1. Myth: Self-funded plans are exempt from market reform changes under the Affordable Care Act (ACA).

Fact: Self-funded plans are subject to the substantive ACA market reforms, as well as numerous other Federal laws, including (but not limited to) the Employee Retirement Income Security Act of 1974 (ERISA) (P.L. 93-406), the Health Insurance Portability and Accountability Act (HIPAA) nondiscrimination rules (P.L. 104-191), HIPAA privacy and security (P.L. 104-191), the Americans with Disabilities Act (P.L. 110- 325), the Mental Health Parity Act (P.L. 104-204), COBRA continuation coverage (P.L. 99-272), IRS nondiscrimination rules prohibiting benefit differences based on employee status (P.L. 95-600).

This is a sample of "big picture" perspective pieces constantly prepared for SPBA members.  There are alo detailed technical analysis of issues with insider insights for compliance.

(Those who do not know history are doomed to repeat it.  Or, in this case, to create more problems.)

Both supporters & opponents (and regulators who must implement the law) are driving themselves crazy trying to find logic and make sense of the Patient Protection & Affordable Care Act (a.k.a. PPACA, ACA, & Obamacare).  Relax…it was an accident.  The current text was never intended to be passed into law.  It was a fluke & political accident explained below.

The list below was requested by a magazine to help employers to prepare them for what to expect when starting the process of shifting to a self-funded health plan with a TPA. Every situation is personalized, but these are main points to expect.

Why use self-funding? Clarification: Self-funding is best known as a funding vehicle for employee benefit plans, especially health coverage. That is the topic of this paper. However, self-funding is also broadly used for such things as Workers Compensation and Property & Casualty coverage. The governing laws & focus is so different that those are generally considered totally different. So, this is health employee benefits.

Some observations from SPBA Active Past President Fred Hunt

IMPORTANT PREFACE:  Let me say that I and many people recognize that careful well-run self-funded Multiple Employer Welfare Benefit Plans (MEWAs) would help the country greatly in providing cost-effective health coverage for businesses and minimizing the number of uninsured Americans. HOWEVER, decades of secret agendas against MEWAs and too many scandals among fly-by-night or misguided promoters have left multiple-employer plans as poisoned ground, politically.