Discrimination Appraisal Described

The purpose of the Discrimination Appraisal Work-Product is to permit the subject health care plan (through its vendors or sponsor) to appraise (i.e., understand, measure, compare) either, or both, of these discrimination analyses:

Analysis Number l – Broader Meaning of Discrimination

This Analysis is in the form of a checklist that includes all of the relevant dimensions of discrimination (in its broader scope) such as (a) the prohibited class, (b) the protected class (race, sex, ethnicity. religion, disability, handicap), (c) federal benefit-related mandates (HIPAA, e.g.), (d) new PPACA-created classes (providers, consumers and insurers) and (e) Federal Trade and Commerce-related (PPACA denies the McCarran-Ferguson exemption to health care plans).  The Appraisal extends to an inquiry relative other benefit arrangements are to be tested (i.e., cafeteria or dependent child reimbursement plans).

Analysis Number 2 – Eligibility and Plan Aggregation

This Analysis is optional and is based on the eligibility data
(total employees, eligible employees, excludible employees and participants) for each medical reimbursement plan of the employer (cafeteria and dependent child reimbursement plans are excluded). This Analysis shows (a) whether or not each plan meets the IRC Section 105(h) eligibility test and (b) whether or not plan aggregation is a reasonable option.

Because Analysis Number 2 involves a quantitative analysis, the entire Work-Product is offered as actuarial opinion (and even then only if an inked signature and review of the submitted data by the actuary is made).