Since President Obama signed the Patient Protection and Affordable Care Act (PPACA) and the subsequent Health Care and Education Reconciliation Act of 2010 in March, Blue Cross Blue Shield of Arizona (BCBSAZ) has been working diligently to interpret the law and what it means for our members and others interested in obtaining health insurance from us.
One of the most common questions we receive is when all of the reforms become effective. Different provisions become effective at different times over the course of the next four years, with most reforms effective by 2014. In addition, there are many regulations yet to be fully developed by the government before BCBSAZ can provide concrete answers for certain provisions. These regulations are pending and will be issued by the United States Department of Health and Human Services (HHS) and other state and federal agencies.
The following information is based on our current understanding of the law and our best estimation of how those regulations are likely to be written. As the regulations become finalized, we will share how we expect them to affect you. Please review the following information to get insight into how your current insurance benefit plans may be affected by health care reform. For member-specific information, you can refer your employees to our consumer information center.
We also encourage you to review the U.S. Department of Labor Employee Benefits Security website. Refer to the section on the Affordable Care Act. This section contains a series of FAQs that are helpful with the PPACA implementation for group health rights.
Health Care Reforms Affecting Employers and Employer-Provided Coverage
- Reforms Effective in 2010
- Pre-existing Conditions Exclusions for Children
- Dependent Coverage Extension Up to Age 26
- Premiums
- Grandfathering
- Early Retiree Reinsurance
- Rescission Policy
- Small Business Tax Credit Program
- Tax Credits for Large Employers
- Exchanges
- Lifetime Limits
- Annual Limits and Obtaining Waivers for Certain Plans
- Internal Appeals and External Review
- Medical Loss Ratio Requirements
- Non-discrimination Requirements for Group Health Plans
- Health Savings Accounts and Over-the-Counter Medicines
Health care reforms are set to become effective in stages from 2010 through 2014.
Reforms Effective in 2010
Following is a list of health care reforms for group plans starting or renewing on or after Sept. 23, 2010. Click each one for more specific information.
- Elimination of Pre-Existing Condition Exclusions for Children
- The law says children under age 19 can no longer be subject to pre-existing condition waiting periods. New HHS regulations amend the definition of pre-existing condition so that plans may no longer deny an application of coverage to an individual under 19 due to a pre-existing condition. Additionally, waivers or pre-existing condition waiting periods to these individuals will not be applied. Read more about pre-existing condition exclusions for children.
- Dependent Extension up to Age 26
- Effective with plan years on or after September 23, 2010, dependents up to age 26 will be allowed to remain on their parents’ policies. Read more about dependent extension up to age 26.
- Grandfathering
- Policies that were in effect on March 23, 2010, are exempt from some – but not all – of the insurance changes. A “grandfathered plan” is an existing group health plan or health insurance coverage in which an individual was enrolled as of March 23, 2010. Read more about grandfathering.
- Early Retiree Reinsurance
- The new health care reform law creates a temporary retiree insurance program that will reimburse employers for qualifying retiree medical expenses. Employers may be reimbursed for up to 80 percent of expenses between $15,000 and $90,000. Retiree expenses of employees over age 55, but not yet eligible for Medicare, will be eligible. Employers must be certified to participate in the program and submit claims to the Secretary of HHS for reimbursement. Read more about early retiree reinsurance.
- Small Business Tax Credit Program
- Effective for 2010, many small businesses and not-for-profit organizations providing health insurance to their employees will qualify for a special tax credit of up to 35 percent (25 percent for tax-exempt organizations). Read more about the small business tax credit program.
- Coverage of Preventive Services
- Effective for plan years or policy years beginning on or after Sept. 23, 2010, group or individual health insurance plans must cover certain recommended preventive services from an in-network provider without cost sharing. This requirement does not apply to grandfathered plans.
- The recommended preventive services include:Select services with a grade of ‘A’ or ‘B,’ in the current recommendations by the U.S. Preventive Services Task ForceImmunizations for routine use in children, adolescents and adults recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). For a list of routine use immunizations, see the Immunization Schedule from the CDC.
Preventive care and screenings for infants, children and adolescents supported by the Health Resources and Services AdministrationPreventive care and screenings for women provided in guidelines supported by the Health Resources and Services Administration
- The complete list of recommended preventive services is included on the federal government’s health reform website, managed by the U.S. Department of Health and Human Services.
