work but they are all hitting employers simultaneously. 

But for health reform, SBG sees this as a three phase program; the first year which will stretch out through September of 2011, the second phase that ends in December 2014, and then every thing else in the law that extends beyond 2014.  There is going to be a lot of confusion among patients and employees as the first part of the law is enacted.  People have been lead to believe that the first phase will all happen in September of 2010 but that is not true. Insurers and employers will have a full year to enact phase one changes. The only phase one change that must occur this September is the lifting of the preexisting condition rules for children.

All this discussion about phase one changes is highly speculative anyway.  There are no rules, policies, or procedures written for employers to follow.  Nothing has been written and when it is written it must go through a comment period.  It is possible that September will arrive and we may have no rules.  The agencies that will sit on the committee and that will be writing the rules have just been announced.  These agencies are HHS, IRS, EEOC, FTC, and the National Association of State Insurance Commissioners. 

There is some concern about two of the phase two initiatives; the high risk pool and the Medicare gap reinsurance program.  Georgia has announced that they will not be participating in either program.  The health reform law allows HHS to establish these programs for Georgia without the State’s cooperation. 

Phase two is the time period that the exchanges will be created.  There are actually three types of exchanges, one for individuals (The Exchange), one for groups of individuals (Co-op), and one for small businesses (SHOP).  SBG is investigating the exchange concept and believes it may be able to be very effective in the small business insurance option program.

CHIP (which in Georgia is Peachcare) requires universal health care for all children.  There are requirements in the reauthorization bill that require the State and employers to cooperate in providing coverage to all children.  Employers have already had to amend there plans to include new eligibility open enrollment periods based on this law.  The reauthorization act was passed and signed in February 2009 and we are still waiting for the rest of the rules to be released.

Employers will be very busy trying to implement all these new programs but in the end none of these new laws do anything to control the costs of health care.  The expected cost increase for 2011 is at least 7% plus the increases caused by the new laws.  Employers will continue to implement programs to control costs for their own individual health plans.  They will continue to expand health risk assessments and clinical screenings.  There will be more disease management and wellness.  Employers will continue to expand value based benefit reform and will be more aggressive by putting in place tiered benefit programs.  Physicians and hospitals will also be targeted as the employers will expand quality programs to include never events, hospital acquired conditions, public reporting, transparency, expansion of health information technology, and episodic care payments mechanisms.

The next 4 years will be very busy and there will be plenty to do.  It will be very important that information be timely, accurate and it must come from trusted sources.  SBG will be there to assist our members and the employers of Savannah, Chatham County, the Coastal Empire and Low Country.

The Dartmouth Atlas clearly demonstrated that the number of physicians in a given area have significant impact on the number of surgeries and procedures for that region.   Now in a new article from Health Affairs suggests that there is a clear connection between physician owned surgeries centers and high surgery rates.

 The conclusion states “Our data quantify the relationship between surgicenter ownership and surgical volume. “  It continues by stating that there is a clear physician induced demand that requires federal intervention and restriction of physician ownership.  All the things we have every heard about case mix, patient mix, caseloads, and costs were proved to be true in this study.  Physicians really do refer lower complexity cases and high paying patients to their surgicenter and the frequency of the surgery increases.  

 ”…. what underlies the association between ownership and surgery use is more than just a “high-volume surgeon” phenomenon alone.  In other words, it isn’t just that the surgeons who own surgicenters tend to be high-volume surgeons it’s that surgeons become high-volume surgeons once they became owners of surgicenters.”

 The core of this editorial is based on an article in the Health Affairs April 2010 29:4 issue; “Physician Ownership of Ambulatory Surgery Centers Linked to Higher Volume of Surgeries“.  The study was conducted in Florida using their Healthcare Cost and Utilization State Ambulatory Surgery Database for the years 2003 through 2005.

I have read about how people are wondering why health insurance is not sold like automobile insurance.  I never had the opportunity to discuss this point of view with anyone until last Friday.  Theses insurances are not the same and cannot really be compared.  The only people that need auto insurance are people who own cars.  The reason we get auto insurance is because the real owners of our cars - the banks and loan companies - require insurance, they want to insure their loans.  

The comparison of the two insurances is not worth the effort.  The rules regulations and playing field is not equal.  If we bought health insurance like auto insurance we all would be in the single market; people do not understand that health insurance is a group activity.  The laws for single market health insurance are not very good.  All the laws are written fro group coverage.  The new reform bill will change some of this but in the end even reform does not want people in individual coverage. The exchanges, although you sign up as individuals, the management of the exchange is based on group principles.

