New proposed rules springing from the Patient Protection and Affordable Care Act (PPACA) would drastically change how companies communicate information about their employer-sponsored benefits.

The new guidance would require fully insured and self-insured plans to supply a summary of benefits and coverage (SBC) to employees no later than March 23, 2012, according to a report by CCH. The SBC would have to include easy-to-understand language, a comparison tool that would use three real-life examples (having a baby, treating breast cancer, managing diabetes) and a glossary of commonly used health care terms, such as "deductible" and "copay."

The rules call for the SBC to be distributed with enrollment materials and upon request within seven days. In addition, any updates to the SBC would have to be distributed 60 days prior to the change, according to the law firm Ogletree Deakins. Employers who do not meet these requirements could face a fine of up to $1,000 per failure.

"Employers and administrators that already provide summary plan descriptions [SPDs] are understandably concerned about the duplications and additional costs associated with elements of the new SBC requirement," the CCH report said.

The Employee Benefits Security Administration, the IRS and the Department of Health and Human Services (HHS) are accepting comments through Oct. 21, 2011, on how this new communication should be coordinated with SPDs and other enrollment materials.

Plan 'Affordability'
Prior to the release of the proposed SBC rules, the IRS announced it would create new rules to make it easier for employers to determine if their health plans meet the affordability requirements under PPACA, according to a Workforce Management report. Under current rules, plans with single-coverage premium contributions that top 9.5 percent of a worker's family income would be subject to an annual $3,000 penalty in 2014. The new rules would allow employers to base their calculations on wages instead of income, ensuring a more accurate picture of affordability, the IRS stated.

HRA Update
Meanwhile, the HHS loosened some of the PPACA rules on annual dollar limits as they apply to stand-alone health reimbursement accounts (HRAs). HHS announced that sponsors of stand-alone HRAs are exempt from the annual limit requirements on coverage of essential benefits ($750,000 in 2011, $1.25 million in 2012 and $2 million in 2013). However, the exemption disappears after 2014, according to Buck Consultants.

While new research points to a slowdown in the growth of consumer-driven health care plans (CDHPs), some experts say the high-deductible options still have a lot of life left in them.

CDHPs in the U.S. experienced continued growth in 2011, but at a slower rate than in 2009 and 2010, according to preliminary results released by United Benefit Advisors (UBA) from its 2011 UBA Health Plan Survey.

CDHPs grew at a rate of 13.9 percent this year (about two-thirds of the 2010 rate) to 22.9 percent of plans offered and covered more employees (17.3 percent) than HMOs (11.9 percent), according to Bill Stafford, UBA's vice president, member services.

The Northeast region of the country had the largest concentration of CDHPs (31.3 percent), followed by the Southeast region (27.4 percent). The average cost increase for all CDHPs at 8.0 percent was slightly lower than that of the average of all plan types, which increased 8.2 percent this year.

"For the first time in more than seven years of reporting, first-year CDHPs nationally did not create a savings over the clients' in-force plan prior to renewal. This year, first-year CDHPs experienced an increase (2.1 percent), albeit less than the average 8.2 percent increase of all plans," Stafford said. "As these plans become more prevalent, the percentage of savings has continually declined."

Despite this slowdown in growth and savings, some experts predict the continuing rise in overall costs and the pressures created by health care reform will make CDHPs an attractive choice for many employers well into the future.

"Unless there's a significant change in any of the legislation, CDHPs will remain a viable option post-health care reform," said Nick Calabrese of CIGNA Corp. in a recent Business Insurance article. "If you rewind the clock back to before health care reform, there was concern on our end whether they would be eliminated. But, by and large, they were left untouched."

Most CDHPs will meet the minimum coverage and affordability requirements under health care reform, according to the Business Insurance report. By dodging those bullets, CDHPs likely will remain a good option for many employers who are looking for a "double-duty" plan that both reduces costs and improves employee engagement, Calabrese said.

When kicking off a wellness program, employers often rely on big events -- health fairs, walk-a-thons and gym membership promotions, to name a few.

To ensure long-term success, however, employers also need to sweat the details of their plan. That means gathering lots of data with a health risk assessment, experts say.

Research shows that health risk assessments are crucial to wellness programs because they can gather a wealth of accurate and unique information about the participants, according to a recent report on the Society for Human Resource Management's website. This information allows employers to specifically tailor programs that are best suited for individual workers and turns an assessment into a "teachable moment that is highly conducive to engaging individuals in health improvement programs," the SHRM report's authors noted.

While a volume of research demonstrates the value of assessments, recent regulations from a number of federal laws have dampened the excitement for these wellness tools.  Specifically, the Genetic Information and Nondiscrimination Act (GINA) prohibits employers from gathering genetic data, including family medical history, via health risk assessments unless the information is given voluntarily. Employers can offer incentives to encourage employees to take an assessment, but only if the assessment does not require data on family medical history or other genetic information. Also, employers must make it clear the incentive is not tied to answering those questions, according to the law firm of McGuire Woods LLP.

Luckily for employers, the Equal Employment Opportunity Commission (EEOC) recently clarified some rules on GINA and assessments, giving employers a little more wiggle room. In a recent news release posted on HR Morning, the EEOC said employers "may use the genetic information voluntarily provided by an individual to guide that individual into an appropriate disease management program."  This guidance allows employers to use assessment data to steer individuals into specific types of wellness initiatives. Employers should note, however, that participation in these assessments must remain voluntary, according to the HR Morning report.

HIPAA and the Americans with Disabilities Amendments Act (ADAAA) also can muddy assessment compliance, according to the law firm of Verrill Dana LLP. Both laws contain provisions that prohibit nondiscrimination, which could emerge if genetic data from assessments were mishandled. Each law, however, also offers safe harbors for "bona fide" wellness programs (initiatives that are available to all similarly situated employees) and do not impact plans that offer incentives based on participation, not results.

Verrill Dana noted in a recent publication that under HIPAA and ADAAA, employers can require employees to take an assessment as part of a wellness program, and they can provide premium discounts or other incentives if they participate. However, they can't make the assessment a condition of employment, and any incentive must be offered to all similarly situated participants (thus keeping the plan "bona fide"), the law firm states.

Assessments certainly require careful handling, but if done right, they can serve as a cornerstone to an effective wellness program, the SHRM report noted.

"Health assessments . . . have been proven effective in reducing health care cost trends and improving population health and productivity," the report's authors wrote. "It is important to recognize, however, that the role of the health assessment is not to change health outcomes but to make it possible to target and tailor proactive outreach and behavior change programs."