Help for Health Plan Identifier Application

The Center for Medicare and Medicaid Services (CMS) recently provided information for plan sponsors of self-funded plans clarifying the process of applying for a Health Plan Identifier (HPID).

Beginning Nov. 7, 2016, a health plan’s HPID must be used when the health plan is identified in a HIPAA standard transaction. According to a representative from CMS, when the HPID application asks for a Payer ID and the self-funded plan’s TPA uses multiple numbers, the user should type, “Not applicable.”

To read more about HPIDs, click here.

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Filed under Healthcare reform, Self-funded

New Flyer Highlights the Administrative Simplification and Certification Proposed Rule

A new flyer is available in the Healthcare Reform toolkit that provides a high-level overview of the Administrative Simplification and Certification of Compliance for Health Plans proposed rule.

The proposed rule requires health plans, including self-funded plans, to submit information and documentation demonstrating compliance with standards and operating procedures for certain electronic transactions. To learn more, view the flyer.

 

 

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MLR Rebate Checks Being Mailed to Groups

In accordance with the Patient Protection and Affordable Care Act (PPACA) regulations, this week Trustmark is mailing Medical Loss Ratio (MLR) rebate checks with letters to eligible groups as shown below. The size of the group is based on eligible employees.

Small group (based on state definitions, but generally groups with 50 or fewer employees): AR, AZ, GA, IL, IN, KS, MO, MT, NE, NV, OH, TN, TX, UT, VA, WV, WY

Large group (based on state definitions, but generally groups with 51+ employees): AZ, IL, IN, PA, TX, WY

Sample cover letter

Sample letter

Regulations under the Patient Protection and Affordable Care Act require health insurers to spend at least 80 percent of their premiums on medical expenses for small groups, and at least 85 percent for large groups, or rebate the difference to customers.  A lower Medical Loss Ratio (MLR) percentage means a higher potential rebate to the employer. This requirement does not apply to self-funded plans.

Click here to view the MLR rebates Q&A.

A listing of groups and their rebate amounts was emailed to Starmark distribution partners. Groups that are not eligible are not being sent a letter.

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IRS’ Position on Employer Payment Plans

The Internal Revenue Service (IRS) has reaffirmed its position on “employer payment plans,” or arrangements in which an employer reimburses its employees for premiums they pay for health insurance (either through a qualified health plan in the Marketplace or outside the Marketplace). 

The IRS considers these arrangements to be group health plans, which are subject to Patient Protection and Affordable Care Act (PPACA) provisions, including the prohibition on annual limits and the requirement to provide certain types of preventive care benefits without cost-sharing. These arrangements cannot be combined with individual health insurance policies to comply with PPACA.

Employers found in violation of this IRS ruling could face penalties up to $100 a day per employee.

In addition, the IRS requires that any Health Reimbursement Arrangements (HRA) be paired or “integrated” with a group health plan that is compliant with PPACA.

 

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Filed under Exchanges, Healthcare reform

Employers to Receive PCORI Fee Mailing

This week, active Starmark® employers with a self-funded health plan design who are required to pay the Patient-Centered Outcomes Research Institute (PCORI) fee will receive a letter providing their group’s “average covered lives” (using the Snapshot Count method).  As a courtesy, the Broker of Record will receive a duplicate copy of the letter sent to their group.

The Patient Protection and Affordable Care Act requires health insurance issuers and plan sponsors of self-funded group policies be assessed an annual PCORI fee, previously known as the comparative effectiveness research fee.

Plan sponsors of self-funded health plans are responsible for filing and paying the PCORI fee. Sponsors of plan years ending in 2013, are required to send the fee to the IRS on Form 720 by July 31, 2014.

For fully insured plans, Trustmark Life Insurance Company is responsible for filing the form and paying the required PCORI fee.

Click here to view a sample letter.

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Important Opportunity for COBRA Participants

A special open enrollment period for the Federally Facilitated Marketplace is available through July 1, 2014, for COBRA participants. COBRA participants may be able to save money by enrolling in a qualified health plan offered through the Federally Facilitated Marketplace, rather than continue COBRA coverage through their employer-sponsored health benefit plan.

Starmark sent notices to employers with fully insured plans, as well as to their members currently enrolled in COBRA Continuation Coverage.

Employers with a Starmark self-funded plan design who have members enrolled in COBRA Continuation Coverage also received notification, which encourages them to share the employee notice with the COBRA participants in their company’s health plan.

COBRA participants have until July 1, 2014, to select and enroll in a qualified health plan in the Federally Facilitated Marketplace, www.healthcare.gov.

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Health Plan Identifier (HPID) Flyer Now Available

The Department of Health and Human Services (HHS) published the Final Rule on administrative data standards simplification and requirements to adopt a unique standard Health Plan Identifier (HPID) for use in HIPAA standard transactions effective Nov. 7, 2016.

A new flyer is available that answers some common questions about the HPID, including what it’s used for, how to obtain a HPID, the timeline for compliance, and more.

The flyer is available in our Healthcare Reform toolkit.

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