Should employers be in the health market?  That can be debated but the reality is that 60% of Americans get their coverage through group coverage through employers.  That started in World War 2 and the United States has had years to change but we choose the route we are on and this is how it is.  We have had to add Medicare and Medicaid.  We have added federally qualified health clinics, community clinics and other safety net providers; all in efforts to create a health system to cover everyone, all because of a national decision 70 years ago.

In automobile insurance we get rated based on our driving record but there is also demographic underwriting for age and gender, where we live, the car we drive, etc.  If we drive poorly, and get caught, our rates are adjusted.  The pricing is not transparent and extremely variable.  Take Allstate’s new commercial that compares folks who switched from other insurance companies to Allstate - they saved as much as folks who switched out of Allstate.  We have options to adjust our deductibles and add options.  We also have to insure ourselves against those that have no insurance but still drive.  But we have this insurance because loan companies demand it.

In health insurance we get rated based on our health status, gender, age and other factors.  If we get sick our rates go up (or the insurance company drops us).  Our insurance rates also include funds for the uninsured, about $1,000 annually.  If I get sick and my rates go up and I can no longer afford the premium I loose my coverage.  It is not like I can then bum a ride or catch a bus.  Life style does impact health just as driving habits impact tickets and accidents, but what about the folks who just get sick, cancer for example. 

Health is not an option like buying a car or getting a license.  Health comes from being human and alive.  The discussion or comparing automobile insurance with health insurance is not very useful.

	Agencies Request Comments on Medical Loss Ratios, Premium Reviews
In a Federal Register document released Wednesday, the U.S. Departments of Treasury, Labor and Health and Human Services put forth requests for public comment on future rulemaking related to annual reporting of the medical loss ratio under Section 2718 of the Public Health Service (PHS) Act added by the Patient Protection and Affordable Care Act (P.L. 111-148). The new health care law also created Internal Revenue Code Section 9815, which incorporates by reference Section 2718 of the PHS Act. Section 2718 requires annual reporting of the medical loss ratio by health insurance issuers of individual or group coverage and, in some cases, a rebate to a plan’s enrollees. A rebate applies if the ratio of the amount of premium revenue an issuer spent in a plan year on clinical services to improve health care quality and the issuer’s premium revenue for the plan year (excluding taxes, fees and accounting adjustments) is less than an applicable minimum standard set by Section 2718 of the PHS Act. According to the comment request document, the rebate provision will begin no later than January 1, 2011. With respect to taxation of insurance issuers, the comment request noted that the new health care law amended the tax code by providing that tax code Section 833 would not apply “to any organization unless the organization’s percentage of total premium revenue expended on reimbursement for clinical expenses (as reported under Section 2718 of the Public Health Services Act) is not less than 85 percent.” Tax Code Section 833 generally provides a special deduction and a higher unearned premium reserve to certain Blue Cross and Blue Shield and other organizations meeting specific criteria, the document said. The amendment to Section 833 applies to taxable years beginning after Dec. 31, 2009. The Federal Register notice includes questions designed to elicit information to assist the departments in developing regulations related to Section 2718 of the PHS Act. Among other things, the questions seek information on: assumptions and methodologies used in calculating minimum loss ratio-related statistics; whether states and other entities currently require MLR rebates for individual, small group, large group, or other insurance markets, and any best practices for the submission, interpretation, or communication of the statistics; and the guidance needed to apply tax code Section 833 for the first taxable year beginning after Dec. 31, 2009. The deadline for submitting comments is May 14. The MLR issue is one of the highest priorities for NAHU members, and we will be extremely involved in the coming weeks drafting NAHU’s formal comments, as well as working in concert with many coalition allies to help ensure that MLR regulation implementation is fair, balanced and in the best interests of consumers and others who are impacted by this provision. Published in NAHU latest newsletter

The definition of an adult who can be covered by a parents health plan under the reform rules is not the same as the IRS definition of a dependant.

Here is a question and an answer provided by HHS to address this issue.

This comment states that changes to the SPD must happen with six months after enactment (September 2010) or the next plan renewal.

Q: How do I get my 21 year old onto my plan?