- Rescissions
- Insurers may not rescind a policy without a showing of fraud or intentional misrepresentation. Read more about rescissions.
- Lifetime limits
- Insurance policies will no longer cap coverage at a certain overall amount. Read more about lifetime limits.
- Annual limits
- “Reasonable” annual limits on essential benefits are permitted until 2014.
- Network Access
- Insurance policies must have the same copays for in and out-of-network emergency room visits. Prior approval of ER visits is prohibited.
- Insurance customers must be able to select any network primary care physician they want to see.
- Women may have direct access to their network OB/GYN.
Pre-existing Conditions Exclusions for Children
The law says children under age 19 can no longer be subject to pre-existing condition waiting periods. New HHS regulations amend the definition of pre-existing condition so that plans may no longer deny an application of coverage to an individual under 19 due to a pre-existing condition. Additionally, waivers or pre-existing condition waiting periods to these individuals will not be applied. This regulation applies to all group plans and only non-grandfathered individual plans. It does not apply to grandfathered individual plans. The term grandfathering means policies that were in effect on March 23, 2010, are exempt from many of the health care reforms.
Dependent Coverage Extension Up to Age 26
The new federal law says that health policies that provide coverage for dependent children must offer coverage to dependents up to the age of 26, effective on or after September 23, 2010, at the start of the group’s plan year or open-enrollment, or individual contract renewal date. Group plans in effect on or before March 23, 2010, are generally considered grandfathered plans under the law. Prior to plan years beginning on or after Jan. 1, 2014, a grandfathered plan need only offer this coverage if the adult child is not eligible for any other employer-sponsored coverage.
In June, 2010, BCBSAZ began to implement this policy for its current group policy holders to continue coverage for young adult dependents.
For small group employers (those with 2-99 employees), BCBSAZ implemented continuing coverage for a dependent under age 26 on their parents’ group health insurance policies effective June 1, 2010.
For large group employers (those 100 or more employees), the employer was given the choice to continue coverage for dependents up to age 26 beginning on June 1, 2010, or at the start of the next plan year or open enrollment on and after September 23, 2010. For many groups, this could mean the change won’t occur until their next open enrollment period. Dependents up to age 26 who are currently not covered under their parents’ coverage will be eligible to enroll at the start of the group’s next plan year, on or after September 23, 2010.
Eligibility for health insurance for these dependents will no longer require verification of student status, marriage status or humanitarian activity. For dependents who cannot qualify as a dependent under their parent’s policy, they may be eligible for one of BCBSAZ’s affordable individual health insurance policies. To reach BCBSAZ’s Sales Department, please call 602-864-4400.
The Department of Labor provided some guidance regarding dependent coverage in its FAQs. This guidance stated that a plan or issuer does not fail to satisfy the requirements of the implementing regulations because the plan limits health coverage for children until the child turns age 26 to only those children who are described in IRS Code section 152(f(1). For an individual not described in the IRS code 152(f)(1), such as a grandchild or niece, a plan may impose additional conditions on eligibility for health care such as a condition that the individual be a dependent for income tax purposes.
Premiums
Based on a research study commissioned by the Blue Cross Blue Shield Association, we believe that premiums will increase as a result of provisions in the reform legislation that will guarantee richer levels of benefits than most consumers who obtain their own insurance purchase today. Insufficient discounts for the young and healthy will encourage many of them to forgo coverage. New fees and taxes mandated by the new law will also likely increase the cost of premiums as they are phased in.
There are a number of factors that are driving health insurance premiums, including rising health care costs. Increasing utilization attributable to an aging population, obesity and chronic illnesses; new treatments; prescription drugs; and expensive new technologies are the biggest causes of increasing health care premiums.
The new law establishes a few pilot programs, but does not aggressively attempt to control rising health care costs. BCBSAZ will continue to work with doctors, hospitals, employers and consumers to contain costs and insurance premiums while improving access to quality health care. How much premiums increase will depend on the further interpretations by the HHS and the extent to which those who are currently uninsured opt to get insurance coverage.
