Chris Johnson, Manager Consulting Services - J.W. Terrill

Healthcare Reform: Plan Provisions• Effective on first renewal following September 23, 2010• Amend appropriate plan documents for non-grandfathered plans.– Include 1 st Dollar Coverage for “Preventive Care” Services• Insure coverage of US Preventive Services Task Force preventive services list with grades of A or B• Insure coverage of recommended Immunizations– Include Patient Protections• No prior authorization or increased cost sharing for OON Emergency services; no referral for access toOBGYN; and “Choice of Provider” enabling selection of PCP from and pediatrician PCP designation.– Include Internal Appeals & External Review Processes• Sponsors will need to ensure that their plan (or insurance carrier) has internal appeals & external reviewprocesses that conform with guidance created by Departments of Treasury, Labor and Health & HumanServices (HHS).• Recognizing that many plans and insurers cannot meet the tight deadline for compliance DOL has announceda grace period for certain standards until July 1, 2011