A: Six months from now, insurers will be required to permit children to stay on family policies until age 26.  This applies to all plans in the individual market, new employer plans, and existing employer plans,  unless your adult child  has an offer of coverage through his or her employer.  This requirement will take effect the next time your plan comes up for renewal.  Adult children who are on their parents’ plan now but who lose that coverage when they graduate from college will have the option of rejoining their parents’ policy in the new plan year beginning 6 months from now.  Those whose parents work at self-insured companies will also be eligible if they do not have an offer of employer-sponsored insurance.

Both married and unmarried dependents qualify for this dependent coverage.

Beginning in 2014, children up to age 26 can stay on their parent’s employer plan even if they have an offer of coverage through their employer. 

 

In September all adult children under 27 will be allowed to be on their parent’s health plan.  Also starting in September children will no longer have any waiting periods for per-existing conditions.

 

Tonite on the HHS website www.healthreform.gov , Kathleen Sebelius, Secretary of Health and Human Services (HHS) and Karen Mills, Administrator of US Small Business Administration answered questions about the national health reform bill.  This was the first of what will be a weekly interview session to answer the public’s questions.  The sessions will be held on Wednesdays, at 7pm eastern.  HHS will have the session available in their archives.

 

In addition to the no pre-existing condition for children and coverage for adult children starting in September, it was announced that small business tax credits, state high risk pools and the Medicare doughnut payments will start this year.  The Secretary admitted that they need to get the rules outlined and distributed quickly.  There has been a lot of misinformation and the Secretary stated that all this needs to be clarified.

 

(Below are some of the items I gleaned from the broadcast.  They are truncated and paraphrased. The full broadcast will be on the HHS Health Reform website if you want a word by word account. Secretary Sebelius and Administrator Mills comments are blended together.)

 

Elimination of pre-existing conditions will start with children this September and by 2014 will be eliminated for adults.

 

There is no small business mandate.  The reform refers to it as employer responsibility but it is not a mandate.  If small businesses choose to offer health care they will be eligible for tax credits.  Businesses under 50 employees are exempt from the mandate.  Businesses with more than 50 employees only have to pay into the exchange if they have an employee in the exchange.

 

The individual mandate is necessary to balance the health pool, it is insurance.  Well people need to be covered and not just sick people.  This is individual responsibility.

 

When asked about premium increases the Secretary responded that they should not because the pool will be bigger, there will be more health and wellness coverage to prevent catastrophic care, insurance companies are being required to spend more of the premium on medical costs, and their will be competition.  A small business exchange will be developed.  Right now small business pays more just because they are small.

 

People who are self employed will be treated as individuals under health reform.

 

Public health will not loose funding.  Funding for clinics will continue, there will be more scholarships for public health providers, and reform will help establish medical homes.

 

The Secretary stated that this is one of the most state friendly bills she has seen in a long time.  When the new markets begin in 2014 the federal government will fund the programs 100%.

 

Medicare Advantage programs are not being eliminated and the Secretary hopes they will continue to be available to patients. What will change is the way the federal government pays the program administrators.

Health Care Reform Update:  Employer Implementation Summary

Immediate 2011 Plan Year Issues FOR SELF-INSURED, FULLY INSURED & GRANDFATHERED PLans To help focus attention on the most immediate issues, listed below are the major provisions that apply to insured and self-insured plans, as well as grandfathered plans that employers may need to address for the 2011 plan year (Note: for plan years starting in October, November or December 2010, these may need to be addressed for the 2010 plan year).

1)      Annual/Lifetime Dollar Limits:  There can be no financial limits on essential benefits starting in 2011.  Essential benefits are the list of benefits required to be covered in the Exchange.  There can be limits on non-essential benefits.  In 2014, HHS Secretary may allow, during the regulatory process, some limits on essential benefits.  (This provision seemingly is retroactive so beneficiaries that reached previous thresholds will be given an opportunity to re-enroll.)

2)      No rescission of benefits, except when fraud or intentional misrepresentation has occurred.

3)      Coverage of adult children to age 26.  There is no requirement to cover the dependents of covered adult children. And, as of 1/1/14, if adult children are eligible for their own employer-sponsored coverage, then the parent’s employer is no longer responsible, but this is difficult to track administratively.  The definition of dependent in this legislation supplants all previous dependent definitions, which entailed student, marital status, etc. 

4)      No denial of coverage for preexisting conditions if under age 19, though plans can have exclusions after 2024 for those 19 years old and older.

 

 Effective 1/1/2011; but Not applicable to grandfathered plans

 

5)      Must cover preventive care without a beneficiary cost share.

