Certain issues related to welfare benefit plans have been addressed by recently enacted laws and regulations. These changes have significant impact on welfare benefit plans.
- Coverage For Reconstructive Surgery Following Mastectomy Required For Plans That Cover Mastectomies
Group health plans (including self-funded plans) and health insurance issuers that provide medical and surgical benefits for mastectomies are required to also provide coverage for breast reconstruction following mastectomies, effective for plan years beginning on or after October 21, 1998.
Plan sponsors are also required to provide participants with written notice of the availability of this coverage. The written notice must be given to each participant upon enrollment into a plan and annually thereafter. Following enactment of the law, written notice must also be given by the earliest of:
- the next mailing made by the plan to participants or beneficiaries;
- the next mailing of any part of a yearly information packet sent to participants or beneficiaries; or
- January 1, 1999.
- Clarification of Rules Regarding Length of Hospital Stay For Mothers and Newborns Following Birth
Group health plans and health insurance issuers may not restrict mothers' and newborns' benefits for a hospital length of stay in connection with childbirth to less than 48 hours following vaginal delivery or 96 hours following a delivery by cesarean section. These rules apply to plans and issuers providing benefits for hospital stay in connection with childbirth. The new interim rules clarify that coverage may be for shorter time periods if the attending provider, in consultation with the mother, decides to discharge the mother or her newborn earlier.
These interim rules become effective for plan years beginning on or after January 1, 1999.
Employers should check with their health insurers or third party administrators to make sure that the required notice of reconstructive surgery coverage is timely sent to participants. Employers also will want to review their plans and summary plan descriptions, in light of the new requirements, and make any necessary modifications.
OTHER ITEMS OF INTEREST
- Self Employed Individuals
The self-employed tax deduction for health insurance premiums was increased to 60% for taxable years 1999 through 2001, to 70% for 2002, and to 100% beginning in 2003.
- Higher Education Institutions
A new law permits institutions of higher education to offer age-affected supplemental benefits to tenured faculty members under voluntary retirement programs. The law provides an exemption under the Age Discrimination in Employment Act for colleges and universities to offer such benefits provided certain conditions are met.