Grandfathering
A “grandfathered health plan” is any group health plan or individual coverage that was in effect on March 23, 2010, the date of the new health care reform law’s enactment. The law provides that grandfathered plans do not need to comply with certain reform provisions. Some of the reforms that do apply to grandfathered policies include:
- Extended dependent coverage to age 26
- Rescission restrictions
- Annual limits and lifetime limits
- Pre-existing condition limitations for children
A policy can lose its grandfathered status. If it does, it becomes subject to most of the health insurance reforms set forth in the law. On June 15, 2010 the federal government issued regulations providing guidance on grandfathered plans. The regulation identifies factors that will result in the loss of a plan’s grandfathered status. In summary, these changes include:
- Eliminating all (or substantially all) benefits to diagnose or treat a particular condition;
- Increasing coinsurance by any amount above the level at which it was set on March 23, 2010;
- Increasing fixed amount cost-sharing (e.g., deductibles and out-of-pocket maximums) more than the sum of medical inflation plus 15 percentage points from the level of March 23, 2010;
- Increasing copays by an amount that exceeds the greater of: (1) a total percentage (measured from March 23, 2010) that is more than the sum of medical inflation plus 15 percentage points, or (2) $5 increased by medical inflation;
- Reducing employer or employee organization contributions based on the cost of coverage or a formula by more than 5 percentage points below the contribution rate on March 23, 2010; and
- Reducing an overall annual dollar limit or adding a new overall annual dollar limit, compared to what was in effect on March 23, 2010.
The regulation generally provides that grandfathered status applies separately to each benefit option offered under a group health plan.
Switching Carriers Permitted
On Nov. 17, 2010, HHS issued an Amendment to the Interim Final Rules for Group Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered Health Plan Under the Patient Protection and Affordable Care Act . Prior to the Amendment, one of the ways an employer group health plan could lose its grandfather status was if the employer changed issuers—switching from one insurance company to another (the original regulation only allowed self-funded plans to change third-party administrators without necessarily losing their grandfathered plan status). The Nov. 17 revised regulations further provided that an insured group health plan could change carriers without necessarily losing its grandfather status. The Amendment allows insured group health plans to switch insurance companies and shop for the same coverage at a lower cost while maintaining their grandfathered status, so long as the structure of the coverage doesn’t violate one of the other rules for maintaining grandfathered plan status. This amendment applies to insured group health plans and not individual plans.
Right to Revoke
In the grandfather regulations, the agencies recognized that some plans may have made changes subsequent to the enactment of the health reform law (March 23, 2010) and before regulations were issued which defined what would cause a loss of grandfathering. To account for this they included in the regulations a limited right to revoke those changes if a plan wished to maintain grandfathering.
Specifically, if a plan adopted changes after March 23, 2010, and before June 14, 2010, which would cause a loss of grandfathering under the regulations, those changes may be revoked or modified effective as of the first day of the first plan year beginning on or after September 23, 2010, for the plan to retain grandfathering.
Changes are considered “adopted” prior to June 14, 2010, if: (a) the changes are effective before that date, (b) the changes are effective on or after that date pursuant to a legally binding contract entered into before that date, (c) the changes are effective on or before that date pursuant to a filing before that date with the Department of Insurance, or (d) the changes are effective on or after that date pursuant to written amendments to a plan that were adopted before that date.
Questions About Grandfathering
Q: Do groups who offer a grandfathered plan prior to the date of enactment and subsequently add a new plan after the date of enactment lose grandfathered status? Example: Group offers a PPO plan on or before the date of enactment and adds an HMO plan on the group’s renewal date after the date of enactment.
A: No. Each benefit package is evaluated separately. The PPO plan will remain grandfathered, but the HMO plan would not be grandfathered. The answer is the same for insured and self-insured plans. However, there are certain anti-abuse rules that apply to mergers and acquisitions of separate benefit plans , which will apply if changes are made and employees are switched from one grandfathered plan based on changes to the plans and whether there the group has a bona fide business reasons for making these changes.
Q: If a group with a grandfathered plan changes carriers after the date of enactment and the new carrier administers the same benefits and cost-sharing as the old carrier, does the plan lose its grandfathered status?
A: No. Insured group health plans may switch insurance companies and shop for the same coverage at a lower cost while maintaining their grandfathered status, so long as the structure of the coverage doesn’t violate one of the other rules for maintaining grandfathered plan status. A self-insured group will not lose grandfathered status if it switches its plan administrator as long as the structure of the coverage does not violate of the other rules for maintaining grandfather status.
Q: An employer group offers two plans that were in effect prior to the date of enactment: a PPO plan and an HMO plan. Can employees change from the PPO plan to the HMO plan or vice versa during open enrollment after the date of enactment without losing grandfathered status?
