April 2017 Edition of the SBC Template and Supporting Documents

Health plans and issuers that maintain an annual open enrollment period will be required to use the April 2017 edition of the SBC template and associated documents beginning on the first day of the first open enrollment period that begins on or after April 1, 2017, for plan years beginning on or after that date. For plans and issuers that do not use an annual open enrollment period, this SBC template and associated documents are required beginning on the first day of the first plan year that begins on or after April 1, 2017.

In addition, the Center for Consumer Information & Insurance Oversight (CCIIO) has temporarily suspended the completion of a new third coverage example for a simple fracture for the 2017 Summary of Benefits and Coverage (SBC).

Until further notice, self-funded plans and insurers should enter default values of “$0” on the Plans and Benefit template for each field for this coverage example, according to the CCIIO, which is part of the Centers for Medicare and Medicaid Services.

Self-funded plans and insurers may continue to use the Coverage Example Calculator approved for plan year 2016 to calculate data for the two other SBC coverage examples: “Having a Baby” and “Managing Diabetes.”

For more information on SBCs, follow this link.

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Regulations on Section 1557 Prohibit Discrimination

The U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) published a final rule implementing Section 1557 of the ACA prohibiting “covered entities” from discriminating in the provision of a health program or activity based on race, color, national origin, sex, age or disability.

The regulations require covered entity’s anti-discrimination notice and taglines be published by October 16, 2016, and health benefit plan documents be amended when renewed on and after January 1, 2017.

Who Is a Covered Entity?

A covered entity may include doctors, hospitals, health plans and other medical providers that receive federal financial assistance from HHS. Examples of federal financial assistance include Medicaid and Medicare Parts A, C and D payments (including prescription drug subsidies).

View a flyer, Navigating Anti-Discrimination Regulations, to learn more. Or for additional reference materials, go to the HHS website.

Starmark® will send potentially affected employers (determined by SIC codes), beginning with effective dates of October 15, 2016, the Notice Regarding Section 1557 of the Affordable Care Act form. Employers who receive this form must complete it and return it to Starmark.

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ACA Reinsurance Assessment Fee – Important Filing and Payment Dates

Sponsors of self-funded health benefit plans are responsible for filing and paying the ACA Reinsurance Assessment Fee. To assist with the filing, Starmark® will calculate the average number of lives covered under the sponsor’s plan and will mail the information to the sponsor mid-October.

To file, sponsors must go to http://www.pay.gov and complete the ACA Transitional Reinsurance Program Annual Enrollment and Contributions Submission Form online no later than November 15, 2016. If they are making the payment in one lump sum, the payment must be remitted no later than January 17, 2017, at http://www.pay.gov; or if making the payment in two installments, they must pay the first installment by January 17, 2017, and the second installment no later than November 15, 2017, at http://www.pay.gov.


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Reinsurance Program Training

The Centers for Medicare and Medicaid Services has scheduled a series of free webinars to help contributing and reporting entities who are required to file the 2016 Transitional Reinsurance Program Annual Enrollment and Contributions Submission Form.

Free training webinars will be held from 1 p.m. to 2:30 p.m. Eastern Time on the following four dates:

Module 1 2016 Reinsurance Contributions Overview Tuesday, Sept. 13, 2016
Module 2 2016 Reinsurance Contributions Counting Methods Overview Thursday, Sept. 15, 2016
Module 3 2016 Reinsurance Contributions Form Completion Tuesday, Sept. 20, 2016
Module 4 2016 Reinsurance Contributions Updating Contributions Filings Tuesday, Oct. 18, 2016

Registration will be on a first-come, first-served basis.

Log on to www.REGTAP.info for registration

For more information on the Reinsurance Assessment Fee, follow this link.

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Letters Being Sent to Employers Regarding Social Security Numbers

Starting this week, Starmark® employers with a self-funded plan design will receive letters via mail providing information on the status of dependent social security numbers (SSNs). This will help with their 2017 ACA 6055/6056 filing requirements by letting them know if we are missing SSNs for any covered dependents. The broker of record will receive a copy of their group(s) letter.

If the employer has any covered dependents in 2016 with missing SSNs, or adds a dependent later with a missing SSN they can log in to the Starmark website and update the information under Manage My Group > Dependent SSN Update. The initiative by the employer to obtain and update all missing information will help to ensure that the January 2017 report available in the Document Center will be as complete as possible.

It is the employers’ responsibility to collect the pertinent information and file 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 benefit plan.

View the letters below:

Social security numbers missing

Add-on information

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IRS Issues Alert on Sections 6055/6056 Return Filing

On June 30, 2016, the IRS issued a QuickAlert about the electronic Affordable Care Act’s (ACA) Sections 6055 and 6056 information return filing.

While the deadline to electronically file ACA information returns with the IRS was June 30, 2016, the ACA Information Returns (AIR) system will remain up and running after the deadline, according to the alert.

Applicable large employers, self-insured employers and other health coverage providers that were not able to submit all required ACA information returns by June 30, 2016, should complete the filing of returns after the deadline.

Electronic Returns

According to the IRS alert:

  • The AIR system will continue to accept information returns filed after June 30, 2016. In addition, the required system testing can still be completed after June 30, 2016.
  • If any transmissions or submissions were rejected by the AIR system, filers have 60 days from the date of rejection to submit a replacement and have the rejected submission treated as timely filed.
  • Entities that submitted information returns and received “Accepted with Errors” messages may continue to submit corrections after June 30, 2016.

The IRS is aware that some filers are still in the process of completing their 2015 tax year filings. According to the IRS alert:

  • As is the case for other information returns, penalties may be associated with the submission of the ACA information returns for failure to timely file required returns.
  • As the IRS has publicly stated in various forums in recent months, filers of Forms 1094-B, 1095-B, 1094-C and 1095-C that miss the June 30, 2016, due date will not generally be assessed late filing penalties under section 6721 of the IRS Code if the reporting entity has made legitimate efforts to register with the AIR system and to file information returns, and it continues to make such efforts and completes the process as soon as possible.
  • Consistent with existing information reporting rules, filers that are assessed penalties may still meet the criteria for a reasonable-cause waiver from the penalties.

Paper Returns

Entities that are not electronic filers and missed the May 31, 2016, paper filing deadline for ACA information returns should also complete the filing of paper returns as soon as possible, the IRS stated.

For more information on Sections 6055 and 6056, follow this link.

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COBRA Notice and Additional Information

When a group health plan administrator sends out the COBRA model election notice, it may include, in or along with, additional information about the Health Insurance Marketplace, according to federal departments.

The federal Departments of Labor, Health and Human Services and the Treasury report that plan administrators may include other information about the marketplace (or exchange), such as:

  • how to obtain assistance with enrollment in the marketplace or exchange (including special enrollment);
  • the availability of financial assistance;
  • information about marketplace websites and contact information;
  • general information regarding particular products offered on the marketplace; and
  • other information that may help in choosing between COBRA and other coverage options.

The federal departments indicate that COBRA election notices are required to be easily understood by the average plan participant, and therefore, should not be too lengthy or difficult to understand.

This information is contained in “FAQs about Affordable Care Act Implementation (Part 32),” which was released on June 21, 2016. For more information, follow this link.

COBRA generally applies to all group health plans maintained by private-sector employers with 20 or more employees, or by state or local governments. COBRA does not apply to plans sponsored by the federal government or by churches and certain church-related organizations.

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