Core - laws and acts Flashcards
What does Family and Medical Leave Act do?
FMLA guarantees employees up to 12 weeks of protected, unpaid leave per year. Provides opportunity to continue health benefits or resume benefits upon returning to work.
What does Medical Health Parity Act of 1996 do?
MHPA restricts imposing more restrictive annual or lifetime dollar limits. Requires parity with respect to financial requirements as cost sharing, visit limits, and treatment limits.
What does Minimum pay health plans Medicare Secondary Payer (MSP) rules do?
Requires that group health plans are primary payer with respect to active employees. Prohibits group health plans from denying coverage to otherwise eligible employees
What does Newborns’ and Mothers’ Health Protection Act of 1996 do?
Requires group health plans to pay for minimum hospital stays for mothers and their newborns immediately following childbirth
Able to stay 48 hours after a vaginal delivery and 96 hours after a C-section
What does Women’s Health and Cancer Rights Act of 1998 do?
Requires health plans to cover post-mastectomy reconstructive surgery.
What does Michelle’s Law do?
Generally prohibits the plan from terminating coverage when an enrolled dependent leaves school to take a medically necessary leave of absence.
What does Genetic Information Nondiscrimination Act (GINA) of 2008 do?
Prohibits group health plans form setting group premium or contribution amounts based on genetic information. Prohibits requiring genetic test for underwriting purposes.
What did DEFRA do?
Deficit Reduction Act of 1984 severely limited the use of welfare benefit funds and insurance company reserves to fund retiree life and health benefits. It also places limits on coverage amounts allowed to be funded for retiree life insurance benefits.
- Retirees are taxed on benefits when they receive them. There are limits on amounts that can be contributed on a pre-tax basis.
- Employee contributions to purchase group annuity contracts are made with after-tax money.
What does Age Discrimination in Employment Act (ADEA) do?
- ADEA states that cost of benefits must not decline with advancing age of the EEs
- Most companies provide benefits paid until age 65 for disability prior to age 60, and then grading down between ages 60 and 70
What did Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) do?
Created Part D OP prescription drug benefit
What did ERISA do when it passed in 1974?
Focused on retirement benefits and addressed employers’ pretax employee benefits.
Established appeal rights for denial of benefits and established new regulations for employers that self-funded their benefits plans in order to avoid state regulation and taxes.
What did McCarran-Fuerguson Act of 1954 do?
Exempted insurance companies from federal oversight, leaving the obligation to the states.
What did the HMO Act of 1973 do?
- Authorized startup grants and loans and ensured access to the employer-based insurance market.
- Grants and loans available for the planning and for service area expansions for existing HMOs.
- State laws that restricted the development of HMOs were overridden for HMOs that were federally qualified.
- Dual choice provisions required employers with 25 or more emplyees that offered indemnity coverage to also offer federally qualified HMOs.
What did the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 do?
Authorized Medicare to pay HMOs on a capitated basis
Allowed states to impose nominal cost sharing on certain beneficiaries and services but exempted some groups like pregnant women and children
What did Balanced Budget Act of 1997 do?
Allowed provider organizations to accept risk and contract directly with Medicare as provider-sponsored organizations (PSOs) if they met certain criteria.
Created Medicare + Choice program
Provided coverage for low income children
Shifted prescription drug responsibility for dually eligible individuals to Medicare
What did COBRA in 1985 do?
Allowed individuals who lost eligibility for group coverage to continue group coverage for up to 18 months.
What did Baucus Amendment do?
Induced each state to adopt insurance laws that met Congressional minimums for Medicare Supplement policies.
What did Health Information Technology for Economic and Clinical Health Act (HITECH) do?
Strengthened individual’s right to access PHI
Important employment laws
- Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)
- Family and Medical Leave Act of 1993 (FMLA)
- Health Insurance Portability and Accountability Act of 1996 (HIPAA)
- Mental Health Parity Act of 1996 (MHPA)
- Newborns’ and mothers’ health protection act of 1996 (NMHPA)
- Women’s health and acencer rights act of 1998 (WHCRA)
- Medicare prescription drug, improvement, and modernization act of 2003 (MPDIMA)
- Working families tax relief act of 2004 (WFTRA)
- Heroes earnings assistance and relief tax act of 2008 (HEART act)
- Michelle’s Law
- Mental health parity and addiction equity act of 2008
- Genetic infotmation and nondiscrimination act of 2008 (GINA)
- Patient Protection and Affordable Care Act (PPACA)
What did Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 do?
- Repealed AFDC and replaced it with a block grant to the states, temporary assistance for needy families, severed link between eligibility for cash assistance and Medicaid
- Barred Medicaid coverage for most illegal immigrants who entered the US after August 22, 1996
What did Deficit Reduction Act of 2005 do?
Required people applying for Medicaid to provide proof of citizenship
What does PACE do?
Program of All-inclusive Care for Elderly provides fully coordinated, site-based care and funding for individuals over the age of 55 who are eligible for nursing home care
Filings for the SEC
10K: submitted annually and includes comprehensive information such as earnings, cash flow, balance sheet, executive pay, litigation, and management discussion and analysis
10Q: submitted quarterly and is a shorter version of 10K
8K: submitted whenever any development that is material to shareholders and the company happens such as mergers, acquisitions, accounting problems, or hiring and firing of key executives
13D: submitted whenever an individual or corporation acquires a 5% stake
14A: a proxy statement that includes details of issues to be voted on and background on management and Board of Directors
What did the 1942 Stabilization Act do?
- imposed wage and price controls on businesses, including limiting their ability to pay higher wages to attract scarce workers
- the Act did allow workers to avoid taxation on the employer contribution to certain employee benefit plans, including health benefits, which gave impetus tot he growth of commercial health insurance
What did the Medicare Modernization Act do?
- Created HSAs
- only individuals covered by an HDHP may make tax-deductible contributions to an HSA
- individuals eligible for Medicare, claims as a dependent on somebody else’s tax return, or covered under another policy are not eligible to contribute to an HSA
- any money left in an HSA at the end of the year may be rolled into the next year