A: Yes. An employee can move between the two plans during open enrollment without jeopardizing the grandfathered status of the plan. The answer is the same for insured and self- insured plans.
Early Retiree Reinsurance
The new health care reform law creates a temporary early retiree insurance program that will reimburse eligible employers for qualifying retiree medical expenses. Employers may be reimbursed for up to 80 percent of expenses between $15,000 and $90,000. Retiree expenses of employees over age 55, but not yet eligible for Medicare will be eligible. Additionally, the program also includes claims for the spouses, and surviving spouses and dependents of the early retiree. Employers must apply to, and be certified by, HHS and submit claims to HHS for reimbursement.
The program was effective June 1, 2010, and the application is available on the HHS website. The program is scheduled to last until January 1, 2014. Funds are now being distributed on a first-come-first-serve basis. If program funds become depleted, the HHS can choose not to accept additional applications. Final regulations have recently been issued, which provide more details about the program and the application and claims submission process. Learn more about the Early Retiree Reinsurance Program.
Rescission Policy
Rescission is the termination of a health insurance policy by the health insurer. The PPACA places restrictions on the practice of rescinding or terminating a policy, stating that a policy may only be rescinded in cases of fraud or intentional misrepresentation of material fact during the underwriting process. In 2009, BCBSAZ processed 31,376 individual under-age-65 applications and initiated one rescission. This is due to BCBSAZ’s controls and safeguards in our rigorous review process, which involves medical services and legal specialists as well as a two-level appeals process for the policyholder.
Small Business Tax Credit Program
Effective for 2010, many small businesses and not-for-profit organizations providing health insurance to their employees will qualify for a special tax credit of up to 35 percent (25 percent for tax-exempt organizations). This tax credit is designed to encourage small businesses to offer or continue to offer health insurance to their employees. There are certain eligibility criteria that must be met, and that information is available at www.IRS.gov. In general, the tax credit is available to small businesses that pay at least half the cost of single coverage for their employees, employ fewer than 25 employees AND pay wages averaging less than $50,000 per year. The maximum credit is available to smaller employers, those with 10 or fewer employees, paying annual average wages of $25,000 or less per year. In 2014, the tax credit will increase to 50 percent of premiums paid by eligible small businesses and 35 percent of premiums paid by eligible tax-exempt organizations. View a recording of a webinar on the Small Business Tax Credit provision of the Patient Protection and Affordable Care Act (PPACA) conducted June 1 by BCBSAZ Treasurer and Vice President Kate Baker.
Webinar Materials
Small Business Tax Credit Estimator
Small business owners can use this calculator, powered by H&R Block, to help estimate how their business may benefit from the small business tax credit available under the new health care reform legislation. This tool provides an estimate only and is not intended as legal advice. Please consult your tax advisor for details on the small business tax credit. H&R Block is not affiliated with Blue Cross Blue Shield of Arizona. Kate Baker, Vice President, Treasurer, Blue Cross Blue Shield of Arizona, comments on the small business tax credit.
Tax Credits for Large Employers
Beginning in 2014, businesses with 50 or more employees that do not offer minimum essential coverage and have at least one full-time employee who receives a federal premium assistance credit to purchase health insurance on his own through an “exchange,” must pay the federal government a $2,000 per-employee penalty. The first 30 employees would be excluded from this assessment. Large businesses – those with more than 200 full-time employees – that offer health insurance will have to automatically enroll workers into a health plan. An employee, however, may choose to opt out of this automatic enrollment into their employer’s health plan.
Exchanges
An exchange is a marketplace for insurance to allow consumers to shop by price while comparing the offerings of a plan. The PPACA has established that exchanges must be functional by Jan. 1, 2014. In 2017, a state may elect to make large group coverage available through the exchange. According to the PPACA, exchanges may be for individual or small business only or combined. Exchanges will be state run, and in the cases where the state does not set up an exchange, the federal government will offer the exchange.
Lifetime Limits
Insurance policies will no longer be allowed to require a specific dollar cap on essential benefits. New regulations also permit individuals who previously reached a lifetime maximum and who are otherwise still eligible for coverage an opportunity to re-enroll. The prohibition on lifetime limits applies to all group and individual plans. Notice to members who may have reached a lifetime maximum benefit is required under the regulations. BCBSAZ is reminding its groups to provide these notices as required. The notice is available here.
