2020 Cost-Sharing Limits

A non-grandfathered group health plan’s annual in-network out-of-pocket maximum for Essential Health Benefits for the 2020 plan year cannot exceed $8,150 (currently $7,900) for a self-only plan and $16,300 (currently $15,800) for other than self-only coverage, an increase of slightly more than 3 percent from 2019.

The new cost-sharing amounts were released by the U.S. Department of Health and Human Services’ Notice of Benefit and Payment Parameters for 2020. The in-network individual out-of-pocket maximum applies to all individuals, regardless of whether an individual has a self-only plan or other than self-only coverage.

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Employers to Receive PCORI Fee Mailing

Next week, Starmark clients with a self-funded health benefit plan design that are required to pay the Patient-Centered Outcomes Research Institute (PCORI) fee will receive a letter via mail providing their group’s “average covered lives” during the plan year ending in 2018 (using the Snapshot Count method).

As a courtesy, the Broker of Record will receive a duplicate copy of the letter sent to their group(s). The letter will also be posted to the Document Center on the Starmark website for the employer, the Broker of Record and the broker’s managing general agent to view.

The Affordable Care Act and associated regulations require health insurance issuers and plan sponsors of self-funded group health plans to file and pay an annual PCORI fee.

Plan sponsors of self-funded health plan years ending in 2018, are required to pay the fee to the IRS and file Form 720 by July 31, 2019.

Click here to view a sample letter.

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IRS Reporting Deadlines Extended Again

The IRS has extended the deadline for employers to furnish individuals the 2018 Form 1095-B, Health Coverage, and the 2018 Form 1095-C, Employer-Provided Health Insurance Offer and Coverage, from Jan. 31, 2019, to March 4, 2019.

The IRS also extended the good-faith transition relief from Section 6721 and 6722 penalties to the 2018 information-reporting requirements under Sections 6055 and 6056 of the IRS Code.

The due dates for employers filing the 2018 Forms 1094-B, 1095-B, 1094-C and 1095-C with the IRS remains Feb. 28, 2019, if not filing electronically, or April 1, 2019, if filing electronically.

Starmark has provided a spreadsheet, available in the Document Center, that employers may use to help them with compiling the data needed for the forms. For help with completing the forms or filing with the IRS, see your accountant, tax adviser and/or payroll services company.

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Employers to Receive Letter About Social Security Numbers

Starting this week, employers with a self-funded health benefit plan administered by Starmark will receive a letter via mail if Social Security numbers (SSNs) for any employee dependents are missing. This will help with the employer’s 2019 Affordable Care Act 6055/6056 reporting requirements by letting them know if we are missing SSNs for any covered dependents. The broker of record will receive a copy of the letter sent to their group(s).

If employees have covered dependents in 2018 with missing SSNs or add a dependent later with a missing SSN, employers can log in to the Starmark website and update the information under Manage My Group > Dependent SSN Update. The initiative by an employer to obtain and update all missing information will help ensure that the January 2019 report available in the Document Center will be as complete as possible.

Employers are responsible for collecting pertinent information and filing the appropriate documents with the IRS for all employees. Employers should consult a professional benefit adviser or legal counsel regarding how the law may impact their business and specific self-funded health benefit plan.

View a sample letter.

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Employers to Receive PCORI Fee Mailing

Over the next few days, Starmark® clients with a self-funded health benefit plan design that are required to pay the Patient-Centered Outcomes Research Institute (PCORI) fee will receive a letter via mail providing their group’s “average covered lives” during the plan year ending in 2017 (using the Snapshot Count method).

As a courtesy, the Broker of Record will receive a duplicate copy of the letter sent to their group(s). The letter will also be posted to the Document Center on the Starmark website for the employer, the Broker of Record and the broker’s managing general agent to view.

The Affordable Care Act and associated regulations require health insurance issuers and plan sponsors of self-funded group health plans to file and pay an annual PCORI fee.

Plan sponsors of self-funded health plan years ending in 2017, are required to pay the fee to the IRS and file Form 720 by July 31, 2018.

Click here to view a sample letter.

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2019 Cost Sharing

The U.S. Department of Health and Human Services (HHS) has set the 2019 in-network out-of-pocket maximum for Essential Health Benefits for group health plans at $7,900 for self-only coverage and $15,800 for other-than-single coverage, an increase of 7 percent from 2018.

The 2018 maximum annual limitation on cost-sharing is $7,350 for self-only coverage and $14,700 for other-than-single coverage.

HHS announced the new out-of-pocket maximums in the 2019 Notice of Benefit and Payment Parameters final rule, which was released on April 9, 2018. The cost-sharing limitations apply to nongrandfathered plans.

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Cadillac Tax and Health Insurance Provider Fee

As part of the legislation to end the federal government shutdown, the President signed into law a bill that affects certain provisions of the Affordable Care Act (ACA).

The legislation:

  • Delays the Cadillac Tax until 2022: The Cadillac Tax, which previously was scheduled to take effect in 2020, will now take effect in 2022. The ACA imposes a 40 percent excise tax, known as the Cadillac tax, on the cost of coverage of an employer-sponsored plan exceeding $10,200 for single coverage and $27,500 for family coverage.
  • Establishes a Health Insurance Provider Fee Moratorium in 2019: The fee will not be collected in 2019. The fee is effective for 2018, but was not collected for 2017. Self-funded health benefit plans are not affected by this fee.

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