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EGHPEmployer Group Health Plan
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A seven-month special enrollment period is provided if Medicare has been the secondary payer of benefits for individuals age 65 and older who are covered under an employer group health plan because of current employment.
If a person declines to enroll (or terminates enrollment) at a time when Medicare is secondary payer to his employer group health plan, the months in which he is covered under the employer group health plan (based on current employment) and Hospital Insurance will not be counted as months during which he could have been but was not enrolled in Medical Insurance for the purpose of determining if the premium amount should be increased above the basic rate.
For employer group health plans, these changes generally take effect at the beginning of the first plan year starting after June 30, 1997.
Since large employer group health plans are not required to provide an EHB package, the ACA does not directly mandate that these large group plans comply with the federal parity requirements.
Most large employer group health plans that did not conform to parity standards in 2009, even after implementation of the MHPAEA, modified their plans by 2011 to eliminate the more restrictive substance use disorder benefits.
Most employer group health plans must pay fees to help fund reinsurance for insurance companies as they transition to covering high-risk individuals without adjustments for pre-existing conditions.
Under the PPACA, employer group health plans are required to have both an internal and external review process for appeals of claims and coverage determinations that meet certain standards.
* Employer group health plans for employees and their spouses
The law incorporates a mental health parity measure that requires employer group health plans that offer mental health coverage to make that coverage the same as for medical and surgical benefits.
Employer group health plans are required to have an external review process for appeals of coverage determinations and claims that meet certain standards (effective January 1, 2011; applies to newly created health plans).
The total cost of the disease was $35.32 billion, including coverage by Medicare and other payers, such as employer group health plans.
Employers are not required to provide this notice, nor is it a substitute for any required COBRA notice or other information required by law to be furnished to participants or beneficiaries in employer group health plans.
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