Annual Limits
This provision restricts and later prohibits insurance policies from imposing dollar amount-based annual limits on essential benefit plan services. Annual limits are restricted for plan years beginning on or after Sept. 23, 2010, and prohibited for plan years beginning on or after Jan. 1, 2014. The limitation on annual limits does not apply to individual grandfathered plans. The term grandfathering means policies that were in effect on March 23, 2010, are exempt from many of the health care reforms. Specific guidelines for what is defined as essential benefits are pending from HHS.
Internal Appeals and External Review
The Patient Protection and Affordable Care Act (PPACA) set forth new standards for non-grandfathered plans regarding processes for internal appeals and external review. The federal agencies published Interim Final Regulations on July 23, 2010, and have issued various technical releases, model notices and guidance materials to further define the requirements which must be met. BCBSAZ currently complies with internal grievance processes required by the Department of Labor (DOL) and internal and external appeals requirements of the State of Arizona for its insured members. The following describes some of the key changes required by PPACA and the steps which BCBSAZ is taking to satisfy these requirements.
Internal Appeals
For non-grandfathered group health plans (both fully insured and self insured), PPACA includes the following changes to existing internal appeals processes: (a) the definition of an “adverse benefit determination” (ABD) has been modified to also include a rescission; (b) notices for urgent care claims must be provided within 24 hours; (c) claimants may review the claim file and present evidence and testimony; new evidence considered must be provided free of charge in advance of the date the notice of final internal ABD is due; and before a final internal ABD based on a new or additional rationale, the rationale must be provided free of charge and in advance, (d) new requirements to ensure independent decision making, (e) notices of ABD must be provided in a culturally and linguistically appropriate manner, (f) additional information must be provided in notices of ABD and final ABDs including (among other things) diagnosis codes, procedure codes and their meanings, the reason for the determination must include the denial code and its meaning and a description of the standard that was used in denying the claim. A notice of final internal ABD must include a discussion of the decision.
The DOL issued Technical Release 2010-02 on Sept.20, 2010, which sets forth an enforcement grace period until July 1, 2011, with respect to the requirements listed above in (b), (e) and (f).
BCBSAZ has made the process changes necessary to meet the new requirements which non-grandfathered plans were required to have in place for plan years starting on and after Sept. 23, 2010. BCBSAZ has a large, cross-functional team assembled to address the requirements listed in (e) and (f). With respect to the requirements in (e), plans should soon be receiving a request for information regarding language literacy for its plan participants. This information is necessary in order to assess the languages into which certain notices must be translated.
External Review
For non-grandfathered, fully insured and non-ERISA self insured groups, changes to existing external review processes are not required until July 1, 2011. By that time, one of the following will have occurred which will dictate the required next steps: (1) HHS determines that Arizona’s external review process meets the NAIC model’s consumer protections and groups may continue to comply with Arizona’s current external review process, or (2) HHS concludes that Arizona’s external review process does not meet the NAIC Model’s consumer protections and the State modifies Arizona’s process to meet those by July 1, 2011 so that groups would need to comply with the modified Arizona process, or (3) HHS concludes that Arizona’s external review process does meet the NAIC Model’s consumer protections but Arizona does not modify its process so that groups would need to begin complying with the federal external review standards (which have not yet been defined in regulations).
For non-grandfathered, self-insured ERISA groups, the external review process must comply with the interim federal process described in DOL Technical Release 2010-01 (Aug. 23, 2010) because the Arizona Department of Insurance has not formally agreed to permit self-funded plans to voluntarily comply with the external review process it administers under Arizona law.
BCBSAZ administered self-funded groups may choose to implement their own external appeals process or elect to use BCBSAZ services. BCBSAZ expects more guidance from HHS concerning requirements for implementing internal and external appeals. We will keep you updated as we receive additional information.
Employer-Provided Coverage — Not Taxable; Reporting Requirement Optional in 2011
Starting in tax year 2011, the Affordable Care Act requires employers to report the value of the health insurance coverage they provide employees on each employee’s annual Form W-2. However, to provide employers the time they need to make changes to their payroll systems or procedures in preparation for compliance with this requirement, the IRS will defer the reporting requirement for 2011, making that reporting by employers optional in 2011.