6)      Non-discrimination in favor of highly compensated individuals, under section 105H rules, is extended to insured coverage. (Currently applied to self-insured plans.)

7)      Must provide an avenue for external review of health plan appeals.

8 )      Must allow female beneficiaries to select their OB/GYN as their primary care physician; and allow children’s pediatrician to serve as their primary care physician.

9)      Automatic enrollment of employees required when there are more than 200 employees.  Technically effective on date of enactment; but realistically employers should wait until the regulations are issued.

10)   Cannot use HSA, FSA or HRAs for pay for over- the- counter pharmaceuticals.

11)   Early retiree reinsurance program- 90 days after enactment (March 23, 2010) the federal government will reimburse (80%) early retiree claims of $15,000 to $90,000 for non-Medicare eligible retirees age 55 to 64.  Funding and scope is limited for this program and the funds must be applied for by plans for deductibles, copayments, etc.  

12)   Employers must report the value of provided health benefits for the 2011 tax year on the 2012 W-2 form. 

13)   Plans and employers must provide enrollees with a summary document of benefits.   (Effective 24 months post-enactment)

 

 

 

2013 Plan Design Changes for Group Plans & Grandfathered Plans

 

1)      FSA plan contribution limited to $2500 annually.

2)      Taxation of employer Medicare Part D retiree drug benefit subsidy.

 

2014 Plan Design Changes for Group & Grandfathered Plans

 

1)      Employer mandates and enrollment penalties go into effect (coincides with Insurance Exchange program.)

2)      Allows an enrollment waiting period of up to 90 days waiting period at the most for group and grandfathered plans.

3)      Guaranteed access and renewal.

4)      First dollar coverage for preventive care, but only for new plans.

5)      Employee wellness program incentive program will permit employers to use rewards or penalties, up to 30 percent of the cost of coverage can be leverage. The amount could go up to 50%. (Currently 20%)

6)      Requires 60 day plan change notice in advance of enactment (currently 60 days post-enactment)

 

2018 Plan Design Changes for Group & Grandfathered Plans

1) Excise tax on high-cost health plan benefits.

(Source: American Benefits Council, Health Care Reform Update Conference Call, Employer Responsibility Issues, Thursday, March 25, 2010)

 

 

USEFUL HEALTH CARE REFORM LINKS

Legislative links:

ü  H.R. 3590, Patient Protection and Affordable Care Act (PPACA)

http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590ENR/pdf/BILLS-111hr3590ENR.pdf

 

ü  H.R. 4872, Health Care and Education Reconciliation Act of 2010 (The Reconciliation Act)

http://www.gpo.gov/fdsys/pkg/BILLS-111hr4872EH/pdf/BILLS-111hr4872EH.pdf

 

American Benefits Council (ABC) Resources (www.americanbenefitscouncil.org):

ü    Side by Side Comparison Chart http://www.americanbenefitscouncil.org/documents/hcr_sidexside-compchart_022610.pdf

 

ü   Priority Employer Issues Issueshttp://www.americanbenefitscouncil.org/documents/hcr_priority-issues-president_031010.pdf

       Kaiser Family Foundation Resources – Implementation Timeline & Comparative Chart

ü  http://www.kff.org/healthreform/8060.cfm

 

ü  http://www.kff.org/healthreform/sidebyside.cfm

Society for Human Resource Management: health care reform web page with numerous resources related to employer/employee benefits

ü  http://www.shrm.org/hrdisciplines/benefits/Articles/Pages/HealthCareReform.aspx

A detailed impact summary related to fully-insured and self-insured group health plans, prepared by the Washington, D.C. based law firm, Alston + Bird LLP, is also now available on the American Benefits Council Web site: 

ü  http://www.americanbenefitscouncil.org/documents/hcr_summary-alstonbird032310.pdf

 

ü  Attached is an employer impact overview prepared by the benefits-focused law firm of Miller-Chevalier.  This is one of the strongest summaries we have seen so far. 

Ropes Gray law firm has produced a helpful overview of the new law’s federal tax implications:

ü   http://www.ropesgray.com/healthcaretaxconsequences/

 Disclaimer

•       Although the PPACA and the companion reconciliation bill have been enacted, few organizations will find a copy of the statutory text particularly helpful since the statute, amendments, and the reconciliation process have generated well over 2,500 pages of material.

•       The law’s implementing “regulations” has not yet been issued. Moreover, regulations will not be issued for some time, and employers/plan sponsors are well advised to wait for the guidance included in regulations prior to making final plan design changes.