In most areas of the country, leaves have already begun to fall bringing with them not only autumnal color, but some benefit compliance dates that you'll want to mark on your calendar. Here are the key items and their due dates:

  • Medicare Part D Disclosure Notice - October 14
  • 5500 Form for Calendar Year Plan Extension Filers - October 15
  • Health Plan Identifier (HPID) - November 5
  • Transitional Reinsurance Fee Membership Count - November 15
  • COBRA Federal v. State Annual Review - December 31

MEDICARE PART D DISCLOSURE NOTICE

Employers who provide a prescription drug benefit to employees or their  dependents who are eligible for Medicare Part D must provide certain individuals with a Creditable Coverage Disclosure Notice no later than October 14th, prior to the start of the Medicare annual open enrollment period. Individuals who must receive the Notice include:
  • Medicare-eligible actively working employees, COBRA participants, and their dependents;
  • Medicare-eligible disabled individuals, including dependents; and
  • any retirees and their dependents.
In addition to providing this Notice once a year, plan sponsors also need to provide it in the following circumstances:
  • prior to the effective date of an individual's enrollment in the plan and upon any change that affects whether the coverage is creditable prescription drug coverage;
  • prior to an individual’s initial enrollment period for the Medicare prescription drug benefit; and
  • upon request by a plan participant.
Because you may not necessarily know the Medicare status of a dependent, (especially a disabled dependent), we recommend making the Notice available to all plan participants. You may meet the annual distribution requirement by incorporating the Notice into your benefit and enrollment materials, if you make those materials available at least once a year and in other required instances. In any event, it is important to document how the Notice is distributed so you are able to demonstrate compliance. The Model Notices (available in English and Spanish) may be found at the Center for Medicare and Medicaid Services (CMS) website.

CALENDAR YEAR PLAN 5500 EXTENSION FILERS

If your employer sponsored health plan runs on the calendar year and you filed for an extension, October 15 is the last day to file your 5500 with the Department of Labor without incurring late penalties.  (5500's for employer sponsored pension plans, such as 401(k) plans, 403(b) plans, and IRA plans, have the same deadline.) In addition, following the filing of the 5500, you must provide plan participants, including COBRA participants, with the Summary Annual Report (SAR) no later than December 15.

HEALTH PLAN IDENTIFIER (HPID)

As required by the Administrative Simplification Rule under HIPAA, all large "controlling" health plans must apply for an HPID no later than November 5. The intended purpose of the HPID is to provide a unique, standardized identifier for all health plans, including employer-sponsored health plans, that handle HIPAA covered transactions, ideally making their processing more efficient. A large health plan is one that has more than $5 million dollars in annual receipts. (Small plans have until November 2015). While carriers will apply for HPIDs as the controlling health plan for fully insured groups (which will be considered subgroups and aren't required to have an HPID themselves), self-insured plans are considered controlling health plans and will need to apply for an HPID themselves. There are three steps to apply for the number:
  1. Register for a CMS account at the CMS Enterprise Portal
  2. From the Portal, select the link to the Health Insurance Oversight System (HIOS). This step may take up to 48 hours for processing.
  3. Select the link to the Health Plan and Other Entity Enumeration System (HPOES) and follow the prompts.
While the number of acronyms may make this seem complex, the actual amount of information needed to complete the process is minimal, including items such as company name and address, federal tax ID number, and an authorized company official. CMS assistance is available at 877-343-6507 or by email at insuranceoversight@hhs.gov. A Quick Guide  and FAQ have been created to help plans through the process.

TRANSITIONAL REINSURANCE FEE MEMBERSHIP COUNT

The Transitional Reinsurance Program was created by the ACA to provide relief to insurers and help stabilize premiums in the individual market for providing coverage to high-risk individuals. The Program, managed by Health and Human Services, runs from 2014-2016 and requires the collection of $25 billion over the three year period. Reporting and payment for fully insured plans will be handled by the carriers and those plans should expect to see the Reinsurance fees reflected on their invoices. Self-insured plans are responsible for reporting their membership counts and making the Reinsurance fee payments themselves, however most ASO's will provide the required data to their groups (although you may need to ask for it). Remember that this fee is calculated per covered life not per covered employee, so dependents do need to be included in your count. Here are the key dates and steps for the Reinsurance fee:
  • November 15, 2014 – Provide membership count to HHS via pay.gov and schedule your payment(s).
  • January 15, 2015 – Due date for making the first payment, ($52.50 per covered life), if paying in two installments or the last day to make the full payment, ($63.00 per covered life), if paying in one installment.
  • November 15, 2015 – Due date for making the second installment, ($10.40 per covered life), of the 2014 payment.
Flexible spending arrangements (FSAs), health savings accounts (HSAs), integrated health reimbursement arrangements (HRAs), and expatriate coverage are not subject to the Reinsurance fee. Also note that the fee is tax deductible as an ordinary and necessary business expense.

ANNUAL COBRA REVIEW

While the Marketplace is heading into its second year, is hasn't replaced COBRA. Whether or not an employer sponsored health plan is subject to Federal COBRA in any given year depends on whether an employer had 20 or more employees for more than 50 percent of its business days during the previous calendar year. Both full and part-time employees need to be counted, with part-time employees being included fractionally according to the proportion of full time they work. Employers may find that they are newly subject to Federal COBRA or conversely, no longer subject to it. Many states, however, have their own COBRA statutes (California included), so even if you fall below the federal threshold, your employees may still be eligible for state required continuation coverage. In general, this coverage is handled directly between the employee and the carrier, with much less involvement and administration on the employer's part. We recommend you take some time to make this calculation soon, especially if you think you could be newly subject to Federal COBRA, so that you have enough time to prepare to meet all of its requirements by January 1.

IN CLOSING

Yes, lots to think about, but we hope we've helped simplify some of the current benefit compliance issues for you. We look forward to continuing to provide you with important updates throughout the year.