The revised Form W-2 for 2011 is now available in draft for viewing. This is the W-2 that most employees will receive in early 2012. The draft form includes the codes that employers may use to report the cost of coverage under an employer-sponsored group health plan.
This reporting is for informational purposes only, to show employees the value of their health care benefits so they can be more informed consumers. The amount reported does not affect tax liability, as the value of the employer contribution to health coverage continues to be excludible from an employee’s income, and it is not taxable.
For information, see IRC New release and draft form and guidance.
Medical Loss Ratio Requirements
On Dec. 1, 2010, HHS published its interim final rule (IFR) implementing the minimum medical loss ratio (MLR) and premium rebate provisions of Affordable Care Act (ACA). The provisions of the rule are generally applicable for plan years beginning on or after Jan. 1, 2011.
The IFR adopts recommendations made by the National Association of Insurance Commissioners (NAIC). The IFR generally requires that issuers (i.e., health insurance companies) report to the Secretary the mandated information by June 1 of each year. The initial report, containing calendar year 2011 data, will be due June 1, 2012. Insurers will be required to make the first round of any required rebates to consumers by Aug. 1, 2012 based on their 2011 medical loss ratio. Very small plans are exempt from the MLR requirement and larger small plans are allowed to adjust their MLR to reflect their “special circumstance” of not having sufficient experience to be statistically valid for purposes of the rebate provision. On Jan. 3, 2011, HHS issues some technical corrections to the medical loss ratio interim final rule, these were effective Jan. 1, 2011.
Some of the key provisions in the regulations include:
- Health plan issuers offering group or individual health insurance coverage, including a grandfathered health plan, must submit a report to HHS by the June 1 following the end of an MLR reporting year. An issuer must submit this report for each state in which it is licensed with data that include all policies issued in that state, aggregated separately for the large group market, small group market, and the individual market.
- Small employer (small group) is defined as up to 100 employees, except that as provided under PPACA, until 2016 a state may substitute 50 employees for 100 employees consistent with current law in most states.
- Health plan issuers are required to submit their HHS report by June 1 following the 2011 MLR reporting year, but there is a reporting exception for certain issuers who will also be required to provide quarterly reports by May 1, August 1, November 1 during the 2011 MLR reporting year.
Reporting of Activities that Improve Health Care Quality Activities that improve health care quality that will be counted with incurred claims when calculating the MLR. Generally, these activities must:
- be designed to improve health quality;
- increase the likelihood of desired health outcomes in ways that can be objectively measured;
- be directed toward enrollees or a specific segment of enrollees or provide health improvements to the population beyond those enrolled; and
- be grounded in evidence-based medicine, widely accepted best clinical practice, or criteria issued by recognized professional medical associations, accreditation bodies, government agencies or other nationally recognized health care quality organizations.
Many details of compliance continue to be discussed with HHS and the states. BCBSAZ is continuing to work on these details. As you know, we have already begun the process of collecting information from our employer groups to provide the necessary reporting for 2011.
Non-discrimination Requirements for Group Health Plans
The interim guidance on changes to the nondiscrimination requirements for group health plans (commonly referred to as the practice of including ‘management carveouts’) can be found in IRC Notice 2011-1. Employers must determine their own compliance with non-discrimination requirements. The IRS released new guidance on Dec. 22, 2010, that delay applicability of this requirement. Read the latest from the IRS on this component of the health reform law.
Health Savings Accounts and Over-the-Counter Medicines
Effective Jan. 1, 2011, the cost of an over-the-counter medicine or drug cannot be reimbursed from Flexible Spending Arrangements or health reimbursement arrangements unless a prescription is obtained. The change does not affect insulin, even if purchased without a prescription, or other health care expenses such as medical devices, eye glasses, contact lenses, co-pays and deductibles. The new standard applies only to purchases made on or after Jan. 1, 2011, so claims for medicines or drugs purchased without a prescription in 2010 can still be reimbursed in 2011, if allowed by the employer’s plan. A similar rule goes into effect on Jan. 1, 2011, for Health Savings Accounts (HSAs), and Archer Medical Savings Accounts (Archer MSAs). For more information, see IRC news release IR-2010-95, Notice 2010-59, Revenue Ruling 2010-23 and the IRC questions and answers.
FSA and HRA participants can continue using debit cards to buy prescribed over-the-counter medicines, if requirements are met. For more information, see IRC news release IR-2010-128 and Notice 2011-5.
