The following are three frequently asked questions regarding compliance of premium reimbursement arrangements and the Affordable Care Act Implementation, paraphrased from information published jointly by the Department of Labor, HHS and the Treasury.
Q: An employer offers employees cash to reimburse the purchase of an individual market policy. Does this arrangement comply with market reforms?
A: No, the employer’s payment arrangement in this scenario would still be considered part of a plan, fund or other arrangement established or maintained for the purpose of providing medical care to employees, regardless of whether the money was pre-tax or post-tax to the employee. Because the arrangement would be considered a group health plan, it would be subject to the market reform provisions of the Affordable Care Act applicable to group health plans.
Q: An employer offers employees with high claims risk a choice between enrollment in its standard group health plan or cash. Does this comply with market reforms?
A: No, this is considered discrimination based on one or more health factors and does not comply with market reforms and may, depending on the facts and circumstances, also result in discrimination in favor of highly compensated individuals in violation of Internal Revenue Code section 125 cafeteria plan nondiscrimination rules.
Q: A vendor markets a product to employers claiming that employers can cancel their group policies, set up a CODE section 105 reimbursement plan that works with health insurance brokers or agents to help employees select individual insurance policies, and allows eligible employees to access the premium tax credits for Marketplace coverage. Is this permissible?
A: No, these arrangements are considered group health plans and therefore employees participating in such arrangements are ineligible for premium tax credits or cost-sharing reductions for Marketplace coverage (from an Exchange). Also, such employer health care arrangements cannot be integrated with individual market policies to satisfy the market reforms and will trigger penalties such as excise taxes.
The Centers for Medicare & Medicaid Services (CMS) extended the deadline for reporting enrollment counts (not payment dates) until Dec. 5, 2014, for the Reinsurance Assessment Fee on Pay.gov.
Please note the payment date(s) have not changed. The first payment installment (or combined payment) is still due on Jan. 15, 2015, and the second payment is due Nov. 15, 2015 for those who choose to pay in two installments.
The announcement is also available on the CMS website.
The Patient Protection and Affordable Care Act (PPACA) mandates non-grandfathered health plans provide coverage without cost-sharing for certain in-network preventive care services for adults and children. Effective January 1, 2015, Starmark® self-funded plan designs will include 100% benefits for the preventive services listed below when they are received from an in-network provider. (Out-of-network services are subject to the plan deductible and coinsurance.) Services may vary by plan/state.
|Additional PPACA-Mandated Preventive Care Services for Men:Abdominal aortic aneurysm screening
||Starmark Self-funded Plan Designs Include:Effective Jan. 1, 2015, screening for men age 65 to 75 who have ever smoked.
|PPACA-Mandated Adult Immunizations:Haemophilus influenzae type B (Hib)
||Starmark Self-funded Plan Designs Include:Effective Jan. 1, 2015, one to three doses if some other risk factor is present.
|PPACA-Mandated Screenings for Children and Teens:Hepatitis B screening
||Starmark Self-funded Plan Designs Include:Effective Jan. 1, 2015, for non-pregnant adolescents.
The Preventive Services flyer has been updated and is available in the Healthcare Reform Toolkit.
The Centers for Medicare and Medicaid Services is hosting a series of webinars in November to discuss Pay.gov and explain the process for submitting information and paying the Reinsurance Assessment Fee. Self-funded employers, health plan administrators, health insurance issuers and ASO contractors should consider participating.
Plan sponsors need to complete the contribution form on Pay.gov no later than Nov. 15, 2014.
The webinars are scheduled for:
- 3 to 4:30 p.m. Eastern Time on Nov. 10, 2014
- 1:30 to 3 p.m. Eastern Time on Nov. 12, 2014
- 11:00 a.m. to 12:30 p.m. Easter Time on Nov. 13, 2014
- 2 to 3:30 p.m. Eastern Time on Nov. 14, 2014
- 3 to 4:30 p.m. Eastern Time on Nov. 17, 2014
How to Register
Participants must register on RegTap, but the webinars are free. After registering on Regtap.com, click on “training events” and then click the magnifying glass icon next to the webinar “Reinsurance Contribution Submission Process User Group Series.” From here, click the “register me” button and follow the prompts.
For more information on the Reinsurance Fee, view our flyer.
On Friday, the Department of Health and Human Services (HHS) announced a delay in enforcement of Health Plan Identifier (HPID) requirements.
The HPID final rule required controlling health plans, as defined in the regulation, obtain an HPID by November 5, 2014, for large health plans and by November 5, 2015, for small health plans.
The new guidance delays enforcement of obtaining an HPID and use of HPID in transactions until further notice. This delay applies to all HIPAA covered entities, including healthcare providers, health plans, and healthcare clearinghouses.
We will provide more information as it becomes available.
The form that plan sponsors are required to use to calculate their contribution for the Reinsurance Assessment Fee is now available on Pay.gov. Plan sponsors must submit the form no later than Nov. 15, 2014. A manual on completion of the form was posted on the website for the Centers for Medicare & Medicaid Services (CMS): Annual Enrollment and Contributions Submission Form Manual, Version 1.0.
How to access the form and pay the fee
1. Register: Plan sponsors must register on Pay.gov.
2. Complete the contribution form: Go to “find a form” and then “click here to view a listing of all forms.” Then, click on “ACA Transitional Reinsurance Program Annual Enrollment Contributions Submission.”
Plan sponsors need to enter the average number of members in its health plan for the first nine months of the calendar year on the contribution form on Pay.gov no later than Nov. 15 in 2014, 2015 and 2016. Starmark will provide such count1 via a letter sent in October.
The form also requires information for a billing contact and billing address, as well as the name and contact information for plan sponsor contacts. The form will automatically calculate the contribution amount(s).
3. Upload: Plan sponsors must upload their supporting documentation. The federal government has posted two documents on the CMS website to assist in the process:
4. Enter payment information: Plan sponsors should schedule a payment date by selecting “Type of Payment” based on plan sponsors’ preference on when to make the contribution. The first installment deadline is Jan. 15, 2015, and the second installment deadline is Nov. 15, 2015. Plan sponsors can also pay the fee in full by the deadline of the first installment.
For more information on the Reinsurance Assessment Fee, view our flyer.
A new flyer is available that provides an at-a-glance look at the Employer Mandate. This flyer covers the requirements, a glossary of terms, and includes a graphic illustration to help larger employers determine if they are in compliance.
For more detailed information about the Employer Mandate, including specifics about when the rules apply, how to determine full-time employees, penalties, and more, view the Guide to the PPACA Employer Mandate. This guide also includes an example using a fictional company to help illustrate the steps an employer must take to determine its obligation under the Employer Mandate.